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Drugs - Royal Commission of Inquiry - Report - Book C - Parts X to XIII


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The Parliament of the Commonwealth o f Australia

AUSTRALIAN ROYAL C O M M ISSIO N OF INQ UIRY INTO D R UG S

Report

Book C: Parts X to ΧΙΠ

21 December 1979

Presented by Command and ordered to be printed 18 March 1980

Parliamentary Paper No. 27/1980

Australian Royal Commission of Inquiry into Drugs JSEPORT BOOK C

The Government of The Commonwealth of Australia and the Governments of the States of Victoria, Queensland, Western Australia and Tasmania

Australian Royal Commission of Inquiry into Drugs Commissioner: The Hon. Mr Justice E. S. Williams

Report

Book C: Parts X—XIII

Australian Government Publishing Service Canberra 1980

(c) Commonwealth of Australia 1980

ISBN for this volume: 0 642 04776 6 ISBN for set of volumes: 0 642 04778 2

Publisher's note

In order to make this volume available as rapidly and economically as possible the text has been reproduced from originals prepared as computer print-out.

The publishers recognise that this method has its limitations and regret any lapses in typographical quality.

Printed by C. J. Thompson, Commonwealth Government Printer, Canberra

Contents

PART X Treatment

Chapter 1 Institutions Offering Treatment and Their Funding

Facilities in the States and Territories

Annex X.1

Annex X.2

Chapter 2 Approaches to Treatment

An Overview

Residential Programs, Isolation, etc.

Withdrawal

Opiate Maintenance in Australia, and Some General Assessments

The 'British System'

Counselling and Confrontation

The Role of Private Medical Practitioners

Alternative Forms of Therapy

Chapter 3 Evaluation of Success

Criteria

Rates of Success

Measurement of Success

Chapter 4 Present Role of the Criminal Justice System

Some General Observations

The New South Wales Diversionary Program

Chapter 5 Conclusions and Recommendations

Conclusions

Recommendations

PART XI Drug Education

Chapter 1 Objectives

Australian Philosophy

Other Views

Page

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C43

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C57

C73

C74

iii

Chapter

Chapter 3

Chapter 4

Chapter 5

Chapter 6

PART XII r

Chapter 1

Chapter 2

Chapter 3

Overseas Experiences

Broad Guidelines and Concepts

Australian Programs

Commonwealth Program

State and Territory Programs

Non-Government Organisations

'Legal' Drug Use Education

Target Groups

General Public Groups

Occupation Groups

Other Groups

Role of the Media and Advertising

Role of the Media

Advertising

Evaluation of Success

Conclusions and Recommendations

Conclusions

Recommendations

g Use Controls

General Considerations

The Background to Controls

Existing Control Standards

Liberty and Drug Controls

Alcohol

Federal Controls

State Controls

Nicotine

Commonwealth Controls

State Controls

Page

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Cl 15

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C157

C165

iv

Chapter 5

Chapter 6

Chapter 7

Chapter 8

Chapter 9

PART XIII

Chapter 1

Chapter 4

Commonwealth Controls

State Controls

Advertising

Conclusions and Recommendations

Heroin

The Debate Concerning Relaxation of Controls

Conclusions and Recommendations

Methaqualone

The Use and Abuse of Methaqualone

Conclusions and Recommendations

Pentazocine

Conclusions and Recommendations

Methadone

International Controls

Commonwealth Controls

State Controls

Conclusions and Recommendations

Cannabis

Cannabis and Health

Cannabis and Society

Should Legislation Be Changed?

Policy Options

Conclusions and Recommendations

Improving Some Existing Controls

Drug Detector Dogs

Extent of Use

Selection and Training

Effectiveness

Dog Training in Australia

Conclusions and Recommendations

Analgesics

Page

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C177

C201

C207

C211

C215

C271

C273

v

Chapter

Chapter 3

Chapter 4

Chapter 5

Chapter 6

Chapter 7

Ultrasound Techniques

Ultrasound and its Properties

Medical Ultrasound in Australia

The Equipment for Ultrasonic Examinations for Drugs

The Effectiveness of Ultrasound in Drug Detection

Performance of an Ultrasonic Examination to Detect Drugs

The Safety of Ultrasound

Conclusions and Recommendations

Forensic Laboratories

Australian Attitudes

Conclusions and Recommendations

Forged Prescriptions

Frequency of Prescription Forgery

Methods Employed by Forgers

Security of Prescription Pads

Other Methods of Preventing Prescription Forgery

A Recent Initiative : Special Prescription Pads for Schedule 8 Drugs

Conclusions and Recommendations

Financial Controls

Financial Aspects of the Illegal Drug Trade

Controls in the United States

Australian Controls

Conclusions and Recommendations

Drugs in the Post

Recommendations

Interception of Communications

Arguments for and against Interception

Controls on Interception Powers

Availability of Interception Devices

Page

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C309

C339

C365

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C385

vi

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Page

Chapter 8

Overseas Experience

The Joint Task Force

Implementation

No Short-term Expectations

General Application

Task Forces

vii

viii

Part X

T reatm ent

Part X Treatm ent

Chapter 1 . Institutions Offering Treatment and Their Funding

Chapter 2 . Approaches to Treatment

Chapter 3 . Evaluation of Success

Chapter 4 . Present Role of the Criminal Justice

System

Chapter 5. Conclusions and Recommendations

It was remarked in Part I that much evidence was

tendered to the Commission emphasising the importance of treatment in the control of illegal drug abuse. This is

not surprising as many people support a 'medical model' of drug abuse control for they see drug abuse as a medical

cond i t i o n .

The evidence that the Commission received concerning treatment of drug abusers in Australia is dealt with in this P a r t .

Chapter 1 identifies the institutions offering treat­ ment and their administration and fun d i n g . Chapter 2 considers the different approaches to treatment which are currently in use and Chapter 3 endeavours to assess how

successful those approaches are.

Chapter 4 deals with what the Commission considers is an important topic. If drug abusing is purely or principally a medical cond i t i o n , should not the drug abuser be forcibly directed to treatment so that, even if treatment fails in his case, he remains identified? Conversely, to what

extent should the courts refrain from imposing normal penalties on conviction for, say, theft, when the convicted person is a drug abuser whom treatment may cure?

Chapter 5 contains conclusions and recommendations emanating from this Part.

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Chapter 1 Institutions Offering Treatm ent and Their Funding

Treatment for drug abuse is provided in one form or another at all public hospitals. Additionally, voluntary and community organisations in all States and Territories conduct individual prevention, treatment and rehabilitation programs which Government organisations, because of

their more rigid structure, are unable to provide.

Government hospital and treatment services are funded on a cost­ sharing basis by the Commonwealth Government and the individual State Governments. Many private organisations, including hospitals, also receive government financial support, in varying amounts.

A specific Commonwealth expenditure associated with drug abuse is the funding of the Australian Foundation for Alcohol and Drug Dependence (AFADD), an information and resources dissemination organisation. In the last financial year AFADD received a total of $491 000 in

Commonwealth funds, to be applied as follows:

* $247 000 for the National Alcoholism and Drug Dependence in Industry Program.

* $244 000 for general purposes.

Commonwealth funds used for drug dependence treatment and

rehabilitation purposes are part of the more general Commonwealth allocations made to the States under the Hospitals Agreement and the Community Health Program and in some cases it would appear that these are not isolated on an individual costing basis.

Evidence concerning private organisations involved in drug abuse treatment and rehabilitation included references to these organisations' own fund-raising efforts. They included donations from private organisations and individuals, sponsorship by religious bodies, social security payments for inpatients and income-producing activities carried out by the organisations themselves. In some cases, specific resources

such as the use of premises or the services of social workers were obtained free of charge.

In an attempt to obtain a comprehensive picture of the treatment facilities available in Australia and the funding of these facilities, the Commission sought information from the various State and Territory health authorities. These requests were worded as follows:

You will find enclosed a list of treatment centres for drug addiction. The Commission would appreciate your verification of its accuracy, or, if inaccurate, your assistance in

compiling an accurate and up-to-date list. Furthermore, any information you can supply to the Commission about the funding of such centres by way of government grants or otherwise and

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the amount of such payments in the last fiscal year, would be especially helpful. (OT 22266)

Information contained in the replies to these requests is incorporated below. Although it is supplemented by the evidence of various witnesses who spoke on the subject, a number of the replies received by the Commission were deficient in certain respects. In some cases there was little to indicate whether, in fact, the various government bodies contacted were in a position to provide the

information.

Witnesses who gave evidence concerning the prevention of drug dependence as well as treatment and rehabilitation stressed that no single form of treatment was appropriate to all forms of drug dependence and that a variety of treatments and programs were offered by the various institutions and at times, within the same institution. Some witnesses also strongly suggested that the funding of any treatment program should be contingent upon an undertaking that evaluation of the program would be carried out.

FACILITIES IN THE STATES AND TERRITORIES

As noted above, details given about facilities for treatment of drug dependence in the States and Territories are based principally on information received from government bodies with responsibilities in these areas. The Commission does not suggest the information is exhaustive.

New South Wales

The New South Wales Health Commission has responsibility for administration and operation of State Government treatment services. Outpatient and inpatient facilities are provided on a decentralised basis throughout the State's Health Regions. Of a total of 72 treatment centres, 33 are situated in the four Sydney metropolitan regions and the remainder in the provincial regions.

Another State-funded body concerned with drug dependence is the NSW Drug and Alcohol Authority, an autonomous body which reviews and researches drug and alcohol problems in the State with a view to providing continuing reports to the Government. That Authority also undertakes research and evaluation of drug dependence treatment programs and provides some support, financial or otherwise, to private organisations.

In 1979 private organisations were listed as operating 76 centres throughout the State for the treatment of problems associated with alcohol and drug dependence. In the 1978--79 financial year the NSW Health Commission provided funds totalling $1 714 882 to 37 of these

centres operated by voluntary organisations.

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The Commission was informed (Open Exhibit 655) that treatment services offered by the various government and private centres vary considerably, but include:

- detoxification; - inpatient rehabilitation; - outpatient rehabilitation; - counselling; - crisis intervention; - referral; - family and individual support;

- emergency accommodation; - 'outreach'.

Victoria

Thirty-three government and private centres cater for the treatment of drug dependence in Victoria.

The Alcohol and Drug Dependent Persons Service, part of the Mental Health Division of the Victorian Health Commission, operates four specialist units for the treatment of drug dependence. They are:

- Smith Street Clinic;

- Pleasant View Assessment Centre;

- Gresswell Rehabilitation Centre;

- Heatherton Hospital.

These units, according to the evidence before the Commission, offer treatment services including the following:

- detoxification;

- outpatient programs;

- methadone maintenance (low dose) and withdrawal treatment;

- counselling.

All inpatients are followed up for three months after discharge, if still living in the area. The Commission was told that resources were inadequate to provide a complete follow-up service for outpatients (Open Exhibit 655, p.49).

The Commission received evidence that a number of voluntary agencies play an important role in the treatment of drug dependence in Victoria and that many receive government funds. However, a Commission request to the Victorian Health Authority for details of such funding did not produce appropriate information.

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Queensland

State Government activities in the treatment of drug dependence are centred in the Queensland Alcohol and Drug Dependence Service and the psychiatric hospitals administered by the Queensland Health Department's Division of Psychiatric Services (Open Exhibit 655, p .4). Government services for treatment of drug dependence include the following methods of treatment (Open Exhibit 655, pp.42, 43):

- outpatient methadone withdrawal and maintenance programs;

- counselling;

- inpatient withdrawal or short-term psychiatric admission;

- long-term inpatient psychiatric care.

Private psychiatrists and other medical practitioners may treat persons for drug abuse by use of conventional psychiatry or methadone maintenance. Patients must be registered with State Government health authorities before being eligible to receive methadone for maintenance purposes.

More than 40 voluntary organisations, including many operated by religious groups, provide treatment services for drug dependence. Support services are also offered by numerous other organisations.

Treatment programs offered by private organisations principally utilise drug-free rehabilitation regimes. They include outpatient and short to intermediate term inpatient programs. Methods used include:

- counselling;

- withdrawal treatment;

- 1 therapeutic community' approaches;

- outpatient aftercare.

A considerable number of private organisations receive government support. Details of this funding and that of the Queensland Government organisations during the 1978--79 financial years, as supplied by the Queensland Health Department, are listed as Annex X.I. to this Chapter.

South Australia

The South Australian Alcohol and Drug Addicts Treatment Board has wide-ranging functions in connection with the treatment and

rehabilitation of persons addicted to alcohol and certain other drugs. Only 11 per cent of the Board's clientele is treated for problems involving drugs other than alcohol.

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Other treatment facilities are provided by the South Australian Health Commission, particularly the Mental Health Services Division, and a small number of voluntary organisations.

Services and treatment provided by these government bodies include:

- drug-free therapy;

- social and psychological support;

- use of drugs other than narcotics;

- methadone maintenance.

Details of the 11 South Australian Government treatment centres and their funding as supplied to the Commission are given in Annex X.2. to this Chapter.

Four voluntary organisations offering services associated with drug dependence receive funds from the South Australian Government. Three of these deal principally with alcoholism. The other organisation, The Service to Youth Council of Adelaide, provides specialist expertise in counselling and family support.

Western Australia

Treatment of drug dependence in Western Australia is provided by the State's Alcohol and Drug Authority. Mental Health Services, another government body for people with drug-related problems, treats psychiatric problems arising from drug dependence. During hearings in Western Australia on 29 March 1979, the Commission was informed that

eight government facilities were offering treatment for drug dependence, but it was intended that two of these would close when a new clinic became operational. Facilities being administered by the Alcohol and

Drug Authority included (Open Exhibit 655):

- assessment facilities;

- methadone maintenance facilities;

- detoxification units;

- long-term rehabilitation;

- outpatient after-care facilities.

Patients who have been detoxified at government treatment centres are followed.up on an outpatient basis by field staff (Open Exhibit 655, p. 50).

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Little evidence was received by the Commission concerning private organisations offering drug dependence treatment in Western Australia. However, evidence suggests that some voluntary agencies were encouraged to provide accommodation for drug users, but that most drug users preferred to find their own accommodation (Open Exhibit 655, p.24). No

evidence was received on how many voluntary agencies offer treatment for drug dependence.

The Commission was unable to obtain specific details of the funding provided to individual treatment centres or organisations providing drug dependence treatment. The Commission was told there was no division of costings between treatment for alcoholism and treatment for drug abuse. The Commission received information indicating that Commonwealth and State funds totalling $1 753 732 were expended on the treatment of alcoholism and drug abuse. Of this amount, $1 226 195 was allocated by the Hospital Fund, half of which was funded by the Western Australian Consolidated Revenue Fund. The remainder was provided by Commonwealth and State Government allocations under the Community Health Program.

Tasmania

The central government authority for treatment of drug dependence in Tasmania is the Alcohol and Drug Dependency Board, which is administered by the Mental Health Services Commission, a body separate from the Tasmanian Health Services Department.

The six government institutions providing drug treatment are:

- John Edis Hospital;

- Launceston General Hospital;

- Mersey General Hospital;

- North-Western General Hospital;

- Royal Derwent Hospital;

- Royal Hobart Hospital.

Treatment methods used include:

- counselling;

- medical care;

- inpatient treatment;

- withdrawal treatment.

The Commission was told that funding for these institutions was provided from both State and Commonwealth Government allocations, but

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that it was not possible to isolate the proportion of funds utilised for alcohol and drug dependence treatments.

The Tasmanian Department of Health Services informed the Commission that a small number of private organisations provided treatment services for alcoholism because it was felt that that was the greatest need.

Northern Territory

Treatment services for drug dependence are provided by the Northern Territory Health Department at two centres. They are:

- Darwin Hospital psychiatric unit and day centre;

- Alice Springs Hospital psychiatric unit and day centre.

A private establishment, Banyan House in Darwin, is also regarded as making a significant contribution to the treatment of drug dependence. It received an operational grant of $28 000 from the Commonwealth Department of Health for the six months to December 1978. Another

$35 000 in funds were supplied by the Northern Territory Government for the six months to June 1979 (OT 21553).

Ten other organisations in the Northern Territory also provide treatment and rehabilitation services but mostly in connection with alcohol problems.

Australian Capital Territory

In October 1977, the Capital Territory Health Commission approved a plan which integrated the resources of the Commission and those of the community to provide a comprehensive range of prevention and treatment services for alcohol and drug dependence. The Commission now operates

three treatment centres, which are funded through normal budgetary appropriations:

- Alcohol and Drug Dependence Unit ($101 000 for 1978 — 79) ;

- Drug Dependence Unit at Woden Valley Hospital, which commenced operation on 1 May 1979 (funding for first three months of operation was $14 000);

- Canberra Hospital where one full-time nurse deals exclusively with alcohol and drug problems (not separately costed).

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Services provided at the centres include:

- inpatient care in general hospital wards;

- counselling;

■ group therapy;

- medical treatment;

- support services.

Four voluntary organisations operating in the A.C.T. have established drug-free treatment facilities for drug dependent persons. Three of these are assisted by the Capital Territory Health Commission. They are:

Karralika Therapeutic Community, operated by the Alcohol and Drug Problems of the A.C.T. (ADPACT). The Capital Territory Health Commission provides the facilities rent free in addition to a grant. Operations commenced in December 1978. $28 100 was provided for the period 1 December 1978 to 30 June 1979.

Drug Referral and Information Centre, Canberra College of Technical and Further Education. This received a grant of $8000 for the period 1.12.78 to 30.11.79 and $5200 in the previous year to assist with salaries and operating costs.

Thomas Cahill Cottage at Manuka operated by the Society of St Vincent de Paul. Some premises are provided rent free by the Capital Territory Health Commission.

Salvation Army Mancare Centre.

Services provided by these organisations include:

counselling;

drop-in centre;

'therapeutic community' approaches;

family support;

detoxification centre;

acupuncture;

hypnotherapy;

self-examination;

long-term residential accommodation and rehabilitation.

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In addition to the private treatment centres, some organisations including Alcoholics Anonymous, ALANON, ALATEEN, Narcotics Anonymous and NAR-ANON offer support services (OT 23157— 58, Open Exhibit 655, p.5).

General

This short summary in respect of institutions and their funding again points out deficiencies in the collection, assessment, and dissemination of information in respect of yet another area relevant to the Commission's Terms of Reference. Similar problems reappear in each

subsequent chapter of this Part. The accumulation of the deficiencies adds urgent emphasis to the reasons justifying establishment of the Drug Information Centres recommended by the Commission in Part XIV.

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ANNEX X.l.

QUEENSLAND FACILITIES FOR TREATMENT OF DRUG DEPENDENCE

The following list of government and private organisations providing treatment for drug dependence in Queensland and details of their funding arrangements in the financial year ended 30 June 1979 is based on information the Commission received from the Queensland Health Department

(OT 24276-80).

GOVERNMENT ORGANISATIONS

Unit

Brisbane

Funding Amount ($)

Alcohol and Drug Dependence Service

Drug Dependence Clinic

Commonwealth/State) 1 740 868 Government funded ) ) )

Wacol Rehabilitation Clinic State Government 760 774

funded

Lowson House Commonwealth/State Included in

Government funded Royal Brisbane (through Cost Share Hospital costs Agreement)

Alcoholism Clinic (Pavilion 4) State Government 83 777

funded

Mary Street Psychiatric State Government Clinic funded

Prince Charles Hospital, Chermside Commonwealth/State Government funded

(through Cost Share Agreement)

Stones Corner Psychiatry Clinic Commonwealth/State Government funded

Wolston Park Hospital, Wacol State Government funded

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NON-GOVERNMENT

A considerable number of the treatment organisations listed below received State and Federal Government grants during the financial year 1978--79, which supplemented their own fund-raising activities:

Facility Commonwealth State

Crossroads Farm, Brisbane

Nil Department of

Welfare Services

Brisbane Youth Service

Nil Department of

Welfare Services: $6500 (grant)

Drug Referral Centre

50%--$6294.15

Department of Health: 37.5%

Griffith House, Ipswich

Nil Department of

Health: 100% deficit funded

GROW---

(a) Brisbane 50%--

$37 044.91

Department of Health: 37.5%

(b) Rockhampton 50%--

$15 215

Department of Health: 37.5%

Gold Coast Drug Referral Centre Burleigh

50%--$5500

Department of Health: 37.5%

House of Freedom, Brisbane

Nil Department of

Welfare Services: $50 per occupied bed per week,

$25 per unoccupied bed per week

Jodaro Department of Nil

Rehabilitation Centre Aboriginal Affairs: Brisbane wages and vehicles.

Aboriginal Hostels Ltd.: wages for cook, manager, night

watchmen, building maintenance

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Facility Commonwealth State

Life Line--(a) Brisbane 50% of expenditure

(health component) Department of ---$6772.88 Health: 12.5%

also Department Dept of Welfare of Health grant of Services: $10 000 salaries of one

and a half social workers

(b) Ipswich 50% of

expenditure--$8600

Department of Health: 12.5%

(c) Toowoomba 50% of

expenditure--$10 120

Department of Health: 12.5%

(d) Townsville 50% of

expenditure--$11 250

Department of Health 12.5%

Additionally, the Queensland Social Service League, a voluntary emergency organisation, gives a 50 per cent subsidy for material relief expenditure. The latter organisation in turn receives the following financial assistance from the Department of Welfare Services.

(a) Brisbane Special Grant Administrative Expenses Grant

Sub-total

$4336.67 $3000.00

$16 500.00 $23 836.67

(b) Rural and Regional 57 affiliated branches $115 498.30

TOTAL $139 334.97

Facility Lucinda Hostel, Brisbane

Moonyah, Brisbane

Olivet House, Brisbane

Commonwealth State

50% of Nil

Supervisor's and relief supervisors's salary

Subsidy for some Nil

salaries under the provisions of the Homeless Persons Act.

Nil Health

Department 90% deficit funding: $5839.93

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Facility Commonwealth State

Richmond 50% of Nil

Fellowship Half Way House, Brisbane.

salaries

Serenity Hostel, Health

Ipswich Department:

90% deficit funded--$712.92

Shelta, Brisbane 75% of operating

cost

Nil

St. Vincent de Paul 50% of social Department of

Shelter, Brisbane worker's salary; Welfare 50% of welfare Services

worker's salary; (Relief 25 cents a meal Office): $2400 subsidy (Homeless (approx.) Persons Act) (Queensland

Social Services League: 50% subsidy for material

relief expenditure plus fund raising)

Teen Challenge, Special grants Department

Brisbane $8000 of Health

Grant: $2500 Department of Welfare Services $3400 (approx.)

(a) Primmer Lodge, ) Department

Brisbane ) of Welfare

(b) Hebron House, ) Services: $50

Brisbane ) occupied bed/

) week $25,

) unoccupied ) bed/week

The Grand, Brisbane 25 cents a bed, Department

and 25 cents a of Welfare

meal subsidy Services: food

through the vouchers and

Homeless Persons Act accommodation

The Haven, Brisbane Nil Health

Department: 90% deficit funded--$10 342.33

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Facility Commonwealth State

Trephina House Townsville

Nil Health

Department: 90% deficit funded (no

claims received)

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ANNEX X.2.

SOUTH AUSTRALIAN GOVERNMENT DRUG DEPENDENCE TREATMENT CENTRES

Details supplied to the Commission concerning the 11 South

Australian Government treatment centres concerned with drug dependence treatment and rehabilitation are as follows:

Unit Responsible Funding (1977 — 78)

Authority

Birralee Hospital (a)

Alcohol and Drug Addicts Treatment Board

Not yet in service (31.5.79)

Christies Beach Community Health Centre (b)

Community Health Services Not separately costed

Clovelly Park Community Health Centre (b)

Community Health Services Not separately costed

Elura Clinic Alcohol and Drug

Addicts Treatment Board

$135 000

Glenside Hospital Psychiatric Services Not separately costed

Hillcrest Hospital (c)

Psychiatric Services

Not separately costed

Loxton Hospital (b)

Community Hospital Board Not separately costed

Mansfield Park Community Health Centre (b)

Community Health Services Not separately costed

Osmond Terrace Clinic Alcohol and Drug Addicts Treatment

Board

$495 000

St. Anthony's Hospital (a) Alcohol and Drug Addicts Treatment

Board

$456 000

Whyalla Hospital (b)

Government Hospital

Not separately costed

(a) At the time

intended that transferred to

the Commission received evidence (31.5.1979) it was St. Anthony's Hospital should be closed and operations Birralee Hospital, which would treat alcoholics only.

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(b) Denotes units conducted principally as clinics for the treatment of alcoholism.

(c) The cost of the methadone program administered at the Hillcrest Hospital in 1978 was $95 000 (Open Exhibit 655, p.48).

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Chapter 2 Approaches to Treatm ent

AN OVERVIEW

Evidence received by the Commission indicated that most treatment centres are structured to treat drug dependence rather than drug use or misuse. Indeed, most treatment centres are solely concerned with alcohol dependence, or to a lesser extent narcotics dependence, although

a considerable body of evidence indicated that the major health problems associated with drug use involve legally obtained sedatives, analgesics and minor tranquillisers. Consequently, in accordance with the Commission's Terms of Reference, this Chapter of the Report deals mainly with the treatment of narcotic dependent persons, and a summary of evidence of general relevance to this topic follows.

The Commission observed a widely held belief that treatment is not purely a question of physical health; the mental and social well-being of the individual are also to be considered. Although there is no simple explanation for the occurrence of drug addiction, drug use is

heavily linked with the individual's lifestyle and with environmental factors. Drugs may be used, for example, to allay anxiety or boredom. The question arises as to whether treatment should initially be aimed at solving those problems; in other words, should treatment be symptomatic

or causative or both? Often the first cries for help are received from parents when family relationships begin to deteriorate or when the user faces legal action for drug use. Alternatively, a crisis situation such

as a drug overdose may precipitate acceptance of treatment. At this stage a thorough assessment should be made of the offenders' lifestyle and of potential problem areas. The importance of individual

assessments before any course of treatment is begun was strongly stressed to the Commission. What may be successful for one individual could be entirely unsuitable for another.

The Commission received no evidence demonstrating that one treatment method was clearly better than the rest. A variety of treatment methods were described in evidence, all of which had their supporters and detractors, but little empirical evidence was provided to show on what

basis judgments were made. A number of these methods are discussed later in this Chapter.

Witnesses told the Commission that, while there can, and should, be specialisation, no agency should restrict itself to using one treatment method only. Rarely is an adequate range of services available within one accessible area; country areas especially are very poorly served. Whilst this may reflect lower levels of narcotics abuse in those areas,

other drug use levels are high, though probably marginally lower than in city areas.

The Commission received evidence indicating that most persons working in the treatment field were unaware of what others were doing. Co-operation, co-ordination and referrals between treatment agencies are desirable. In practice, antagonism and competition between agencies is

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the rule rather than the exception. Treatment agencies usually have one ’stock-in-trade' method of treatment, which they believe to be a panacea for all drug dependency. The ideal of providing a range of treatment options from which to select that best suited to the individual drug user is rarely encountered. Consequently, the treatment received is dependent on the agency selected by the drug user.

Witnesses explained that, in many cases, drug treatment programs are merely extensions of programs devised for people with alcohol-related problems. This further diminishes the effectiveness of overtaxed personnel. Generally, treatment centres are inadequately staffed as great difficulty is experienced in attracting suitably qualified persons into an area having so little job satisfaction. Drug users make heavy demands on staff members but are rarely grateful for the services provided to them. Consequently, staff turnover rates are high. The problem of staff shortages is compounded by inadequate pre-service and

in-service training.

The Commission was informed that there is no formal postgraduate training in Australia aimed at the provision of treatment services for drug dependence and related problems. Accordingly, there is no regular recruitment of professionals, no specialist recognition, no career structure, nor any permanent commitment in this field. Generally speaking, drug users are not held in high regard by the community. Similarly, those treating drug dependence are not highly regarded by fellow professionals. Treatment programs do not have high success rates and it is inferred that the people responsible for providing treatment have failed in their task. This, of coufse, is due to the fact that drug use is only a manifestation of a deeper psychological problem, which must first be resolved. The morale and productivity of treatment staff is further eroded by such criticisms of their efficiency, and this exacerbates rapid staff turnover.

It has been suggested that the needs of drug users would be better served if drug dependence treatment programs were integrated into the general health care system. Perhaps also the needs of staff would be better met if service in a drug treatment clinic formed part of a

rotation system through all areas of health care. Generally speaking, the Commission was told, little has been done to achieve this. The major drug-related health problems, involving the misuse of analgesics, tranquillisers and sedatives, have been almost totally ignored in the context of health care.

In government institutions drug dependencies are generally treated by mental health personnel. It was suggested to the Commission that quite often people fail to present for treatment on account of this association. Integration of all forms of treatment for drug dependence into the general health care system could do much to overcome this difficulty. Witnesses also observed a need for central co-ordination and control of treatment programs since there is fragmentation and lack of uniformity but little communication, between the eight State and Territory Health Departments and the Commonwealth Health Department.

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Variations in the rules of the different State Medical Boards were said to cause difficulties in treating drug dependent medical practitioners.

In confidential session, a well-informed witness told the Commission that a variety of treatment facilities should be available in any one locality. These facilities include:

* information centres;

* drop-in centres to allow contacts to be made in the early stages of drug misuse;

* outreach programs for contacting those who may require assistance;

* detoxification centres;

* opiate maintenance clinics; and

* residential centres, both long term and short term.

In the opinion of certain witnesses some of these facilities are better provided by voluntary agencies rather than government-run institutions. Voluntary agencies usually form in response to the identification of

some need perceived within the community. They are faster to react than government-run agencies. When needs are fulfilled the organisation should cease to exist. The point was also made that, however unfounded such views may be, drug users are often suspicious of presenting for

treatment at a government-run institution. They are concerned about lack of confidentiality and the possibility of ensuing police action.

Treatment in the early stages of drug use has a greater probability of success. Therefore, it is important to provide adequate facilities to attract drug users at this stage. Very few persons will present voluntarily for treatment once an addiction has been established. As Dr J. Gabrynowicz, Director of the Alcohol and Drug Addicts Treatment Board

of South Australia, told the Commission:

...voluntary treatment for addiction is a myth; it does not exist. No person who is addicted to anything, including tobacco, will voluntarily come for treatment. There is always a coercive element involved. He may be coerced into the

therapeutic situation by a lawyer, by a judge, by a police officer, by a doctor, by a wife, by a friend-- someone;

there's always someone who points out to him the ill effects of his drug taking, whatever it may he. The same coercive

elements can be then used in order to keep him in a treatment situation. (OT 8750)

Whilst treatment methods do not always succeed during a treatment program, it was pointed out to the Commission that the addict learns the technique and frequently manages withdrawal or cure alone at some later stage. Also, evidence has shown that most persons who survive their

initial period of addiction grow out of narcotics dependence by 25--3S

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years of age, although many grow into other dependencies, such as alcohol.

RESIDENTIAL PROGRAMS, ISOLATION, ETC.

The Commission was told that very few residential programs are available for persons with drug problems and the variety available in any one geographical location is extremely limited although the need for such facilities is well recognised. Long-term rehabilitation programs generally take the form of relatively quiet confinement in a

government-run institution. There are almost no community hostels providing a long-term protective and rehabilitating facility for persons who have completed a treatment program. Nor is there any protective accommodation for persons in danger of becoming dependent on drugs, progressing in an outpatient program, or relapsing after treatment. A

small number of therapeutic communities are operated by voluntary agencies. Opinion is divided on the ideal size, duration and

requirements of such programs. No two communities are run in the same manner, but no one pattern would be suitable for all persons with drug problems.

Entry requirements for such communities are extremely rigorous and consequently many individuals are deemed unsuitable for the particular program. For example, one such centre in Brisbane described to the Commission is run along the lines of a family program accommodating eight persons with minimal staff. The management feels that it could not cope successfully with eight persons with long histories of drug use and failed treatment. Consequently, such persons would not be admitted.

Most therapeutic communities aim to help the drug abuser to develop an alternative, drug-free lifestyle, self reliance, and an attractive self-image. Medical care is provided since the programs aim to rehabilitate participants physically as well as psychosocially. Detoxification is often the initial step toward achievement of those goals. A patient will be more responsive to treatment when in a drug-

free state. Isolation from drug contacts and a previous way of life is considered a necessary step.

Support for the proposal that drug addiction should be declared a 'notifiable disease’ with all the attendant precautions, compulsory isolation, etc., came from a number of witnesses. In some States medical practitioners are required to notify the relevant authority if

they have had a consultation with a person whom they believe to be a drug addict. The relevant legislation is:

Tasmania--Alcohol and Drug Dependency Act, No. 61 of 1968, Section 18;

Victoria--Drugs of Addiction and Restricted Substances Regulations 1966 to the Poisons Act 1962, Section 73(1) of Division 15.

Western Australia-- Communicable Diseases Regulations of the Health Act.

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It is unclear what action is taken following notification. It was suggested by Dr L. R. H. Drew, Senior Medical Adviser in Mental Health, Commonwealth Department of Health, that it would be simpler to maintain a central register of drug misusers than to try to coerce doctors into notifying drug dependent patients if narcotics dependence became a notifiable disease (OT 20361--63).

Most witnesses who favoured the isolation of drug-addicted persons saw it as being beneficial for all concerned. Gaol sentences were not seen as being beneficial for anybody. Very little treatment is offered to persons who are imprisoned for drug use or drug-related offences. It was thought that detention in an appropriate treatment centre afforded

the best protection for the addict and the community.

To this end, the Commission was told that some organisations have established centres providing a totally new environment from which they operate therapeutic communities. Severe restrictions are usually imposed on the conduct of persons in the communities. They are often

'confined to barracks' initially and visits from family may be allowed only at specified times, but there is gradual relaxation of this aspect of treatment as the participant progresses through the program. Restrictions may also be placed on personal appearance, clothing, hairstyles, etc.

The Commission observed that one common characteristic of such therapeutic communities is their reliance upon social structure as the primary therapeutic tool. Peer group pressure plays an important role in rehabilitation. Several programs such as Banyan House in Darwin operate on a system of levels, entry to which is determined by patients' peers. Participants progress through the various levels, with their

attendant responsibilities and advantages, until they are considered ready to leave the program. It is a feature of many programs that patients are kept busy at all times and are not left to dwell on their problems. Consequently, days are rigidly scheduled with little time

allowed for leisure or the sharing of drug experiences with other residents. Such controls would not be possible in outpatient programs.

Whilst some of the organisations operating therapeutic communities have claimed a high success rate, the Commission noted that little statistical evidence exists to substantiate such claims. It is also important to realise that such claims have given no consideration to the

selectivity practised in choosing participants for entry to the program or to the fact that any success may be dependent primarily on the personal qualities of those providing the administration and guidance for the program rather than on the actual structure of the program. The

operation of a therapeutic community requires a high degree of flexibility to respond to the specific needs of the drug environment in that particular locality. The Commission often was told that this is not easily achieved in a government-run program, and such communities are better conducted under the auspices of a voluntary agency, as, in

fact, they are in Australia.

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WITHDRAWAL

The subject of withdrawal from drugs of addiction was raised by a number of witnesses appearing before the Commission. Differing opinions were expressed as to the severity of withdrawal from narcotics, particularly heroin. True narcotics withdrawal can produce intense physical and mental agitation. Symptoms include rhinorrhoea (running nose), vomiting, diarrhoea, cramps, dilation of the pupils, increases in

the pulse rate and blood pressure, and goose-flesh ('cold turkey') and sweating, especially over the trunk of the body.

Narcotics withdrawal may be effected with or without use of other drugs to reduce the intensity of symptoms; for example, tranquillisers and Lomotil are used at the Smith Street Clinic, in Fitzroy, Victoria. (Lomotil is given for the symptomatic treatment of acute and chronic diarrhoea.) Some individual drug users stated that they used marihuana or barbiturates to assist them withdraw. The use of methadone in withdrawal is permitted by the National Policy on Methadone for patients over 18 years of age who have a well established physical addiction if it is expected that withdrawal symptoms will be severe and there is a need to strengthen the bond between the addict and the treatment staff. The aim is to reduce discomfort, to use the episode of withdrawal to

improve the patient's motivation for change, and to assist him or her towards a drug-free existence.

The Commission was also told in confidential session by a senior official of the Commonwealth Department of Health that facilities for drug withdrawal under medical supervision were generally inadequate.

Whilst withdrawal may be physically easy, in the sense that no physical addiction was previously established, little has been said about the trauma of withdrawing from a drug to which psychological dependence has developed. A number of witnesses told the Commission that the psychological aspect was much harder to deal with than the physical withdrawal. In some cases nervous breakdowns had been the

result. The psychological factors cannot be ignored. It was suggested that physical withdrawal must therefore be accompanied by appropriate support to enable complete psychological withdrawal, which will be the most difficult and time-consuming part of the treatment process.

Several witnesses stated that heroin withdrawal symptoms were greatly exaggerated. One witness said that enforced 'cold turkey' suffered as a result of the unavailability of drugs and experienced alone in prison was a much more harrowing experience than withdrawal in the reassuring atmosphere of a rehabilitation centre. However, the body of evidence suggesting that narcotics withdrawal is not as severe as might be expected is perhaps explained by the adulterated state of

'street' heroin. Whilst it is not always precisely clear what strength of heroin was being taken prior to withdrawal, evidence suggests that heroin concentrations in street sales are often too low to produce true physical addiction although still capable of producing psychological addiction. Some treatment centres have introduced the use of narcotics

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antagonists such as Narcan to establish whether true physical addiction exists before any further steps are taken.

Methadone withdrawal was pronounced by some witnesses as far more severe than heroin withdrawal. This would relate to the fact that methadone is not given in the adulterated forms in which heroin is available to users. Consequently, true physical addiction to methadone may develop, whereas physical addiction to heroin may not previously have existed.

OPIATE MAINTENANCE IN AUSTRALIA, AND SOME GENERAL ASSESSMENTS

Methadone is a synthetic narcotic. It has been used in Australia in the treatment of narcotics addiction for more than 10 years. On 1 April 1977 methadone prescribing under the National Health Scheme was restricted to 1 disabling pain associated with malignant neoplasia or self-limiting disorders of short duration not responding to non-narcotic analgesics'. The National Health and Medical Research Council (NH & MRC) recommends that the use of methadone in the treatment of narcotics

addiction be restricted in accordance with the objectives of the National Policy on Methadone. This Policy emphasises that methadone has a small role to play in the treatment of narcotics addiction and it should be used as only one element in a total treatment approach. It

states:

Patients should be appropriately informed of the advantages and disadvantages of methadone treatment and should indicate their willingness to accept oral syrup medication before commencing methadone treatment.

The legitimate objectives of methadone treatment as stated by the National Policy are:

...a combination of reduced mortality, improved physical and psycho-social well-being, diminished involvement in anti-social behaviour, and containment of drug abuse...

Abstinence itself is only one of many possible goals...

Success does not necessarily depend on the achievement of the treatment goals. Partial achievement may be considered a measure of success. (Open Exhibit 140, pp . 1--2)

Criteria for admission of patients to methadone treatment were outlined in the National Policy as follows:

...Methadone withdrawal may be used in cases of narcotic

withdrawal where addiction is well established, when it is

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expected that symptoms will be severe, and there is a need to strengthen the bond between the patient and staff. The aim is to reduce discomfort, to use the episode of withdrawal to improve the patient's motivation for change and to assist him towards a drug-free existence.

For use of methadone in withdrawal the patient should:

- be over 18 years of age;

- have a history of fairly continuous opiate usage over at least one full year;

- be demonstrably (usually by use of an antagonist)

physically dependent on opiates.

...Methadone maintenance treatment, that is, the regular administration of oral methadone over a long period of time, may be used where there is chronic, intractable addiction which is severely impairing health or social functioning. The goals of methadone maintenance treatment are to reduce mortality, to

reduce ill-health, to reduce crime, to reduce the contagion of illegal drug use, to increase productivity, and to assist the individual addicted persons in coping. The goal of a drug-free existence is, at least temporarily, deferred. Methadone maintenance treatment appears to be effective because it keeps

the addicted person in contact with the treatment agency; it partially satisfies the needs of the addicted person and at the same time reduces the effects obtainable from use of other opiates; it removes the need for the addicted person to be preoccupied with obtaining and using illegal drugs; it allows

the addicted person to get on with the job of organising and living his life.

...High dosage (80--120 mg per day) methadone maintenance is recommended. Low dosage methadone maintenance (up to 60 mg per day) has been found to be less effective because of association with continuing illegal drug use. It merely supplements other

drug use.

For use of methadone as maintenance the patient should:

- be over 18 years of age;

- have a history of fairly continuous opiate usage over at least two full years;

- be demonstrably (usually by use of an antagonist)

physically dependent on opiates;

- have attempted other treatment alternatives extending over a period of at least six months and including at least two withdrawals. (Open Exhibit 140, pp. 2— 3,7)

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The Policy also recommended supplementing methadone treatment by regular counselling sessions (at least once a fortnight) and adequate follow-up care. Reviews of methadone patients should be conducted at least once every three months. The Policy advocated the enforcement of strict controls on the availability and administration of methadone and restricting access to daily doses of liquid methadone in the presence of a professional person. These controls are deemed necessary to prevent diversion of methadone to illegal channels and to avoid the dangers of overdose in unsuspecting children or adults.

Whilst concluding that methadone programs could be extremely valuable 'for a small group of chronically addicted individuals', the National Policy advocated that efforts be continued to develop innovative approaches and new treatment strategies.

The Commission heard evidence from a number of witnesses who were critical of the National Policy. High dosage maintenance was criticised as providing more than the minimum lethal dose. The high dose, it was claimed, produced significant side-effects and also increased the dangers of death by overdose, especially if a patient's weekend supply

came into the wrong hands-- a child, for example. Also criticised were the criteria for use of methadone maintenance which specified that the drug user should have attempted other treatment alternatives over a period of at least six months, including two withdrawals. An addict presenting for treatment may waste another six months before being

granted the form of treatment which the individual and the treatment organisation have assessed as most suitable at that stage.

Evidence received by the Commission indicated that attention is not always given to the constraints imposed by the National Policy on Methadone nor are criteria for admittance always observed. This was confirmed in a study entitled 'A review of New South Wales treatment

services for narcotic dependent persons' by I. Reynolds, J . Di Gusto and R. McCulloch, released in 1976 by the Division of Health Services Research of the New South Wales Health Commission. The study found that

approximately two-thirds of persons receiving methadone had received no prior treatment for drug dependency. One-quarter were recorded as having a habit of one to two 'hits' per day, and it was therefore

improbable that they were physically addicted to opiates. While all prescribers felt it was important to see and assess clients personally before prescribing methadone the majority reported difficulties in carrying out this procedure in practice owing to lack of time or other duties. This study also found that 13 per cent of clients stated that methadone had been prescribed by general practitioners who were not

authorised prescribers.

A confidential assessment by a senior medical officer of the Commonwealth Department of Health of the operation of methadone programs since the advent of the National Policy on Methadone revealed the following anomalies, support for which can be found in other

evidence.

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* Some therapists prescribe methadone for anyone who has used a

narcotic recently and approaches the treatment agency. Yet when tests of physical dependence have been applied they show relatively few users to have been strongly addicted.

* The advent of official methadone prescribing attracts massive numbers of drug users, but a tightening of controls in the program leads to a rapid loss of clients.

* Programs tend to be administered according to the treatment

philosophy of practitioners rather than the individual needs of drug users.

* Despite almost universal acknowledgement that the use of methadone should be only a small part of the total management program, in practice, where used, it is almost the only method of treatment.

* Controls are inadequate to meet the minimum principles accepted by the NH & MRC. While inadequate resources may be the reason for this, the outcome may be programs that are a hazard to health.

* There is no standard record keeping to enable evaluation, and a national approach is needed to obtain this.

The Commission's attention was drawn to an interesting situation existing in Tasmania, where methadone is not used for blockade or maintenance. Persons requesting methadone are offered withdrawal in hospital, and support for a sufficient time to allow them to readjust to society. Persons coming from another State are given sufficient methadone to permit them to return home. The incidence of narcotics use

in Tasmania apparently remains very low but there is no way of knowing whether this is a consequence of the policy adopted or the geographical isolation of Tasmania and the small, and widely dispersed, population, making Tasmania an unattractive location for drug trafficking.

It was pointed out that a natural experiment may be occurring in Queensland at present. Methadone is available in Rockhampton and Mackay. In Townsville its availability is greatly restricted. It may there be used only after the patient has been hospitalised for

assessment. It remains to be seen whether the relative unavailability of methadone in Townsville will continue and whether this will influence the patterns of drug use and drug problems there favourably or

adversely.

A number of drug users gave evidence to the Commission that they had used other drugs while receiving methadone treatment. This was to tide them over if they ran short of methadone or because the methadone dosage was too low. Random testing-- urine analysis, for example---can reveal

that other drugs have been taken. Methadone is then usually withheld from those persons. In the words of one informed witness:

...When looked at objectively they (the therapists) are

becoming angry at people who are merely displaying a symptom of their illness. The result of the anger is that people have

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their methadone withdrawn and are thereby punished by having to undergo withdrawal. (CT)

Alternatively, the addict will seek illicit drugs.

Concern has been expressed about the impairment of psychomotor functions, in the control of machinery, for example, when methadone is used. It is generally agreed that some disabling effects do occur. As regards the influence of methadone on driving skills, the Commission was told that persons using high-dose methadone were almost certainly better drivers after taking a methadone dose than they were before it or if they discontinued treatment. Witnesses said that there was more danger

from persons using narcotics intermittently than from persons receiving high-dosage methadone maintenance.

The effects of methadone in a high-dosage methadone program on unborn infants is a matter of considerable concern. A child born to an addict will suffer withdrawal after birth since narcotics can transgress the placental barrier. This will occur whether the woman is addicted to methadone, heroin, or some other narcotic. Evidence given to the

Commission indicates that the options for the pregnant addict are:

- acute detoxification;

- slow detoxification using methadone substitution and later withdrawal;

- methadone maintenance; or

- no change in the addiction pattern.

Acute detoxification is poorly tolerated by the foetus, which suffers withdrawal symptoms and frequently dies. There are few data relating to the effects of detoxification at different stages of foetal development. Whilst the problems for a newborn child do not differ significantly between heroin and methadone addiction, the two drugs can produce significantly different effects prior to birth. Heroin is

extremely toxic to the foetus, more so than methadone. Also, the heroin addict is greatly at risk from infectious disease, notably hepatitis, pulmonary infections, skin infections, gonorrhoea and syphilis. The pregnant addict often supports her habit through prostitution, thereby

increasing the risks of untreated syphilis and gonorrhoea. Hepatitis B, syphilis and septicaemia readily spread to the foetus transplacentally. Gonorrhoea usually causes ophthalmia neonatorum during descent in the birth canal after rupture of the membranes. These considerations prompted one informed witness to suggest that the best solution would be methadone maintenance with the shortest course at the lowest possible dose that would not induce the mother to use heroin, barbiturates or tranquillisers.

Whilst abstinence from drug taking during pregnancy is obviously the ideal, it can be seen that withdrawal from drugs after conception may not be the best alternative.

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Narcotics present the greatest danger to the foetus during the first three months of pregnancy. This period is most important in relation to abortion, deformities and still-birth. Pregnant addicts rarely present for antenatal treatment during this period so the opportunity to attempt detoxification does not arise. Expert antenatal care may reduce neonatal risks.

The long-term effects of foetal narcotics addiction on the person during childhood, adolescence and later life are not known with any certainty. However, it appears that general development is delayed and behavioural problems arise, whether or not the child remains with its mother or is fostered. The effects on intellectual development are not known.

The Commission received evidence from several witnesses concerning the efficacy of methadone treatment in achieving its goals.

Improvements were reported in general health, mental well-being and social behaviour. Patients were able to gain, or retain, employment, and many achieved withdrawal. To those who have become physically addicted to heroin, acceptance into a methadone program can only bring relief. The cost of maintaining a narcotic habit is enormous and some criminal behaviour is usually necessary to support it. The criminal activities may take the form of stealing, prostitution, or drug dealing with other persons. The last-mentioned activity helps to spread drug use deeper into the community.

A submission from the Royal Australian and New Zealand College of Psychiatrists, Queensland Branch, concisely summarised the situation:

Despite on-going argument about the value of methadone, we feel that it does offer one of the few avenues in our society for containing addicts and preventing spread of the disease of narcotic addiction. We believe that the addict who is taking methadone under supervision at a Government Health Clinic

(where staff are trained to deal with addicts) is being effectively treated and held, and also is prevented from spreading the social disease to others.

Thus, society's need for prevention is met and the individual victim is held in a manner which protects his life and physical health from the severe ravages of street narcotic addiction and

the individual then has time to grow and mature out of his problem. (OT 14967)

The objections to methadone treatment can be summarised as follows:

It is simply the substitution of one drug of addiction for another, and is no sense a treatment or a cure for narcotics addiction.

It is at least as difficult, and possibly more difficult, to withdraw from methadone as from heroin.

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As mentioned elsewhere in this Chapter, street heroin is sold in a very adulterated state and in concentrations unlikely to produce physical addiction unless extremely large doses are taken. Methadone is not diluted in this way, so physical addiction is more likely to occur.

In that case, withdrawal would be more difficult. On the other hand, some drug users have expressed the opinion that heroin withdrawal was much worse than methadone withdrawal.

Success rates of methadone programs have come under considerable criticism. There appears to be little recognition of the fact that not all treatment programs aim at a drug-free or opiate-free state. Methadone programs have different, more attainable, aims for their participants.

Concern was expressed that the ease of entry to methadone treatment may, in fact, be converting non-dependent persons to narcotics addiction. Such criticism is closely related to the administration of methadone programs and it was suggested that these problems might be

avoided if the criteria of the National Policy on Methadone for entry into a methadone program were observed. Inadequate assessment of drug users prior to their starting methadone treatment would seem to be the

major problem.

The Commission was told that methadone treatment centres may have a 'honeypot' effect, attracting daily numbers of active drug users to a single location. This may facilitate the influence of drug dependent persons on one another to take additional drugs or their contacts with

those wishing to sell them drugs. There is a possibility that if methadone programs are not strictly controlled patients could obtain methadone from more than one centre and face the risk of overdosage. In programs where patients are permitted to take away methadone, even if

only for their weekend use, there is a danger of non-dependent persons, particularly children, receiving an overdose and of the illegal diversion of supplies. Since methadone is itself a narcotic there is a

possibility that other drugs taken legally or illegally to supplement the legal methadone dosage may lead to overdosage. Also, since potential drug users or drug users not yet dependent see methadone accepted as a substitute by heroin dependent persons, they too may seek methadone either legally or illegally.

The Commission noted an observed tendency for persons on methadone treatment to use alcohol heavily as a supplement or substitute. If the methadone dose is insufficient to reduce the anxieties previously controlled by heroin, then copious amounts of alcohol are found to be

the most effective substitute. Little is known about the interaction of methadone with alcohol and other drugs.

Also not enough is known about the long-term effects of methadone. Evidence received by the Commission indicates that the only demonstrable long-term effects were some sexual impotence or loss of potency, constipation and other gastro-intestinal symptoms, and loss of appetite. These are similar to the long-term effects produced by heroin and other

narcotics. 1

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Acceptance of methadone as a treatment for addiction to narcotics may discourage exploration of other avenues of treatment which could turn out to be more effective. This objection was implicit in many of the statements by witnesses opposed to methadone use. The National Policy on Methadone states that efforts should be continued to develop

innovative approaches and new treatment strategies. If the National Policy recommendations are followed there can be no blind acceptance of methadone treatment as a wonder cure; other possibilities must be explored.

Heroin also may be used in the opiate maintenance treatment of narcotic dependent persons. It has been used in this capacity, along with methadone, in treatment programs in the United Kingdom since 1926. However, since 1968 the prescription of heroin to addicts has been

restricted to certain medical practitioners, attached to treatment clinics, who have been specially licensed for that purpose. There is no such restriction on the prescription of methadone, which can be prescribed for addicts by any doctor. During the past decade there has been a steady decrease in the number of persons being prescribed heroin from 45 per cent of known addicts to 4--5 per cent in 1976, and further since, though there is great variation between the clinics. This has been attributed entirely to the smaller number of practitioners able to prescribe heroin. With the reduction in the amount of heroin

prescribed there was a dramatic increase in the illicit price of the drug, from one pound sterling for six tablets to one pound sterling per tablet (Open Exhibit 569), indicating a continuing demand for the drug.

It was suggested to the Commission, that if heroin were made legally available to addicts in Australia, then many of the people currently using it would cease to do so, because a lot of the charisma attached to being a 'junkie' would disappear (OT 12462). Heroin use would become a health problem, rather than a statement of flouting the system. Others who disagree feel that the majority of heroin users will just keep

lining up for their free handout (OT 12236).

It was asserted that if an addict is in a situation of obtaining his narcotic from a health authority, then the probability of his entering a treatment program would be substantially higher than it would be if that contact did not exist. Also, consideration must be given to the fact that heroin maintenance may attract more addicts than does methadone maintenance. A number of addicts have expressed dislike for methadone as a drug.

Other propositions have been advanced in favour of heroin

maintenance in preference to methadone maintenance.

It was pointed out, by a medical practitioner who had had experience with heroin maintenance in the United Kingdom, that in many cases the person is addicted not only to the drug, but also to injecting it with the needle. The provision of oral methadone does not satisfy that need. If intravenous heroin is provided initially, it may be possible, over a number of years of treatment, to wean the person from heroin onto

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methadone, then from injectable to oral methadone, and finally off narcotic drugs while socially rehabilitating them, but it would be a gradual process .

However it was asserted, in the report on 'Treatment' by the

Canadian Commission of Inquiry into the Non-Medical Use of Drugs, that:

There are good medical reasons to reject a treatment procedure which would continue to use the intravenous method of drug administration-- the method to which the habitual heroin user is accustomed. Unpredictable and dangerous hypersensitivity

reactions may occur when heroin is administered intravenously, and, although these reactions are rare, they may be fatal; and indeed, it is estimated that fatalities occur once in 100 000

such injections. From the general medical point of view, intravenous injections of any substance are always more hazardous than oral administration or other forms of

injections.

(Open Exhibit 562, p. 19)

Other arguments advanced in favour of heroin maintenance were:

* Heroin distributed by a government agency would be pure and not cut with unknown constituents of unknown potency.

* The distribution of legal heroin makes the illicit supply of the drug less attractive to the criminal elements.

In reply to this the Canadian Commission's report stated:

As to the reduction of the illegal heroin market, the

supporters of methadone maintenance, who would not allow any legal heroin, argue that the illegal market for heroin would be reduced automatically if our efforts to find most heroin-

dependent persons and treat them with methadone could be made successful, because a person treated adequately with methadone would soon extinguish his heroin habit through lack of

reinforcement resulting from the absence of any heroin effects. (Open Exhibit 562, p. 19)

The Canadian Commission's report went on to give other reasons why methadone was preferable to heroin:

...the effect of heroin is of shorter duration than that of methadone, so that abstinence symptoms occur earlier and make more frequent administration of the drug necessary. For an opiate-dependent person who is regularly employed-- but also

for those who are not employed-- it might be very inconvenient to have to attend the clinic or another centre authorized to administer the opiate more than once every 24 hours and thus increase the probability that the patient would drop out of the program. Finally, there seems to be general agreement that

intravenous injections of heroin produce more intense euphoria

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than orally taken methadone, and more intense euphoria is more likely to impede possible social rehabilitation by interfering with normal day-to-day functioning of the individual, and keep him preoccupied with the waiting for the next 'fix'.

The British statistics which show that registered opiate addicts under maintenance treatment function better socially than they did prior to treatment do not distinguish between persons maintained on heroin or methadone. As for

the...assumption, that the number of heroin addicts would drop if heroin would be legally available, it should be noted that in Britain in 1968-- one year after the introduction of the new legislation which made heroin legally available in special treatment centres-- ten times as many new cases of opiate addiction were being recorded as in the ten years previously. This was interpreted in Britain as evidence that more heroin users had been induced to register because of the new

legislation. The number of cases seen in 1969 was considerably lower than in 1968. There is no documented evidence available for the assumption that more heroin dependent persons would register for treatment if they could continue to receive heroin legally, nor is there well established proof that any person who can be successfully maintained on heroin could not, at least, be maintained equally well on methadone.

(Open Exhibit 562, p. 19)

An evaluation of the relative merits of heroin and methadone maintenance was made and reported in a paper entitled 'Evaluation of heroin maintenance in a controlled trial' by Richard Hartnoll and Martin Mitcheson, made available to this Commission prior to publication. The

results provided by the study 'do not indicate a clear overall

superiority of either approach. Both treatments have advantages in some areas, but at the expense of disadvantages in other areas. Which approach is favoured depends on the priorities assigned to the various outcomes' (OT 15010).

THE ’BRITISH SYSTEM’

Concern for the treatment of drug dependence in the United Kingdom dates back to 1926 when the Ministry of Health Committee on Morphine and Heroin Addiction (the Rolleston Committee) expressed the view that the condition of drug dependence 1 must be regarded as a manifestation of disease and not as a mere form of vicious indulgence1.

The Rolleston Committee in its 1926 Report considered that there were a number of circumstances in which a doctor might properly supply a drug of addiction to a drug addict. Appropriate cases where this might be done were:

(a) Those who are undergoing treatment for cure of the addiction by the gradual withdrawal method; and

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(b) Persons from whom, after every effort has been made for the cure of the addiction, the drug cannot be completely withdrawn, either because:

(i) complete withdrawal produces serious symptoms which cannot be satisfactorily treated under the ordinary conditions of private practice; or

(ii) 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.

(OT 15002)

After 1926, doctors in the United Kingdom prescribed narcotic drugs to addicts within the guidelines set out in the Rolleston Report. However, cases of abuse occurred, particularly in the early 1960s when there was a sharp increase in the incidence of heroin addiction in the United Kingdom.

In 1961, the Inter-Departmental Committee on Drug Addiction (under the Chairmanship of Sir Russel Brain) was set up to review the Rolleston Committee's Report of 1926, and this Committee was re-convened in 1964. The second report of the Brain Committee was published in 1965 and it pointed to an alarming increase in addiction to heroin and heroin used

in conjunction with cocaine. The main source of supply of these

substances was said to be over-prescribing by a small number of doctors, and the recommendations of the Committee included:

* Compulsory notification of addicts to a central authority.

* The provision of treatment centres as part of psychiatric hospitals or of the psychiatric departments of general hospitals.

* Prescribing of heroin and cocaine to addicts to be restricted to doctors on the staff of the treatment centres.

* Compulsory powers to be provided for detaining addicts for brief periods during acute episodes in treatment they had voluntarily accepted.

* The establishment of a Standing Advisory Committee to keep the whole problem of drug addiction under review.

The recommendations of the Inter-Departmental Committee were accepted by the government of the day and they were implemented in the form of legislation as follows:

* The Dangerous Drugs Act 1967.

* The Dangerous Drugs (Supply to Addicts) Regulations 1968.

* The Dangerous. Drugs (Notification of Addicts) Regulations 1968.

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Facilities for the treatment of addiction were established in the form of special outpatient clinics at 14 hospitals in the London area, and arrangements were made outside London for addicts to be treated by ordinary hospital psychiatric services with a few centres modelled on the London outpatient clinics.

Licences were available to doctors under the provisions of the Dangerous Drugs (Supply to Addicts) Regulations to enable them to prescribe heroin and cocaine to addicts, but the issue of such licences was linked with the planning of the hospital services where possible and, in the event that there were no special clinics available, licences were issued to psychiatrists in the hospital service on a limited basis.

The institution of these outpatient clinics (and some inpatient clinics) for the treatment of drug dependence has resulted in the experience of treatment of narcotics dependence in the United Kingdom being termed the 1 British system' particularly in the United States. Workers in the field of drug dependence in the United Kingdom dislike

references to a 1 British system' and deny the existence of any system in relation to the treatment of narcotic dependence. The term 'British system' seems to be equated simply with the administering or prescribing of narcotic drugs to patients as part of their treatment, but no one

form of treatment is practised in the United Kingdom to the exclusion of others. Also, in recent years changes in the incidence and social effects of narcotic dependence have brought about changes in the law and in approaches to treatment.

Responsibility for planning, management and co-ordination of services for drug misuse rests with the health authorities. The purpose is to integrate the treatment clinics into the overall pattern of the National Health Service but essentially the treatment clinics operate

independently and plan their own programs. Professional staff other than medical personnel are employed. They include social workers and psychologists.

In October 1972, in a paper entitled 'The treatment of narcotic dependence in the United Kingdom', J. E. M. A. Glancy expressed the following opinion concerning the evaluation of the programs of the treatment clinics:

It is certainly not our object to make exaggerated claims for the effectiveness of the methods of treating narcotic

dependence used in the United Kingdom. We have, we hope, made it clear beyond any doubt that the procedure of prescribing heroin or methadone is far from being regarded as a panacea. The risks which this procedure entails are fully recognised by all concerned with the treatment of the condition. On the other side, however, there has to be balanced the risk that the addict will seek illicit supplies, perhaps engaging in crime to get them, and in the process will run very much

greater dangers to life and health and become yet further alienated from the rest of society. The decision to prescribe

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drugs to an addict can never be taken lightly. A doctor will do so only if he judges that it is this course of action which will on balance best serve the interests of his patient...

What success have the clinics achieved in their three or four years of life? This question needs to be answered in terms not only of addicts who have been helped by their association with the clinics to adjust to the demands of society by having a

regular job, a settled home, steady family relationships and so on. Substantial numbers of the addicts or ex-addicts who attend the clinics are in regular work...and in other respects too are more or less successful in functioning in society. What is difficult to ascertain is the extent to which this is

the result of the work done by the clinics. Research

studies... should in course of time make possible a better assessment of the impact the clinics have had and of how the patients they have treated compare with others treated in different ways. But it is still rather early after only

three or four years of experience with the present

arrangements-- to form a definitive judgement of success in dealing with a condition like drug dependence which is generally recognised as having a protracted natural history and a high incidence of relapse.

(OT 15008)

Whilst statistics compiled by the Home Office for the first few years after the revision of this system in 1968 indicated a continuing downward trend, recent evidence suggests a different trend. An article in the British medical periodical 'The Lancet' of 11 August 1979 (OT 24092--93) entitled ’Drug addiction: time for reappraisal' suggested that recent Home Office statistics threaten faith in the 1 so-called British System1. The article revealed substantial increases during 1978

in the numbers of addicts known to be receiving narcotics from medical practitioners and in the numbers of new addicts notified for the first time. The article concluded that these figures, undoubtedly an underestimate, cannot be attributed only to improved notification owing to the operation of other factors. There was an increase in the number and quantities of seizures of heroin, cocaine, dipipanone and methadone, and an increase in the number of persons found guilty of offences

involving these drugs. Increases were also reported in the number of patients attending drug treatment centres and in the number of private and general medical practitioners prescribing opiates. These indicators all suggest an increased demand within the population for opiates.

It has become apparent also that 'polydrug' abuse, rather than dependence on a single drug, is now the established pattern of drug abuse. A wide range of non-notifiable drugs are being abused.

The article suggested that one possible response to this increase would be to restrict the right to prescribe these drugs to addicts to specifically licensed doctors only and to bring barbiturates under stricter control. These measures would reduce the availability of these drugs, but others would undoubtedly take their place. 'The preventive

role of the clinics in relation to the black market is now seen as

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preventing overspill by frugal prescribing rather than undercutting it by competitive prescription' (OT 24092).

A consequence of tightening the availability of these drugs would be an influx of new addicts presenting to clinics as their only legal source of supply. This, in turn, would increase the demand for

treatment resources.

The article concluded that critical evaluation and future planning were needed immediately 'so that action is not always an urgent response to an impending crisis'. The fact that treatment of drug dependence has 'little emotional appeal or political muscle' was suggested as the reason that the service to notified addicts offered now was worse than it was in 1968 (OT 24093).

After a visit to the United Kingdom to study the situation, Mr Geoffrey Miller, Junior Counsel Assisting the Commission, concluded:

The experience of treatment of narcotic dependence in the United Kingdom suggests that many of the problems faced by those working in the field are peculiar to the United Kingdom itself. There seems a general consensus of opinion that the drug problem in the United Kingdom at the present time is one of multiple drug use (as it seems to be in most parts of the world) but the extent of the problem of drug use in the United Kingdom may well be less alarming than it is in the United

States of America and indeed Australia.

The introduction of the drug dependence clinics in London (and of other facilities outside London) in 1968 established a facility for the treatment of the drug dependence, although in many cases the treatment was no more than the maintenance of addicts on injectable heroin or methadone.

The consequences of these programs of maintenance are now being assessed but it is fair to say that there is no uniform program in the country and certainly no 'British system' of treatment of narcotic dependence. At one of the most successful

treatment clinics (University College Hospital) the success of heroin maintenance could at best be described as equivocal. (OT 15011)

On balance, the evidence suggested that critical evaluation and reappraisal of the system are urgently required and that there is need for the treatment system to have a capacity to foresee problems that may arise and to respond to changes in drug abuse patterns.

COUNSELLING AND CONFRONTATION

These techniques are often used in conjunction with other forms of treatment, as well as playing major roles in drug-free programs. Given

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the variety of individuals, their different personal problems, motives for drug taking, family circumstances and support, and motivation for seeking treatment, it is obvious that some will seek and respond to counselling, others will not. It was pointed out by Dr L. R. H. Drew of the Commonwealth Department of Health that it is the drug user himself who requires the treatment rather than the drug addiction, which is only

one of his problems (OT 20271). Many drug users do not see that they have a problem for which they need counselling. Enforced counselling may be counter-productive in that a person in a methadone program who objects to counselling may abandon it altogether if counselling is

forced on him, and thus all contact would be lost (OT 20371--72). It should be noted that this attitude is in opposition to the National Policy on Methadone, which advocates counselling of all participants at least once a fortnight (Open Exhibit 140, p.5).

Drug counselling is a sensitive and specialised field and requires suitably qualified professional personnel if it is to be effective in treating drug abusers. The Commission received evidence indicating that few, if any, qualifications are required for appointment to counselling positions. Induction training programs for recruits and in-service training are usually inadequate. Participation in the few formal training programs available is seldom encouraged.

Counselling of drug users takes several forms:

* Round-the-clock telephone counselling, e.g., Lifeline, the Addcare Service, Teen Challenge. These agencies offer aid in crisis situations, such as drug overdose, and referral services to other organisations. Further face-to-face counselling may be arranged. These services are mostly offered by voluntary agencies.

* Informal drop-in centres are provided mostly by voluntary agencies. These are usually of a general nature but drug counsellors are available. These facilities are important because they may allow contact to be made in the early stages of drug use before addiction becomes a problem. Severe cases are usually referred to more

appropriate organisations.

* Assessment and referral centres are operated by both government and voluntary agencies, either as part of a general health or youth service or as a separate entity. The centres may be linked with specific treatment programs.

* Detached worker programs aim to establish a link between youth or treatment agencies and young people who have a drug problem.

* Outpatient drug-free programs provide counselling for the drug user and the user's family. Success relies heavily on the development of a constructive personal relationship between the counsellor and the user. Participation in group activities is also considered basic to

the treatment. The Commission was informed that counselling at this level appears to be of little use to many narcotics dependent persons. Lack of success may be related to the fact that much of the counselling is performed by non-professionals lacking experience. *

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Vx Inpatient drug-free treatment programs place great emphasis on counselling and confrontation techniques. These types of program provide counselling to participants before, during, and after residential treatment. Evidence received indicated a disheartening

response by some participants to group therapy or confrontation sessions. In these circumstances some participants are unable to provide constructive criticism or comment. Consequently the sessions prove to be of little use to them.

As an adjunct to methadone and withdrawal programs (see previous comments).

Another form of drug-free treatment which was brought to the Commission's attention involves parents in a non-institutionalised setting. The Drug Users Parents Aid (DUPA) Foundation of Victoria aims to help the family to solve the problems that led to the drug use. The Foundation concentrates on counselling and the provision of moral support. Referrals for medical treatment are made where

necessary. Firstly there is individual counselling of both the drug user and the user's family. Following this, they are brought together and confronted with each other's thoughts, feelings and problems. Mrs P. L. Searles, founder of the DUPA Foundation said:

We liken drug addiction to a boil, it is useless to clear the top matter which is the addiction, we start working underneath, for when the underneath problems are sorted out, automatically the drug addiction will begin to be resolved.

(OT 3220)

It was her opinion that the Foundation was 85 per cent successful in rehabilitating the drug user in this way.

THE ROLE OF PRIVATE MEDICAL PRACTITIONERS

Many persons seek treatment for drug dependence-- whether alcohol, narcotics or other drugs-- from private medical practitioners in preference to treatment centres. Evidence received by the Commission indicates that a variety of treatment methods are used by private practitioners-- namely, group therapy, counselling, and methadone.

Evidence placed before the Commission suggested that the major advantage obtained from treatment by a private medical practitioner in comparison with treatment through a treatment agency is that the continuity of medical personnel can promote a stable and trusting doctor--patient relationship. If the drug abuser can relate to one person who will support him right through the treatment process, then

rehabilitation is likely to be more effective. Other advantages were said to include privacy-- nobody else need know why the doctor is being consulted whereas attendance at a treatment centre is a clear statement of the problem-- and segregation from other members of the drug culture. Attendance at a drug treatment centre necessarily leads to contacts with other persons from the drug culture. Such contacts are non-therapeutic as conversation inevitably dwells on past experiences, etc. There is little opportunity for this when treatment is sought through a private medical practitioner.

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However, it was pointed out that there are certain disadvantages to private treatment. Many private doctors are inadequately trained to treat drug dependency. The treatment is slow and a busy doctor may not be ab e to devote much time to a drug dependent patient. There are also

dangers in private practitioners' supplying methadone treatment. A narcotic user may seek 'treatment' simultaneously from more than one doctor under one or more names. The doctors would have no way of

checking that the patient had no other sources of supply. This

highlights the need to maintain a central register of persons receiving narcotic drugs and to prohibit prescription of such substances without special authority. Effectively, the dishonest person can obtain sufficient drugs for his own use and a surplus he can sell on the side.

The Commission received evidence indicating that many general practitioners feel that they are not fulfilling their professional obligations if they refuse to prescribe methadone for a person claiming he needs methadone to avoid seeking heroin. Some practitioners cannot

accept that they may have been deceived by a drug user.

Private practitioners may only prescribe methadone tablets and not the liquid methadone available in government-run treatment agencies. Diversion of methadone to other uses is easily accomplished when prescriptions are given for tablets to be obtained from a pharmacy.

Such loose prescribing practices were criticised by witnesses appearing before the Commission. One witness felt that they were responsible for methadone's having a bad name, the use of which she favoured.

ALTERNATIVE FORMS OF THERAPY

A number of witnesses claimed that alternative therapeutic techniques had a role to play in the treatment of drug dependency. The Commission was told that hypnotherapy was a useful adjunct to other forms of treatment. In the few cases where hypnotherapy had been used to aid withdrawal from heroin it was said to have been successful. The subjects were able to use self-hypnosis to help in riding out the withdrawal symptoms. It was pointed out that hypnotherapists seldom

deal with unwilling patients. Most patients seek such treatment voluntarily and are well motivated.

Acupuncture was suggested as a means of treating drug dependency. Whilst there is inadequate documentation to substantiate the proposition, several witnesses supported the idea that acupuncture could have a place in the initial stages of treatment. It was pointed out

that acupuncture will relieve only the withdrawal symptoms, not the psychological problems associated with the addiction. Counselling would be necessary for some time after withdrawal to resolve the psychological difficulties.

Several witnesses claimed that transcendental meditation was an effective tool in decreasing drug use. However, it was stated that no research had been carried out on such treatment of drug dependency. These claims of success were refuted by another witness who saw the Transcendental Meditation Society as 'a typical cult'.

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The Bridge Programme conducted from the Salvation Army William Booth Institute in Sydney aims to rehabilitate addicts through a program of spiritual philosophy with supportive vitamin therapy. No drugs are used. The program utilises the moral philosophy of Alcoholics Anonymous, and a spiritual program of recovery is offered to the addict when he is at his lowest. The Commission was told that 'the programme of counselling includes group therapy, warm Christian fellowship, an

introduction to the love of God and the offer of hope through faith in Jesus Christ as a Saviour and a Healer of body, mind and soul'.

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Chapter 3 Evaluation o f S uccess

CRITERIA

Little authoritative documentation exists concerning evaluation of the success of treatment programs. It has been brought to the Commission's attention that even the need for routine data collection in a

standardised fashion has generally been ignored. Consequently, statistical analysis has not been feasible. In many cases, evaluations could not be made owing to the lack of appropriate resources, i .e .,

adequately trained staff and back-up expertise.

The Commission was informed that the criteria used for measuring the success of a treatment program must reflect the aims of the treatment. Success may be measured by the achievement, or partial achievement, of a variety of goals including:

* a drug-free lifestyle;

* a narcotics-free lifestyle;

* prevention of infection of other members of the community;

* reduced antisocial behaviour, e .g .,

criminality;

a lifestyle free from

* social and emotional stability;

* improved employment status;

* a decreased mortality rate;

* better physical and mental health;

* an improved self-image.

of

For evaluation to be meaningful, scientific controls and a treatment conditions are necessary. These conditions are variety rarely found in practice. It appears that little scientific evaluation is being conducted.

RATES OF SUCCESS

The Commission heard differing opinions regarding the success of voluntary, as opposed to compulsory, treatment. For example, a consultant psychiatrist felt that it was detrimental to those

voluntarily seeking treatment to have to mix with those who did not really wish to give up drug use:

The position is made worse when courts compulsorily send drug users to such centres for rehabilitation. People who do not want to , stop using drugs are then put with people who went to

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the centres to stop using drugs. The same situation is created when a drug user attends such a centre voluntarily, not because he is really motivated to stop using, but knows that he will get a lighter sentence if he is seen to attend such a centre...

By putting people together in a unit, a larger proportion of whom do not want to stop using, there necessarily is under present conditions, a low rate of success... (CT)

On the other hand, Dr B . K. Fenton of the Alcohol and Dependency Service of the Tasmanian Mental Health Services Commission said:

At the beginning when I first started taking people from the courts I told the judiciary that I felt people who were put into treatment forcibly did not do so well as people who came

into treatment voluntarily, and I had to eat my words, because the figures showed that no matter how you get into treatment you do equally as well. (OT 1211)

A number of treatment organisations giving evidence to the Commission claimed high success rates. However, few if any, statistical data were available to support these claims. Evidence was received in confidential session that a claimed success rate of 38 per cent by one treatment centre had been reduced to 4 per cent through discussions at a seminar owing to the unacceptable way in which the first figure was computed. At the same seminar it was disclosed that 4--5 per cent of people ceased drug use as a result of a natural process of maturation. Therefore, the real rate of effectiveness of the treatment centre in question was probably close to zero. This was interpreted as a

reflection of the fact that voluntary behaviour cannot be effectively controlled. It was thought that if a desire to cease drug use existed then this could be achieved without the intervention of treatment centres.

An interesting opinion on the value of rehabilitation programs, even where success rates appeared low, was offered by Mr W. D. Crews of the Wayside Chapel, Kings Cross, Sydney. He said:

What we find a lot is that people will have been through three or four different rehabilitation centres. They will have failed to rehabilitate each time but then, when they have grown out of heroin, they will use a bit of the technique from each programme and stop themselves so that although individually the

rehabilitation programmes are failures, the overall picture is one of ultimate success. I think most programmes have a very low success rate. In the long term they win. (OT 11801)

MEASUREMENT OF SUCCESS

It is difficult in the short term to form constructive judgments concerning success in the treatment of a condition such as drug dependence, which is recognised as having a prolonged natural history

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and a high incidence of recidivism. These difficulties are further exacerbated by the absence of evaluative data upon which to make assessments. It has been brought to the Commission's attention that the

costs, methods and standards of treatment vary enormously among government-run and voluntary agencies, but there are few measures of outcome. The Commission was told that one fairly simple measure of success is mortality rate. This parameter is frequently neglected but

its importance must be stressed. It was suggested that if any drug dependence treatment regimen produces a decrease in the mortality rate, however small, then it must be considered a success.

A well-informed witness asserted that evaluation studies, cost- benefit analyses and accreditation procedures, expensive though they may be, are urgently needed. They would produce benefits in the form of substantially improved results and reduced costs.

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Chapter 4 Present R ole o f the Criminal Justice System

SOME GENERAL OBSERVATIONS

Several Australian States have enacted legislation empowering courts to order the detention, for treatment purposes, of persons who may be considered as drug addicts or inebriates. The legislation is:

South Australia-- Alcohol and Drug Addicts (Treatment) Act 1961 — 71, Sections 4 and 14 (The South Australian Government has never proclaimed the treatment centres, which it has an obligation to do under this Act and these sections are not operable);

Queensland-- The Health Act 1937, Section 130B, and the Mental Health Act 1974, Section 32;

Victoria-- Alcohol and Drug Dependency Act 1968, Section 11;

Tasmania-- Alcohol and Drug Dependency Act 1968, Division II, Sections 30--36.

Evidence received by the Commission indicated that these powers are used in Tasmania, which has a fully operational scheme for the

compulsory treatment of drug dependent persons. Under the Act, dependency is defined as a condition interfering with health of mind or body and capacity to earn a livelihood, undertake other normal

activities or engage in ordinary relationships. Drug dependent persons may be formally admitted to treatment centres located at certain government hospitals that provide facilities under the Tasmanian Mental

Health Services Act. Admission is by:

* voluntary application;

* application from a relative or welfare officer;

* court order made on conviction for any offence which the court is satisfied was committed under the influence of any drug or as a consequence of drug dependence from which the person is still suffering (the convicted person's agreement is not required, and the order must specify the maximum detention period, which may be for a period of up to 2 years); and

* court order if drug dependency manifests itself during a term of imprisonment.

All admissions other than voluntary ones require the recommendation of a medical practitioner that the patient is suffering from drug dependence to an extent that warrants his detention for reasons of his/her own health and safety or in the public interest. Provision for

informal admission to such centres is also envisaged by the Act, but such persons are not subject to any detention provisions.

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Detention is for an initial period of 14 days followed thereafter by renewable 6-monthly periods of detention. All patients must be medically examined after 5 months of each 6-monthly period unless they voluntarily renew their application for admission. The patient may be detained for a further period of 6 months if the examiner deems it to be

for the good of the patient's health or safety or in the public

interest, with the exception of patients originally on voluntary application. For these patients, a new consent to detention must be obtained.

The courts also have the power to suspend a sentence on condition that the offender seeks, and gains, voluntary admission to one of the treatment centres. Under this condition, such admissions may, for a period of up to 3 years, be treated as if the patient was originally admitted on a medical recommendation (following application by a relative or welfare officer).

Other possible conditions are that the courts may release the offender under the supervision of a welfare officer for a period of up to 3 years following detention, and/or that the offender abstain from liquor or drugs during the detention and supervision periods. Any combination of these three conditions may be imposed. Of course, there are provisions to execute a suspended sentence if the offender fails to comply with the court's conditions.

During the past 9 years there have been in excess of three thousand referrals under the Tasmanian Alcohol and Drug Dependency Act.

It should be noted that not all persons referred for treatment are admitted, e .g ., if the offence is regarded as being a 1 one-off1 type of occurrence and the person is not considered to have a dependency problem, then the person may not be admitted.

No record has been kept of the number of referrals which have resulted in admissions to treatment.

There has been no segregation of statistics between those referred for alcohol problems and those with drug problems. However the Commission was told that there are very few referrals for drug problems. It was estimated that only 5 per cent of referrals would relate to drug problems.

1970--71 1971 — 72 1972- -73 1973- -74 1974- -75 1975- -76 1976- -77 1977- -78 1978- -79

80

177 307 426 440 502 507 351 395

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Other witnesses dealing with the role of the criminal justice system in relation to drug offenders were generally of the opinion that although detention might be desirable, or essential, a punitive approach did not work. It was considered that a treatment-oriented approach aimed at rehabilition was required.

Dr G . S. Urquhart, Director of Psychiatric Services, Queensland Department of Health, felt that detention of an offender was not the total answer to the problem-- the offender had to be brought back into the community and enabled to free himself or herself from the drug scene

(OT 2210). Dr Richard Clayer, Director of the South Australian Mental Health Services, believed that the success of treatment depended very much upon the personality of the individual. Accordingly, compulsory treatment for psychological dependence had little chance of success whereas a physically dependent person would have a good chance. At best, however, an enforced detention period of at least six weeks would probably be necessary (OT 7S47--49).

A number of witnesses expressed their concern about the

'contagiousness' of drug-dependent persons. It is thought that the longer a person remains addicted, and the longer the delay before he or she seeks treatment, the more people he or she is likely to 'infect'. For the community, therefore, it is important to determine the best way of eliminating the contagious influence.

In Brisbane, a medically qualified witness with considerable experience of drug dependence and rehabilitation pointed out that although drug dependence could be seen as an 'infection', unlike most ordinary infections it did not produce a natural immunity but, rather,

increased susceptibility. It was therefore not possible to rely on natural mechanisms to eliminate this infection from the community. The witness explained that there are basically two kinds of program for the drug dependent person: treatment-oriented programs and preventive programs. A treatment-oriented program for narcotics dependence

attempts to select people who genuinely wish to abandon illicit drug use. Methadone is sometimes prescribed but an attempt is made to keep dosages as low as possible. Most preventive programs, however, accept,

and attempt to hold, all heroin addicts on a supervised methadone regime. Such programs prescribe dosages that do not tend to drive the addict back to the illegal scene. Thus higher dosages are used in preventive programs. If addicts wish to reduce their intake of

methadone this is encouraged, but not if the addict wishes to drop methadone to return to heroin.

The witness described his experience in drug dependency centres in England and Brisbane and told the Commission that in recent years the policy of the Brisbane centre had moved away from a treatment-oriented approach towards a preventive approach. Before the preventive approach was adopted in March 1977 the average delay before addicts came forward

for treatment was more than 4 years, but by the end of 1977 the delay had been reduced to only 1.94 years. If delay in seeking treatment is equated with 'infectiousness', it could be expected that the preventive approach would lead to fewer new addicts in the community. He believed

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that liaison between the drug centre, the police, magistrates, and probation services was important, and thought that the main role of the police should be to flush addicts towards a treatment centre; the role of the magistrate should be to make use of strategies such as suspended sentences with long periods of probation that included a requirement to attend a supervised methadone program. The role of the drug centre should be to provide extensive programs that could take all existing addicts and supervise each and every daily drug dose. This kind of policy could quickly deprive the illegal drug scene of its entire

clientele.

This witness .favoured suspended sentences for drug users but saw some value in long sentences in the right circumstances-- not as a punitive measure but to prevent the offender adopting a criminal lifestyle and spreading drugs in the community. A hospital setting would do just as well as prison provided the drug addict was kept away

from his illegal activities. He thought imprisonment should not be used in a trivial way. The philosophy of the Brisbane centre is that

rehabilitation is important for the individual but prevention of infection of other members of the community is important for society.

The Australian Medical Association also submitted that prevention of illegal trafficking and use of narcotics could not be separated from the treatment of victims, i.e., addicts. It was suggested in this

submission that the police seemed to be under an obligation to obtain arrests and convictions of drug users but that this did not prevent addiction spreading (OT 14966).

Mr B. J. Unsworth, presenting a submission on behalf of the Labour Council of New South Wales, whose membership he said was in excess of 1 million, told the Commission that the trade unions see a distinction between the addict, the user and the trafficker. There was a belief that drug addicts should be treated in institutions similarly to alcoholics (OT 16458, 16484). The Council’s twelfth Recommendation was that:

Employers and Unions should be encouraged to join forces in providing assistance to employees who are unfortunate enough to become involved in the use of drugs.

Drug users should not be stigmatised but should be recognised as sufferers of a contemporary disease which can be cured with sympathetic and understanding treatment and help. (OT 16481)

This Commission also noted that the South Australian Royal Commission into the Non-Medical Use of Drugs did not advocate compulsory treatment.

Dr R. J. M. Dunlop, President of the NSW Branch of the Australian Medical Association, thought that the drug addict and the trafficker

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should be removed from the criminal jurisdiction, and that special courts should be set up to deal with offences of this kind. He felt that, apart from the large-scale operations, which was another matter entirely, criminal jurisdiction had no part to play in the drug problem

(OT 12062). He had been told by patients that the prison environment was as destructive to this type of offender as the drug scene, that no attempt was made in the prison system, at least in New South Wales, to rehabilitate the drug offender, and that many prisoners, women

especially, were given large amounts of psychotropic drugs and tranquillisers in prison (OT 12062). Dr Dunlop added that he did not oppose the detention of drug offenders but they should be given a chance of rehabilitation away from criminal influences. He suggested that a

special section might be added to the Mental Health Act authorising admission of offenders to particular institutions for a specified period, to be followed by a mandatory parole period of three years (OT 12063--64) .

THE NEW SOUTH WALES DIVERSIONARY PROGRAM

However, evidence given to the South Australian Royal Commission into the Non-Medical Use of Drugs by Mr A. P. Diehm, Director of the Central Drug and Alcohol Advisory Service of the NSW Health Commission, and incorporated into the transcript of this Royal Commission, stated that initiatives had been taken in New South Wales to improve the

situation. The evidence described a diversionary program at present operating from a number of magistrate's courts in New South Wales. The Commission was told by Mr Diehm that the program-- which is not backed by legislation-- was instituted because of the State Government's

concern to remove the addict, the convicted offender, out of the penal system and into the health care system. The program was intended to meet that need. Any person convicted on one of the selected counts of use of drugs, other than marihuana, is eligible to enter the program (OT

9704). The philosophy is to offer treatment as an alternative to penalties.

The program is based on a remand period of short duration (usually eight weeks). The offender is directed by the court to attend the Bourke Street Drug Advisory Centre at 103 Bourke Street, Surry Hills and is released on bail to allow him to comply with the direction. The

initial step at the Centre is a one to two hour assessment, which consists of an interview by two counsellors, to obtain a full social and psychological history from the offender and a medical assessment. At the time the evidence was received the staff at the Centre consisted of

13 persons-- one psychiatrist, two psychologists, three social workers, three nurses, one general medical practitioner, and three drug counsellors. The two persons making the assessment could be any of these.

At the end of the assessment the offender is informed of the

treatment considered most appropriate in the circumstances. If detoxification is required, the options are:

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* hospitalisation-- inpatient withdrawal in one of the seven or eight hospitals in the Sydney Metropolitan Area having the required facilities;

* home withdrawal but maintaining daily contact with the counsellors who will arrange medication (excluding methadone) if necessary;

* methadone withdrawal over an eight week maximum period;

* acupuncture;

* hypnotherapy; and

* herbal medicine.

Methadone maintenance and methadone blockade are not recommended.

The offender then has the choice of accepting or not accepting the recommendations. At the conclusion of the eight week remand period a report is made to the offender's probation officer, explaining the nature of the person's drug problem, his or her response to treatment, and whether any further treatment is recommended.

The offender then makes a further appearance in court. The

Stipendiary Magistrate has a number of options from which to choose after consideration of the report of the treatment agency. The remand period may be extended for a further eight weeks or the offender may be unconditionally discharged or discharged on a bond, a condition of which is the continuation of treatment. It is expected that leniency will be shown if the defendant is satisfactorily undertaking the treatment program (OT 969S--96).

Whilst the Commission received evidence that no comparisons have been made of penalties before the program was instituted with present penalties, for those who undertake the program and those who do not, evidence received from another source indicated that:

There are magistrates who do not give serious weight to the reports received from the drug diversionary program concerning the performance of the remanded offender in the program. There are instances where, for the same offence, an offender who was referred to the drug diversionary program and failed to make any use of it, received a lighter sentence than an offender who made full use of the program.

(CT)

The program is conducted, as stated earlier, only in Magistrates' Courts. This is due to the fact that the program is aimed at persons whose main problem is drug use. It is considered that such persons will be found in Magistrates' Courts rather than in higher courts. Whilst persons who appear in the District Courts may have a drug problem, they

are predominantly 'pushers' and traffickers involved on a substantial scale and charged with indictable offences. However, an arrangement

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exists with the officers responsible for corrective services that on release from prison (if imprisoned) offenders can continue, at either a hospital or a community centre, any treatment program they may have started in prison (OT 9707--08).

Mr Diehm told the Commission:

The advantage of the diversionary program operating in a court is that it is universally applied to every addict charged, and it doesn't depend on the discretion of the magistrate, whether the opportunity is offered. The important things that make the program successful in relation to the first court appearance is

that on at least three occasions before the person gets into the court the details and implications of this program are explained to him first by the duty solicitor at the court, secondly by the probation officer, and thirdly by a police officer who may or may not be the prosecutor and, at the courts where it applies, the magistrate has an obligation when a

person either pleads guilty or is convicted, to ask him has he been told of the program, does he understand the implications? If he doesn't then the magistrate explains from the Bench and then gives him the opportunity to make the choice.

(OT 9709)

However, evidence given by another witness was to the effect that:

Many magistrates simply do not refer offenders to the program, and even those who do, do not seem to do so systematically. (CT)

Only a small proportion of persons receiving treatment for drug offences come within the formal diversionary program. Criticism has been levelled at the application of the program at only a few selected courts, with suggestions that it should be extended to other courts so

that drug offenders appearing at those courts are not seriously disadvantaged. As explained earlier, the program has no legislative base. Accordingly, the opportunity is always present for the magistrate to remand a case for an assessment and report on the offender, in much

the same way as he or she would if participating in the formal

diversionary program. The evidence did not suggest that this was a frequent occurrence (OT 7083).

Similarly, addicts charged with other crimes closely related to drug offences, but still dealt with in the Magistrates' Courts, cannot come within the terms of the diversionary program. Nevertheless, the magistrate has the same opportunity to act as stated above (OT 9698).

The Commission also received evidence that the police should have formal powers which would enable them to direct offenders to a treatment centre rather than arresting and charging them. If the person did not comply with that direction, then an arrest and charge would be in order.

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The magistrate has to use his own discretion in deciding whether the fact that an offender is an addict should be taken into

consideration when determining penalties. On the whole, Mr Diehm thought this should not be taken into consideration because it gave offenders an opportunity of claiming to be addicted in order to mitigate sentences. He pointed out that the question of addiction was never raised in court during proceedings for a drug use offence; if the defendant was convicted he was eligible to join the program, whether dependent or not. Methadone was offered only to those known to be addicted to narcotics, and the use of Narcan-- a narcotic antagonist---had been introduced in many centres to determine whether there was physical dependence (OT 9706--07).

Mr Diehm said it had been suggested that drug users should not be criminally charged with possession of drugs simply to feed their dependence, but he felt that the criminal justice system had an important role in possession offences because it brought into treatment programs persons who would not otherwise have made contact (OT 9700-­ 9701). Transgression of the civil liberties of drug users was an

important matter for consideration, Mr Diehm said, but there seemed to be no clear-cut answers. However, in spite of some objections before the diversionary program was launched, its success appeared to have reassured most critics (OT 9697).

The Chairman of the South Australian Royal Commission into the Non­ Medical Use of Drugs, Professor Ronald Sackville of the University of New South Wales, said, during hearings of that Commission, that the diversionary program seemed clearly to be a considerable advance on the previous system where the drug-dependent person could find himself in

gaol, which did the offender, and perhaps the community, no good. However, he added, there was a dilemma for the courts. Under the diversionary program they might appear to be a channeling agency for a treatment program, and some lawyers or judges might take the view that this was inconsistent with their judicial functions of ascertaining guilt and imposing appropriate penalties (OT 9696--97).

Evidence given by Mr B. D. Stewart, Secretary of the New South Wales Drug and Alcohol Authority, in final hearings in Sydney on 14 August 1979 indicates that such problems have indeed arisen (OT 23415--27). Mr Stewart told the Commission that the success of the program had

fluctuated, and that it was not operating as it should for a number of reasons.

It was felt that the courts were playing too important a role in the treatment process. For the program to function effectively, Mr Stewart said, it was essential to have central assessment facilities, which determine the best treatment for each person at the time that he or she joins the program, segregrated from both the courts and the treatment

facilities. However the Commission received evidence indicating that these central assessment facilities have not functioned as intended owing to government cut-backs in staff and community health resources. A consequence of these fluctuations was a fall in the level of service provided. The magistrates then began to doubt the adequacy of the

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assessments being made, while the medical personnel were unable to see any more prospective clients. Clearly, there is need for adequate and stable staff levels to improve staff morale, ease the task of

management, and thereby achieve the best possible services for clients. Mr Stewart believed that the judiciary were very willing to co-operate since they realised that it was pointless to continue committing offenders to the penal system, only to have them reappear again on

similar charges. Mr Stewart said it was acknowledged that treatment facilities in penal institutions in New South Wales were totally inadequate. Also, the prison environment was conducive to continued drug-taking behaviour when the offender was released. However the judiciary needed to have confidence that the diversionary program was achieving its aims. Mr Stewart added that there was need for adequate and diversified treatment facilities.

Another problem mentioned by Mr Stewart was that some influential treatment agencies have recruited clientele from the courts and claimed that they were participating in the diversionary program, which was not the case. It was clearly stated when the diversionary program was set up that central assessment and central treatment facilities should be available, but certain agencies have been by-passing these facilities. A representative of a treatment agency outside the diversionary program will interview an accused person and then appear in court saying that

the agency believes it can help the accused. The ruling of the court may then be that the offender will not be sent to prison providing he or she undertakes the treatment offered by that particular agency. The result of such actions has been to make it practically impossible to

determine the efficacy of the diversionary program. This problem could be resolved if the program was formalised to such an extent that no court would entertain such a plea on behalf of the accused until the central assessment had been made.

Management of the diversionary program has also posed a problem because of shortages of staff and resources to provide the necessary administration. Mr Stewart also believed that there was a need for the roles of the judiciary and the legal system in general to be reduced and

for more control to be given to the central assessment agencies and to probation and parole personnel.

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Cha p t e r 5 C onclusions and Recom m endations

:o n c l u s i o n s

The man in the street would say that there are two important reasons for spending public money to treat persons dependent upon heroin:

~ 1 curing' the person of his dependence so that he functions as a useful member of society; and

" reducing the market for drug traffickers.

The popular view is that treatment will cure a person dependent upon heroin just as a doctor will once and for all 'cure' a cyst by removing it surgically. The evidence the Commission received shows that treatment is not so simple in its application and not so successful in

its outcome.

A number of general matters established by the evidence must be borne in mind when the question of treatment for drug dependence is considered.

First, although drug dependence may be described as a medical condition it is a complicated condition with physical and psychological aspects. The physical factors involve the body’s development of tolerance to the drug and the resulting requirement to continue taking the drug to maintain the new equilibrium that has been set up in the body. The psychological aspects involve a host of factors both internal and external to the drug dependent person. Personality, unhappiness, loneliness, domestic stress, lack of self esteem, unemployment, anti­ social attitudes and availability of the drug are among the many factors that contribute to a desire to continue taking the drug. The physical

factors of drug dependence can be overcome with relative ease, but the psychological factors are far more difficult to eradicate. The return by a person from treatment, during which he has lost his physical dependence on the drug, to his old environment more often than not

results in a relapse into drug taking.

Secondly, the Commission has concluded that it is most exceptional for a person to seek treatment without some form of external compulsion. The Commission endorses the thrust of the evidence of Dr J . Gabrynowicz which was quoted earlier that 'voluntary treatment of addiction is a myth; it doesn't exist'. The Commission agrees with Dr Gabrynowicz that whether coercion comes from the courts, the police, a wife or a friend,

a coercive element is necessary to push a person into the therapeutic situation. The same coercive elements can then be used to keep the person in a treatment situation.

Thirdly, the community must adopt a rational attitude towards the illegal drug users and what treatment may be able to do for them. The community is more Familiar with the problems of alcohol. The community

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overlooks alcoholism provided the alcoholic functions reasonably well. Once he fails to do so, the community views him with a mixture of pity and contempt which reaches its clearest expression towards the alcoholic derelict in the park. The alcoholic must be assisted long before he

reaches this stage of dependence. A similar approach must be adopted to the abusers of other drugs, both legal and illegal, although the community must realise that dependence in its worst forms will be exhibited much more quickly with narcotic drugs than will the worst form of alcoholic dependence.

The community's attitude to illegal drug users must also reflect the consideration that most illegal drug users spread the use of illegal drugs. Whether to help a friend or make a little money, most will distribute drugs on which they are dependent. This distribution makes more drugs available to other people for experimentation and some of

those people who experiment with the drugs will become dependent upon them. In the Commission's view this important consideration has not been sufficiently taken into account by a large number of well-meaning people who have adopted too sympathetic an attitude towards the victims

of illegal drug use. On the other hand there are people in the

community who have taken too punitive an attitude towards illegal drug users. The aspects of drug dependence to which the Commission has referred should make it obvious that it is counter-productive to put drug users whose only criminal activity lies in breaking the user laws against drug abuse, into prisons.

The community should also recognise the limited success of treatment for confirmed drug abusers. For lesser users it is likely to be much more successful. Society should encourage the genuinely drug-dependent person towards treatment and rehabilitation but should maintain the

sceptical reservation that tinges society's optimism towards the rehabilitation of advanced alcoholics.

The Royal Commision into the Non-Medical Use of Drugs, South Australia, in its final report, pointed out that it had been struck by the reluctance of Australian treatment agencies to state specific goals in treating drug users. The Commission said:

Agencies which emphasise the need to evaluate services are content to put forward objectives in such vague and

unmeasurable terms as 'improving the state of the patient'.

In formulating goals a distinction must be drawn between the kinds of drug users who present themselves for treatment. For example, the objectives in treating an experimental drug user who suffers acute short-term effects from his drug taking are

different from those in treating a multidrug user with a long history of addiction. For the first type of patient the circumstances may suggest that he is unlikely to misuse drugs again. For the second type of patient, experience suggests that the objective may be more difficult to state.

(Open Exhibit 586, p. 167)

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In Recommendation 12 of their Chapter on Treatment, that Royal Commission said:

All treatment services should state goals and be subject to evaluation. The goals stated should take full account of the difficulties, in treating addiction, of achieving abstinence from drug use or even the more modest objectives of improved social functioning. Evaluation should also recognise these difficulties and should not be used to assess results except by

carefully constructed studies. (Open Exhibit 586, p. 213)

This Commission finds itself in agreement with that recommendation. It is desirable that each treatment service should state what it aims to achieve. While abstinence from drug use remains the ideal, this is a goal not realistically attainable for the majority of drug dependent persons in either the short or long term. There is no convincing evidence that there is a final 'cure' for drug dependence; most often it

is a relapsing condition, requiring continuous monitoring. Drug dependence is a complex phenomenon that affects the physical, psychological, and social Wellbeing of the individual, and can also damage the structure of society. Treatment and rehabilitation should aim at remedying or at least lessening these adverse effects. A

treatment service which states modest aims may be more realistic and more deserving of support than one which sets its aims too high.

The factors causing the initial demand for the drug, and the subsequent psychological dependence exceed the problems associated with physical dependence. A distinction must be drawn between the treatment of the short-term effects and treatment of the disease. In most cases

the removal of the psychological dependence will be the most difficult step. The drug dependent person will usually not admit that his or her drug use is a problem. For the individual, treatment should initially be aimed at overcoming the psychological problems, the circumstances that provoke the initial demand for the drug, bearing in mind that treatment should not only aid the individual but society also.

Recognition of the differing modalities of treatment which may be available and the undoubted fact that a program beneficial for one person will be useless for another makes the Commission conclude that chance presently plays too great a role in the selection of the

treatment program that a person undertakes. The Commission has seen many occasions where people have undergone, without any preliminary assessment, program after program before finding one which benefits

them. This is too wasteful of existing resources. The importance of making individual assessments before any course of treatment is begun cannot be too strongly stressed. All too often the course of treatment undertaken by a drug dependent person is determined solely by the agency he approaches and the services it offers. Assessment by competent professional staff at an independent referral agency is essential if a

rational use of existing resources is to be made. The independent referral agency will have to have a good knowledge of the treatment facilities which are available at different geographical locations. At many places, the variety of treatment facilities available is limited

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and the services provided are inadequate to meet the demand. There is a need to expand the number and variety of facilities available in many areas in Australia. The only sensible way to satisfy this need is by the use of an independent referral agency to which the deficiencies of services and facilities will be readily apparent.

The Commonwealth Department of Health gave, through its officers, comprehensive evidence to this Commission on the question of treatment generally. That Department also made a very comprehensive submission to the Royal Commission into the Non-Medical Use of Drugs, South Australia. This Commission accepts that evidence of the Department and considers that the following facilities should be available to all in need:

detoxification facilities: a step towards rehabilitation;

narcotic maintenance clinics;

long term residential facilities for those undergoing rehabilitation and requiring intensive physical and psychological care;

short term residential facilities for those requiring care for short periods following detoxification, or when relapse to former drug­ using style appears imminent;

out-patient rehabilitation facilities;

emergency accommodation;

24-hour counselling to aid in crisis intervention;

family support;

information centres/shopfronts to provide information, counselling on drug use and legal advice to drug users and others concerned with drugs;

drop-in centres where drug abusers can obtain counselling. This should perform the function of an open door for entry into any treatment regime. It is important to attract drug users to

treatment programs in the early stages of misuse; and

outreach programs to reach those unaware that help is available or unwilling to seek help.

The Commission notes that Recommendation Four in the Chapter on Treatment in the Final Report of the Royal Commission into the Non­ Medical Use of Drugs, South Australia demonstrates that that Commission reached almost identical conclusions as does this Commission.

Greater co-ordination will be required if the best use is to be made of existing treatment facilities and if money is to be used prudently in developing further treatment facilities. The only practicable way of achieving this co-ordination in the Commission's opinion is for the Health Department in each State, by a special section, to effect this

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co-ordination. That special section should also require the agencies offering treatment programs to state what the particular program aims at so that the achievements of the program can be monitored and its success evaluated. This will permit adjustments to that program and may suggest that adjustments should be made to other programs. Treatment programs may realistically aim at a number of worthwhile goals, including:

* abstinence from all drugs;

* abstinence from narcotics;

* decreased mortality rate;

* decreased anti-social behaviour, e.g. criminal activities;

* improved physical and mental wellbeing;

* an improved self image;

* social and emotional stability;

* improved employment status; and

prevention of 1 infection1 of others.

The priorities which come to mind when considering the most

appropriate course of action for treating drug dependence are that the drug user must receive treatment which renders him harmless to society, and he should be rehabilitated to play a useful role in society. The interests of society are of the greatest importance. Society's best

interests are served by containing the spread of drug abuse. Reduction in the demand for illegal drugs will be a consequence of successful treatment.

There are a number of ways in which the spread of infection of drug abuse can be contained, some of them more Draconian than our society might presently permit. Drug addiction has been likened to an

infectious disease. Enforced isolation of persons with certain infectious diseases in this country meets with no public resistance, but the public is unlikely to support enforced isolation of drug dependent persons as a matter of course. At the present time, therefore, drug

dependent persons remain free to 1 infect1 or 'reinfect1 others, as indeed many have to do in order to support their own dependence needs. This aspect of illegal drug use is particularly important when treating drug dependent persons. Endeavouring to rehabilitate illegal drug

abusers while they remain in their old environment is a real obstacle to success in treatment.

A further way of reducing the spread of drug abuse would be to

contain or reduce the demand for drugs in the illicit market. It is believed that both methadone maintenance and isolation programs decrease the demand for illegal drugs. The dilemma of narcotic maintenance

arises in this context. While the substitution of one narcotic for another can in no ,way be construed as treatment for opiate dependence,

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the provision of a narcotic to a physically dependent person may be a means of containing his or her drug dependence and providing an

opportunity for the eventual rehabilitation of the person. Certainly, if persons receiving drugs from a government clinic refrain from seeking other drugs, then their ability to infect others is decreased as they no longer need to traffick drugs to feed their own habit. This observation would seem to favour use of the high dosage methadone maintenance as

recommended by the National Health and Medical Research Council (NH & MRC) .

Maintenance programs, even when abused, do produce decreases in drug-related crime such as burglary, prostitution and drug trafficking. Premature withdrawal from narcotics or inadequate dosages of methadone tend to produce other dependencies and multi-drug use. Alcohol figures prominently in these instances.

If true physical addiction has been established on examination, narcotic maintenance should be considered as a possible form of treatment, but not otherwise. The question of providing maintenance must be considered in the light of the benefits accruing to society and

to the individual to determine whether they are sufficient to justify the risks inherent in supplying the drug. If provision of maintenance is likely to achieve worthwhile goals that are not possible with any other treatment regime, such as decreased mortality, narcotic maintenance is to be recommended.

If narcotic maintenance is deemed the best course of action in the short term, then it should be administered in conjunction with other forms of treatment that aim to resolve the psychological dependence: counselling, psychiatric consultations, etc. When an addict is no longer subject to the stress of having to obtain illicit supplies he is sometimes motivated to voluntary withdrawal. Maintenance programs also enable those providing treatment to maintain contact with the drug dependent person. This allows them to offer different forms of aid and to encourage patients to accept other treatment.

While it is realised that narcotics maintenance programs could utilise a number of narcotics, it is not considered that the present practice of prescribing only methadone syrup should be changed. Certainly, intravenous administration is not favoured.

Controls on the prescription and administration of methadone urgently require to be tightened and enforced especially in relation to the prescribing by general practitioners of methadone in tablet form. A positive aid to tightening existing controls would be to maintain a

central register of persons receiving methadone maintenance treatment.

Many of the points raised concerning methadone consumption are incapable of solution at this time. The dilemma of methadone and pregnancy is one such example. Another example is the possible adverse effects of methadone on a person's psychomotor functions. Any such

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effects should be carefully researched since it is not advisable for persons with impaired psychomotor functions, resulting from methadone consumption, to be in charge of mechanical equipment. The 1 natural experiment' concerning methadone availability in Townsville, Mackay and

Rockhampton, mentioned earlier in Chapter 2 of this Part of the Report must also be closely observed.

It is clear that the needs of treatment staff must be better catered for if the efficacy of treatment programs is to be improved. It is believed that morale and productivity of treatment staff would improve if specialist recognition were given to work in this field. Career prospects for professionals entering the field are not good. It is felt

that the needs of both staff and clients would be better served if the treatment of drug dependence were made an integral part of the general health care system in this country, staff being provided on a rotational basis following their completion of suitable specialist training.

The establishment of a career structure in the area of drug

dependence would motivate suitably qualified staff to enter this field. It is a relatively unrewarding field, and staff experience great emotional stress. Rotation would help to preserve their work

satisfaction. Such a system would also provide a pool of suitable personnel to be drawn upon should urgent demands arise.

Use of specialist consultants would also be advantageous. It is also felt that such a system could have some application to drug dependence centres conducted under the auspices of voluntary organisations. Medical practitioners wishing to participate effectively

in this specialist area should undertake appropriate training courses.

It is apparent that there is no uniformity of approach among the States and Territories, but there is need for consistency, not fragmentation. A better system of communication between all agencies, government and voluntary, for reporting treatment successes is urgently

required. Co-ordination and co-operation between all bodies concerned with drugs must be fostered.

The only State in which compulsory treatment is used is Tasmania. The Commission believes that the Tasmanian experience should be carefully monitored. In other places where there is legislation permitting compulsory treatment, there has been virtually no recourse to

that legislation. The subject of compulsory treatment is a sensitive area because it involves questions of civil liberties. The Commission regards a system of compulsory treatment as preferable to using gaol for persistent offenders. The South Australian Royal Commission recommended

the repeal of the South Australian legislation which permitted compulsory treatment. As the Commission has already remarked, it is of the view that some coercive element is nearly always necessary to bring a person to treatment. It does not regard a court order as the most appropriate form of coercion in all cases. The Commission is of the view that a more rational approach to illegal drug use might cause the

family and associates of the illegal drug user to furnish the necessary

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coercion in more cases than presently occur. The Commission is also of the view that a satisfactory diversionary scheme will furnish sufficient coercion in most other cases.

There remains however the problem said to be created by the

incorrigible illegal drug user. The Commission is presently unable to say, such is the dearth of useful statistical material, the extent to which incorrigible illegal drug users constitute a problem in Australia. It is hoped that the work of drug information centres of the kind that

the Commission elsewhere recommends will remedy this deficiency. If it is demonstrated as a result of this work that a sufficient problem does exist because of the number of illegal drug users who have continually failed to respond to any treatment program, this Commission would not shrink from recommending that a form of compulsory detention outside prisons be instituted for such persons. Although gaoling such persons

provides no solution it may come to be rationally demonstrated that national efforts to treat illegal users can only be successful if there is a power to detain these persons for a limited time in a drug-free atmosphere.

Suggestions were made to the Commission that places of isolation should be farms or facilities formerly used for national service training. The Commission obviously cannot reach any conclusion on what type of facilities should be employed as it cannot presently even reach a conclusion that compulsory treatment in any type of facility is necessary. The fact that some States have legislation for compulsory treatment but do not use it suggests that the legislation has preceded the availability of proper facilities or the identification of a real need for compulsory treatment. The Commission can only conclude that the matter should be kept under review. The Province of British

Columbia, which has had a serious heroin problem for some years, is setting up a system of compulsory treatment and attention should be paid to the success that that system may have.

A system of referring drug abusers to treatment centres following an appearance in court is certainly instrumental in bringing the user into contact with those able to provide assistance, whether or not that assistance is accepted. The Royal Commissioner into Drug Trafficking in New South Wales, Mr Justice Woodward, in his Report (October 1979), at p. 1552 discussed the diversionary program which has been operating in

that State. That scheme had grown out of a diversionary scheme for persons charged with driving motor vehicles under the influence of liquor.

Mr Justice Woodward pointed out that defects in the operation of the scheme were probably attributable in part to a lack of planning and a lack of expert knowledge in drug diversion programs. As a result 'the original objectives were at best clouded and uncertain'. He said:

The scheme was to apply to persons subject to a Court referral, and to persons who, independently of any Court proceedings, volunteered for the treatment.

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Investigations of the scheme and its operations have been hampered by the lack of authoritative documents concerning its design and objectives. In the absence of appropriate

documentation, it seems likely that appropriate guidelines for the operation of the scheme were not fixed and that both design features and ultimate objectives were undetermined. The development of the scheme has been largely on an ad hoc basis.

(Open Exhibit 687, p. 1557)

At page 1588 and 1589 of his Report, Mr Justice Woodward said:

I am forced to the general conclusion that the present

diversion scheme is inadequate in conception and operation.

The following are some of the causes of this inadequacy:

1. As discussed the programme has always lacked a

sufficiently defined set of guidelines and objectives.

2. The period of eight weeks intended as a treatment period is far too short for any significant progress to be made in treatment.

3. The major programmes are of an outpatient nature with a drug free objective. Any ambulatory programme of this style must gain a significant proportion of the addict's attention in competition with his suppliers and his peers

in the drug sub-culture. Unless it does he is unlikely to be rehabilitated socially or in employment. I doubt whether such a programme has anything to offer to persons with major problems of addiction.

4. In any case the provision of therapy or care is at a very low level and contrasts most markedly with other

established programmes. The level is quite inadequate when confronted with a chronically remitting addiction problem where redemption can be expected to take many months or even years.

5. Attendance of persons diverted to the programmes, viewed generally, is quite unsatisfactory. It is as if the word has spread that the offender does not have to bother and the average one does not. The programme has no provision made for treatment or treatment failures.

6. The programmes attempted, mostly counselling of an

unspecified type, are not so much vague and ill-defined as unknown. So is any effect they might have on the course of addiction.

7. The programmes are incapable of audit. This, perhaps, is not of critical importance because they could not be considered likely to achieve measureable results.

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8. There seems to have been a communications breakdown

between some therapists and the Courts. A number of therapists made either no reports at all to the Courts or merely perfunctory reports. This seems to have been because of some misplaced view about therapist-patient

confidentiality.

In the context of a scheme which by fundamental design remands persons charged on a pre-sentence basis for assessment, the failure to provide assessments defeats the whole purpose of the scheme.

9. This latter observation brings me to my fundamental conclusion about the scheme-- namely, that, of necessity, limitations were placed upon it by its administrative context.

(Open Exhibit 687, pp. 1588--89)

Mr Justice Woodward went on to review a scheme suggested in a submission made to him by Senior Counsel Assisting the Commission, but in the event His Honour rejected the submission that a 1 new diversion scheme' should be established. His Honour pointed out that Dr James G. Rankin, Director of the Division of Drug and Alcohol Services, Health Commission of New South Wales, who gave evidence before that Royal Commission on 17 August 1979, had identified the following requirements for a diversionary program to have any chance of success:

1. There must be agreement on the objectives of the programme and determination of what is sought to be achieved.

2. An effective management framework must be established.

3. There must be developed an assessment process that can provide useful reports to the courts and also serve as the basis for the treatment recommendations.

4. An appropriate range of treatment options must be

available, such as methadone with control, methadone maintenance, narcotic antagonists or a therapeutic community, leaving it to the discretion of the person to choose the treatment.

(Open Exhibit 687, p. 1595)

Mr Justice Woodward did not recommend the abandonment of the present drug diversion scheme. Indeed he endorsed the idea that Dr James Rankin should continue with the pilot scheme he had under consideration with a view of developing a State-wide drug diversion program.

While accepting that there are the difficulties which Mr Justice Woodward found in the New South Wales scheme, this Commission believes that a drug diversion scheme should be developed for illegal drug users throughout Australia. It believes that it will be essential for any scheme to have legislative backing and the ready assistance of an independent referral agency. This should be the same independent referral agency that has been earlier mentioned in this Chapter. The

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concept of a drug diversionary scheme is consistent with the

Commission's view that imprisonment of drug offenders should be seen only as a last resort as detention with hardened criminals is

undesirable. On the other hand, real criminal activity, even though it is drug-related, must be treated as criminal activity. It is important that persons sentenced to prison for criminal activity should have proper treatment available for the period of their detention. The

diversionary program takes advantage of the coercion which the appearance before the court provides to the drug dependent person to enter a treatment program.

There is an urgent need to evaluate all treatment regimes to determine the effectiveness of the methods used and the efficacy of the programs. A standardised system of record-keeping is essential to facilitate these evaluations and also to make comparisons of the success

rate of different organisations. If government funding of voluntary organisations were contingent upon continuous evaluation of programs and the subsequent reporting of results instead of the total absence of any

system, as at present, there would be greater co-operation and co­ ordination of effort, rather than duplication of mistakes. It would seem that at present voluntary organisatons expend much of their resources in competing for clients.

Opinions have varied on the desirability of maintaining a central register of drug dependent persons. The Royal Commission into the Non­ Medical Use of Drugs, South Australia noted the importance of developing a cumulative case register for research purposes although that

Commission pointed out that this was not the same as calling for registration of addicts in order to regulate their activities more effectively. In recommending that treatment records be kept

confidential Mr Justice Woodward accepted that exceptions had to be made in favour of agencies supervising health legislation.

In the opinion of this Commission, it will be essential to retain a record at a central place in a State of the treatment history of persons who have received treatment for drug dependence. Unless this is maintained there will never be any possibility of properly evaluating

the success of treatment programs because it will not be known whether the person treated at a particular program was undergoing treatment for the first or fifth time. The only argument against the monitoring of records of this kind that the Commission sees as having any validity arises if material in them could be made public or become available to

the police. The Commission will therefore recommend that such a central registry be maintained. The information contained in it should be used only in relation to the further treatment of the persons mentioned therein, for the evaluation of treatment generally and for research. The police should not have access to this information.

The research efforts of other countries should be closely watched for promising developments in drug treatment and rehabilitation. In this area there is a need for research in alternative forms of drug-free therapy such as acupuncture and hypnotherapy, which have hitherto not received much attention. Follow-up studies in all areas of drug

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treatment are also necessary. There is definitely a potential for exploitation of the public by unscrupulous operators. For this reason the Commission believes that no person should be entitled to offer treatment for drug dependence unless the treatment methods have been approved by the special section of the Health Department earlier

referred to.

Voluntary organisations could play a larger role in the treatment and rehabilitation of drug dependent persons. Many users reject an orthodox medical approach, perhaps because they do not view their problems as a medical one. On the other hand, the Commission received no evidence to indicate that voluntary organisations lacked clients. Such organisations should be encouraged to review the facilities they provide at present.

RECOMMENDATIONS

The Commission recommends that:

** Steps should be undertaken to institute specialist training in the field of drug dependence for medical and non-medical professionals in the form of under-graduate, post-graduate, and in-course training.

** A system of staff rotation should be introduced into the general health care system to provide sufficient numbers of professional staff to work in this field.

** A special section of the Health Department in each State or

Territory should be set up to administer legislation dealing specifically with drugs of dependence. The Commission returns to this topic in Part XIV Chapter 5.

** All treatment services should be registered with a special section of the State Health Department and on such registration should state:

- the aims of the service;

- the facilities the service has.

Such statements should be kept up to date.

** Any treatment program that is, on balance, achieving some measure of success in terms of the goals previously stated should be continued.

** Public funding of treatment services should be made only after consideration of a recommendation thereon by the special section of the Health Department. * *

** a register should be kept in each State of all persons who have been treated for dependence upon narcotic drugs. The register should be confidential to the special section of the Health Department

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administering drugs of dependence legislation so far as the names and personal details of any dependent persons are concerned. As a data base it should be available to the State Drug Information Centre for research by it or at its direction.

** A special register should be kept of persons receiving narcotic maintenance to eliminate multiple supplying of maintenance doses.

** Voluntary organisations should be encouraged to persevere with and expand their efforts in the field of drug dependence. The statement of their aims and the evaluation of their success in achieving those aims should be seen by them as vital to their efforts.

** Encouragement to voluntary organisations should be in the form of financial aid contingent upon evaluation of treatment programs.

** Expansion of treatment services and facilities should be undertaken in a rational way so that as an ideal no one in Australia is too far geographically removed from:

- detoxification facilities;

- narcotic maintenance clinics;

- long term residential facilities for those undergoing

rehabilitation and requiring intensive physical and

psychological care;

- short term residential facilities for those requiring care for short periods following detoxification, or when relapse to former drug-using style appears imminent;

- out-patient rehabilitation facilities;

- emergency accommodation;

- 24-hour counselling to aid in crisis intervention;

- family support facilities;

- information centres/shopfronts to provide information, counselling on drug use and legal advice to drug users and others concerned with drugs;

- drop-in centres where drug abusers can obtain counselling. This should perform the function of an open door for entry into any treatment regime. It is important to attract drug users to treatment programs in the early stages of misuse;

- outreach programs to reach those unaware that help is available or unwilling to seek help. * *

** Recognising the importance of attracting drug users in the early stages, facilities such as information centres, drop-in centres and outreach programs should be encouraged. Facilities of this kind could well be sponsored by local government authorities or local community drug^ liaison committees: see Part XIV Chapter 7.

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** The widespread abuse of legal drugs, including alcohol, analgesics, sedatives, and tranquillisers, should be recognised and steps taken to attract persons abusing these drugs to treatment.

** The prescribing of methadone in ampoule and in tablet form to persons addicted to narcotics should be stopped immediately.

** Use of methadone as a preventive measure should continue in

accordance with the recommendations of the ΝΉ & MRC.

** It should be recognised that methadone is not a panacea for drug addiction.

** An independent referral agency should be appointed to:

- assess each drug dependent person and direct him to the most appropriate treatment service;

- make assessments and reports to the courts in the course of operating a diversionary scheme.

It it thought that the independent referral agency could be administered directly by the special section of the Health Department dealing with drugs of dependence to ensure a sufficient geographical spread of the independent referral agency's resources.

** A central authority should be set up to:

- monitor, evaluate and investigate treatment programs and report the findings;

- co-ordinate research carried out by treatment organisations;

- establish procedures and principles for evaluating programs;

- aid in the establishment of training programs;

- participate in the selection of organisations to receive government grants;

- publish regularly the findings it makes on the efficacy of treatment.

The Commission develops this recommendation in Part XIV Chapter 6.

** The States and Territories should legislate to set up diversionary programs for illegal drug users. The matter is considered in more detail in Part XIV Chapter 5.

** The desirability of compulsory treatment for incorrigible drug abusers be kept under review. To this end:

- the Tasmanian and British Columbian systems should be

monitored;

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National and State Drug Information Centres (if they are instituted as is recommended elsewhere) should be required to give priority to identifying any problem presented by

incorrigible illegal drug abusers.

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Part XI

D rug E ducation

1

Part XI Drug Education

Chapter 1. Objectives

Chapter 2 . Australian Programs

Chapter 3 . Target Groups

Chapter 4 . Role of the Media and Advertising

Chapter 5. Evaluation of Success

Chapter 6 . Conclusions and Recommendations

Education has been seen by well-meaning people as the panacea for all of society's ills. It is not surprising

that it was put by many people in the vanguard of the

battle against drug abuse. The evidence revealed that there has been a lot of confused thinking in the past

about what education can achieve in this area. Contention about the proper roles of the media, of advertising, and of schools has enlivened the debate. This Part considers the evidence the Commission took relating to the role of

education in controlling drug use and the efforts which have been made to evaluate success. The topics under which

the evidence is examined are self-explanatory.

The conclusions and recommendations of the Commission are set out in Chapter 6.

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C h a p t e r 1 Objectives

Effective drug education programs were proposed by many witnesses as a positive means to reduce the demand for licit and illicit drugs in the community. There was widespread support for drug education as a form of social control over drug use which would overcome the 'drug problems' of Australia. Some evidence suggested that certain types of drug education would lessen the supply of drugs, particularly the supply of licit

drugs. Educating the medical profession in the dangers of

overprescribing was an example of this. The predominant view, however, was that the demand side of the drug trade, both licit and illicit, was more susceptible to reduction through effective drug education than the supply side.

The assumption that knowledge of the possible consequences of drug use will discourage potential users commonly underlies the belief in the worth of drug education. This assumption was described by D. A. McCune in 'An Analysis of the Role of the State in Drug Education', his

1973 report to the United States National Commission on Marihuana and Drug Abuse, in the following terms:

The traditional rationale has been very simplistic: if an individual knows about the drugs and their harmful effects and if he understands fully the variety of social controls and punishments associated with the use of drugs, he will abstain

from using such substances in order to avoid the consequences. (Open Exhibit 39, p . 59)

This approach has its limitations according to some authorities. In their article 'The Concept of Prevention and Its Limitations', published in the January 1975 issue of the Annals of the American Academy of Political and Social Science (Open Exhibit 39), R. Brotman and F. Suffet of New York Medical College's Department of Psychiatry quoted McCune1s definition and pointed out that even when people accepted drug information as valid, they often discounted the risks. They saw this 'not me' syndrome as especially evident in cigarette smoking: the belief that harm will only happen to someone else. They maintained that drug information was sometimes disbelieved by its

intended audience because its source was not regarded as credible, that is, the source was seen as promoting 'official' moral values.

According to Brotman and Suffet, there may be a conflict between information offered in education programs and information received from friends or from personal observation, and this is especially harmful if the 'official' version is found to be faulty. Brotman and Suffet referred to the 'boomerang' effect of inaccurate information such as occurs in cases where some drug information is so exaggerated that all is believed to be false. A fourth limitation suggested was that drug education programs could stimulate rather than deter drug use and a study done by R. B. Stuart on the effects of one drug program was quoted to support that contention. Brotman and Suffet concluded that drug education programs faced the dilemma that distorted information could cause extra illicit drug use through a 'boomerang' effect while accurate

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information could induce extra usage by increasing drug knowledge and reducing fears about the harmful effects of drug use.

There was strong support in the evidence presented to the Commission for drug education but there was debate about the philosophy which should form the basis of a drug education program for the community as a whole. There was also some disagreement about the value of particular

education programs.

The South Australian Royal Commission into the Non-Medical Use of Drugs in its 1978 publication 'Education: A Discussion Paper'referred to the widespread public opinion it had uncovered that drug education was a key to the solution of the 'drug problem':

Indeed many who made public submissions to us saw 'Education' as a panacea... that present attitudes and practices relating to drug abuse were inadequate or inappropriate, but that

'Education' would in the long run prove to be the whole new solution to this 'problem'. It seemed that primary and

secondary school education was what these respondents mainly had in mind.

...it is clear...that the supply of licit or illicit drugs, being a more public activity, can to an extent be controlled by the law, the police and customs, or by the taxation and the health authorities. But the actual, personal use of a drug,

once it is in the hands (or near the hands) of a potential user is more open to informal social controls, which should be strengthened and encouraged by education and information in relation to the actual dangers of the various drugs.

(Open Exhibit 434, p. 25)

AUSTRALIAN PHILOSOPHY

Although not completely accepted, the most widely accepted expression of drug education philosophy in Australia is that embodied in 'The Philosophy of the National Drug Education Program', a Statement developed by the Drug Education Sub-Committee (DESC) of the National Standing Control Committee on Drugs of Dependence (NSCC). The NSCC is a

joint Commonwealth/State committee established in 1969 to co-ordinate a national approach to the drug problem. The DESC, whose membership is reviewed every two years, comprises Commonwealth and State health and education administrators and government and non-government members with

expertise in health, education, management and law enforcement. It first convened on 28 September 1970 after a meeting of Commonwealth and State Ministers on drug abuse on 24 April of that year agreed to

establish such a sub-committee to advise the NSCC on education matters relating to drugs generally and to integrate and co-ordinate nation-wide activities in drug education in the National Drug Education Program (NDEP).

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In its Philosophy Statement the DESC places drug education within a comprehensive health education format:

The Sub-Committee has developed a National Drug Education Program which aims at assisting all sections of the community and, in particular, young people, to develop healthy and discerning attitudes towards all drugs. A drug is understood to be any substance, that, when taken into the living organism, may modify one or more of its functions. It is believed that drug education is an important part of education and an

integral part of health education. (OT 20321)

The stress on drug education as part of overall health education is emphasised by the DESC in its stated aims of health education (OT 20322). Education about drugs ought to occur as a 1 continuing and developing process involving the family, the school, community agencies, working situations and society at large'. A measure of the effect of a health education program is the extent to which people's behaviour

changes. In the NDEP Philosophy Statement the aims of health education are stated as being to improve the quality of living by assisting communities and families to develop environments wherein the young can achieve optimal growth, to encourage people to develop lifestyles of benefit to themselves and others, and to help them adapt effectively to

these lifestyles as they mature and as changes occur in their

environments. Another stated aim of health education is to assist people to make decisions, based on the best available evidence, on matters affecting their health and behaviour which would be most beneficial to themselves and society.

The more specific aims of drug education in the Philosophy Statement dovetail with the above aims of overall health education. They are to assist people to:

* develop attitudes and behaviour towards the use of drugs which will be most beneficial to themselves and others;

* understand the variability in the effects of drugs and

combinations of drugs in different people and in the same person at different times and under different circumstances;

* recognise when they need help to cope with a drug problem and to know where they can obtain this help,and

* recognise the legal, medical and social implications associated with the use of drugs when making decisions about their own use of drugs. (OT 20322--23)

In dealing with the principles of drug education, the Philosophy Statement recognises that people seek to modify their mood and behaviour in a variety of ways and records that:

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* alternatives to drug use should be presented;

* it should be realised that risk-taking is an attractive aspect of the experimentation with and the use of drugs;

* information should be provided which individuals can build into their existing knowledge and experience and use to change their attitudes and behaviour;

* drug information should be presented in a variety of

different ways to meet the unique needs of individuals;

* familiar educational and social situations should be used to introduce drug education;

* programs should be presented which have sequence,

progression and continuity. (OT 20323--24)

Both the South Australian Royal Commission into the Non-Medical Use of Drugs and the Report of the Senate Standing Committee on Social Welfare (1977) appeared generally to support the NDEP Philosophy. The South Australian Commission in the publication 1 Education: A Discussion Paper' (Open Exhibit 434) agreed with most educators and public health

administrators that in the general public interest, or for reasons of effective teaching, drug education should be part of general health education programs. Education should be for the whole community, not just for schoolchildren:

There seems no reason why all self-conscious levels of a rational society cannot seek to become 'educated' to a greater knowledge of drugs and their effects and in the social and psychological processes by which people take care of themselves

and influence the behaviour of one another. Then in time they should be able rationally to direct or tolerate their usage of all drugs and minimise any accompanying disadvantages. (Open Exhibit 434, p. 12)

In its 1977 report entitled 'Drug Problems in Australia-- an intoxicated society?', (Open Exhibit 379) the Senate Standing Committee on Social Welfare concluded that informed evidence it received supported the NDEP view that drug education should be aimed at broad-value education rather than at one specific form of behaviour. The Committee

recommended that all drug education programs should be evaluated against the stated aims of the NDEP and the community should be made more aware of the objectives of the NDEP.

The South Australian Royal Commission drew attention to the 1960 work of Scheffler who described taught knowledge as falling into the three categories of propositional or factual knowledge, procedural knowledge and normative or moral knowledge (i.e ., the knowledge of what

one ought to do).

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Education in normative knowledge was the type of education suggested by those who told the South Australian Royal Commission education could so change behaviour that those misusing drugs, or proposing to do so, would desist. However, the Commission's discussion paper pointed out that learning an ethical formula did not mean that one would act according to it. Normative knowledge was usually acquired through

informal personal relationships, including those at schools, rather than through formal instruction at schools. Noting the Australian tradition of avoiding normative school teaching because of the belief that such teaching was potentially divisive, the Commissioners said that non­ school influences were strong agencies of normative education in that they taught individuals in a relatively uncontrolled way how to behave:

Yet classroom experiences today are small stuff compared with the overwhelming greater amount of normative knowledge imparted outside the school to young people by mothers, fathers, siblings, relatives, neighbours, neighbourhoods, churches, law makers, law enforcers, peer groups, clubs, gangs, party hosts,

fellow guests, gossipers, advertisers and those who use, or work in, the modern media of entertainment and information. (Open Exhibit 434, p. 8)

An individual's private experiences and experiments were also important influences on behaviour, the South Australian Commissioners said. Because attitudes to drug use could be effectively taught in schools only after the community at large, the setter of standards, was familiar with them, the Commissioners concluded:

Therefore the adult world, rather than that of the school, must be the first target for drug education if the 'drug problem' is not to await its solution for a very long time. (Open Exhibit 434, p. 21)

The South Australian Commissioners in their discussion paper suggested a number of attitudes which should be taken into account in formulating drug education programs. First, the Commissioners suggested that while it was better to have chemicals, drugs and the knowledge of how to make them, it was better not to use chemicals or drugs for

non-medical purposes. If used in the community, however, drugs should be used moderately and information should be made available about their variable effects and how similar effects could be obtained without

drugs. The properties and relative dangers of licit and illicit drugs should be known and the social decisions required to be made about a drug, after reasonable investigation, should not be postponed. Social controls over drug use should always be able to be reassessed and should

stem not from myths but from confirmed properties of the drug, fairly estimated and widely discussed. Drugs more likely to cause dependence, disturb the brain or endanger life should be treated with greater caution. Past reasons why some drugs are licit and others declared illicit should be discussed, and the discouragement of strongly psychotropic drugs should be based upon civilisation's need for

'rationality or logical brain work'. Persons committing crimes under the influence of drugs taken voluntarily should in general be held responsible by the courts. Knowledge about the ways social influences could determine private behaviour ought to be widespread to enable clear

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and autonomous rational drug choices to be made. Public disapproval and enforcement should be directed against large-scale black-marketeers and illegal drug importers of dangerous drugs but drug dependence should be seen as a fact of life in a society which could not be without, or

absolutely control, potentially harmful substances or knowledge.

The views tentatively expressed in the discussion paper were partly modified by the South Australian Commissioners in their final report (Open Exhibit 586):

The major points that flow from our analysis are that education programs, both in schools and in the general community, should abandon a fearful attitude toward mood-altering drugs. Rather they should adopt the positive view, which so obviously

reflects the actual practice of our society, that it is better to have chemicals, drugs and the knowledge of how to make or prepare them, than not to have them. Notwithstanding this, it is generally, although not invariably, better to achieve moods

or bodily states without drugs if this is practicable. Where drugs are used, it is better to use them wisely-- that is, in a way which eliminates or minimises the risk of harm...to the user or other people-- than unwisely.

(Open Exhibit 586, p. 146)

On this basis the South Australian Commissioners formulated measurable goals in the categories of propositional knowledge and normative knowledge. The defined goals of propositional or factual knowledge were suggested as a means of bringing about an understanding

of a number of matters relating to drugs. These included such matters as the importance of dosage, strength, and frequency of use of drugs; the relative dangers of different means of administration; the attractions, advantages and disadvantages of drugs and non-drug

approaches to mood alteration; the addictive properties of alcohol and tobacco, and the various controls over the availability and use of mood- altering drugs.

OTHER VIEWS

Criticism of the National Drug Education Program objectives appeared in a paper presented to the 19th Annual Conference of the Australian College of Education in May 1978. The authors of this paper, Messrs. J. S. Cheetham and D. Call and Dr. L. J. Ausburn, stated that the Victorian and South Australian Foundations of Alcoholism and Drug Dependence

regarded the more specific aims of the NDEP as meritorious in themselves but that 1 strict adherence to the educational emphasis they promoted has led to a "band-aid" approach to drug prevention1. The authors felt also

that the inherent weakness of the aims was that they were probably of little use to people with unmet needs because they did not deal with those causes and needs which led to the misuse of drugs. In the

authors' view the underlying premise that exposure to drug information led to rational decision-making was false because serious unmet needs worked against rational decision-making.

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In the face of such need, cognitive awareness does not

necessarily lead to affective impact or modified behaviour. The nature of drug abuse is self-destructive, and self­ destruction does not constitute rational behaviour. Yet in the preventive area, we persist with the myth that cognitive

awareness will lead to rational behaviour in drug use. (Open Exhibit 564, p. 4)

After stressing the need for closer examination of the reasons why students turn to drugs Messrs Cheetham and Call and Dr Ausburn suggested that one reason was the incompatibility of the education system with contemporary society. Inadequacies in teacher training had led to teachers being unable to meet the needs of today's students and this failure had increased students' confusion and disillusionment and the tendency to turn to drugs. Students should be equipped to handle the

'real world' and a good drug education was needed for the world of 'future shock' the authors stated. Education should enable students to understand and accept continuous change and its implications for society and themselves. Using the fruits of technological advancement would enable current knowledge to be maintained and constructive use of

leisure to be developed. There should also be developed an

understanding of the relationship between the disciplines and the ability to work with all types of problem-solving resources available.

The results of a 1977 study undertaken by Botsman and Browne and published in volume 1 of Community Attitudes to Education in Queensland were quoted by Messrs Cheetham and Call and Dr Ausburn to support their view that current educational programs, especially those involving drug education, are inadequate. In the Queensland study dissatisfaction or

'dissonance' emanating from educational programs was placed in rank order, ranging from dissatisfaction about alcohol education, drug education and personal counselling down through business letter writing, consumer awareness, student politeness, health education and driver education to teaching for an understanding of family life and human relationships. Messrs. Cheetham and Call and Dr Ausburn said that while one of the aims of the NDEP was to assist people to effectively adapt to changes occurring in their environments, delegation of the meeting of this aim to a single drug education unit in a school curriculum was not the complete answer to solving social problems. In order to deal with causes rather than symptoms it would be better to attempt, in the academic and the real environment, to promote awareness and adaptation to change and thereby lessen the confusion and frustration brought about by rapid change and needs left unmet by the educational environment. This frustration contributed, the authors hypothesised, to a rise in teenage use of drugs and alcohol.

Dr L. W. Shears of the Victorian Education Department also saw education as an integral part of a broader-based community health program in his submission to the Senate Select Committee on Drug Trafficking and Drug Abuse in October 1970 (Open Exhibit 272). The five requirements to be satisfied included a program for medical

practitioners, especially regarding prescription procedures for drugs; a program of health education for adults and parents; a total health program for schools directed at the 'optimal functioning of the individual'; tuition in all teacher education which would result in

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dynamic and practical school health programs associated with all teaching; and a resource centre which would house health teaching materials, evaluation facilities and inservice courses for teachers and non-teachers based on therapeutic counselling. Dr Shears warned against

presenting young people with a 1 topical approach' and pointed to difficulties school teachers faced in endeavouring to satisfy the needs of a pluralist society.

OVERSEAS EXPERIENCES

The Commission also received evidence concerning the objectives of drug education in other countries. A summary by the United States Office of Education (USOE) of its drug education program in 1974 was tendered as Open Exhibit 310 during evidence given in April 1978 by Mr A. E. Viney, Chairman of the 1975 New South Wales Joint Parliamentary

Select Committee upon Drugs and at the time of his evidence, Member of the NSW Legislative Assembly for the electorate of Wakehurst.

The summary stated that the USOE program was designed to alleviate drug and alcohol use among youth by promoting understanding of the complex factors involved, by developing and disseminating strategies of prevention and education designed to attack the causes rather than the

symptoms of drug use, and by preparing teams of school and community leaders to conduct drug abuse prevention programs in their own communities. The summary stated that the USOE had, in its approach, always recognised the inadequacy of traditional 'information about drugs' approaches and had stressed the need for new strategies which would take into account all the personal and social forces influencing

individual decision-making about drugs. Two major objectives were attributed to the USOE program. New approaches to prevention had to be developed and disseminated and there had to be training in this area for community leaders, officials, teachers and the like. Youth, at school

and out of school, was the primary target and the strategy was to reach them by appropriate education for them and for those in the school, family, community or peer group who influenced them most directly.

According to the summary the USOE program was based on a number of premises. These included the fact that youthful misuse of drugs was often symptomatic of underlying pressures or problems and successful education programs had to focus on both factual information and the many

other influences leading to youthful drug abuse. Successful prevention programs needed total community support and commitment at the local level to boost the school effort. The USOE program emphasised that an attack on the causes of drug abuse should be made by a network of

communities and institutions in each State, sharing their experiences and expertise.

Certain results were claimed for the USOE program in the summary. These results indicated that schools and communities were most effective when working together and that local resources could be generated with a small amount of money and other assistance with training. Post-training

assistance and follow-up was vital for local programs. Attitudes towards drugs could be improved but it was necessary to involve youth throughout a project to keep it on a relevant and realistic basis. Reductions in drug use and abuse were found to be possible in programs

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fostering personal and social growth. The USOE felt that two issues concerning the most effective role for the national government had evolved by the end of the fiscal year 1973— 74. Should its involvement be on a specific project or overall policy basis and secondly, should the

governmental role be institutionalised in the formation of agencies to deal with specific problems instead of leaving them to existing agencies?

The Le Dain Commission Assessment

The Canadian Le Dain Commission of Inquiry into the Non-Medical Use of Drugs presented its report in December 1973 (Open Exhibit 22). In reviewing the evidence it received on drug education, that Commission observed:

There has been difficulty in finding any broad measure of agreement on objectives, suitable content, and appropriate measures of effectiveness. In many quarters there has been severe criticism of current drug education efforts on this

continent, and even scepticism about what we can hope to achieve with this form of social response. (Open Exhibit 22, p. 207)

The Le Dain Commission pointed out that programs in Canada were developed at the local level with considerable variation in approach. Results of research into a number of school programs conducted by the Commission could be interpreted as supporting certain aspects of the NDEP approach. For example, the Le Dain Commission indicated drug education as a part of health and physical education courses failed because those courses were only regarded as token ones. Moreover,

teachers who could deal effectively with drug and related personal issues were scarce and teachers themselves were pessimistic of achieving success with existing programs. Compulsory special programs featuring guest speakers and films and a 'strongly and naively anti-drug tone' were criticised, as were approaches based on propaganda or

indoctrination. Short, free, informational pamphlets were useful but it was important, the Le Dain Commission stated:

...that drug education should be placed in a more general perspective, related to the other problems of personal adaptation with which students are more generally concerned. (Open Exhibit 22, p. 212)

The Le Dain Commission stressed that drug education should form part of a general education in developing both effective living skills and constructive alternatives to drug use. The Commission added:

...As with any other kind of human problem, we have more to fear from ignorance than from knowledge in the field of non­ medical drug use. Even if drug education is more effective in conveying information than in influencing attitudes or behaviour, its informational function is essential.

Individuals cannot be said to be adequately equipped to make

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wise choices if they do not have the requisite informational basis. (Open Exhibit 22, p . 212)

The proper place of drug education was in a broader context than the school system and parents as well as teachers had to get involved. As for frightening people into not using drugs, the Le Dain Commission believed that programs should not commence with the objective of

stimulating fear. The facts should not be altered to induce fear but if an objective statement of the facts induced fear then this was an acceptable consequence.

BROAD GUIDELINES AND CONCEPTS

At the conclusion of 1 The Philosophy of the National Drug Education Program', the Drug Education Sub-Committee provided the following views upon the content of drug education programs and the guidelines to be followed:

Programs need to be directed at all levels of society. For effective education, a multi-faceted approach to a community is essential, i.e. not only in the school but in formal and

informal groups in the community. The role of the professional health educator is to co-ordinate these programs. For programs to be consistent with the principles laid down by the Drug Education Sub-Committee, there needs to be a core of

professional health educators. In each region there should be co-ordinators whose duties would also include the provision of resource material and involvement with official and volunteer community agencies, including the press.

(OT 20324--25)

The Philosophy Statement is based on the following broad concepts:

* We live in a drug-using society where people use

psychoactive substances for a variety of reasons to achieve a variety of effects.

* Social attitudes and reactions to drugs are determined by a multiplicity of factors. They need not be rationally based nor logically consistent, however, they are part of reality and are unlikely to change quickly.

* A reduction in the deleterious effects of drug use

requires a variety of environmental modifications and acceptance of responsibility by the individual for his own drug use behaviour.

* Drug misuse may be wasteful of time, money, health and in the extreme, life. *

* Any attempt to deal with problems arising from drug use requires a comprehensive approach because all drugs have multiple effects which can vary according to dose, time, individual and setting in which the drug is used at any

one time.

(OT 20326)

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Chapter 2 Australian Programs

COMMONWEALTH PROGRAM

The Commonwealth's commitment to drug education is centred on its involvement in the development, administration, promotion and financial support at the national level of the National Drug Education Program (NDEP), the joint Commonwealth/State program which, as outlined in the previous Chapter, has operated in Australia since 1970 under the

direction of the Drug Education Sub-Committee (DESC) of the National Standing Control Committee on Drugs of Dependence (NSCC).

The Commonwealth Department of Health's submission to the

Commission, which pointed out that NDEP has always stressed the importance of a low-key approach to drug education aimed at long-term changes rather than 'high-fear' appeals, summed up what it saw as the achievement of NDEP in the following words:

The establishment of the Drug Education Sub-Committee and its oversighting of the National Drug Education Program has enabled the development and conduct of a uniform education program

which supports law enforcement and other efforts in the community designed to control drug abuse. (OT 20315 — 16)

Funding

The submission pointed out that drug education in Australia is funded jointly by the Commonwealth and the States. While State Government contributions to drug education are generally part of general health education programs and cannot accurately be separated from them, Commonwealth funding is allocated to the States and the Commonwealth Department of Health mainly under the National Drug Education Program

and on the advice of the National Standing Control Committee on Drugs of Dependence. Allocations are made to the States after budget proposals are presented by the State health authorities to the NSCC's Drug

Education Sub-Committee.

As shown in Table X I .1, Commonwealth funding has grown from a total allocation of $500 000 in the financial year 1970--71 to $825 000 in 1977 — 78. In 1978--79 the total Commonwealth NDEP allocation was $1.2 million of which New South Wales had an allocation of $281 581, Victoria

$205 096, Queensland $164 458, South Australia $89 129, Western Australia $105 191, Tasmania $59 045, and the Commonwealth Department of Health (including allocations for the Northern Territory and the Australian Capital Territory) $95 500. An additional $200 000 was

provided for the development of new initiatives in drug education at the national level.

The Minister for Health, Mr Hunt, announced on 23 August 1979 that drug education funding had been raised in the budget to $1 450 000 for 1979--80. <

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Table XI. 1 C o m monwe alth Funds allocations for Dru g Education

1970-71 1971-72 1972-73 1973-74 1974-75 1975-76 1976-77 1977-78

New S outh W ales V ictoria . .

Q ueensland .

S outh A ustralia . W estern A ustralia T asm ania . .

$ $ $ $

85 650 126 920 130 250 180 000

68 050 112 540 100 050 124 750

39 10) 46 484 58 800 122 885

25 450 34 230 42 200 64 500

38 000 42 660 36 150 69 664

22 300 19 650 19 600 39 015

$

207 900 147 550 126 896 64 310

80 464 44 865

208 000 148 000 127 500 65 000

81 000 45 500

$ $

208 000 224 500

148 000 161 500

127 500 140 000

65 000 74 500

81 000 91 500

45 500 54 500

T o t a l ........................................... 278 550 382 484 387 050 600 814 671 985 675 000 675 000 746 500

S tate Special Projects . . . — — — — — — — 3 500

C om m onw ealth D epartm ent o f H e a l t h ........................................... 221 450* 117 516 112 950 149 186 78 015 75 000 75 000 75 000

T o t a l ........................................... 500 000 500 000 500 000 750 000 750 000 750 000 750 000 825 000

Actual expenditure by Commonwealth $72 775 because of late start to Program.

Initially, allocations for drug education programs were on a per capita basis with adjustments to compensate States with either small or widely scattered populations. The allocations are now based on expenditures made in previous years except that in 1978--79 there was a per capita distribution of additional funds for special projects. Evidence was given to the Commission that ways of arriving at a more

formalised basis for the equitable distribution of funds are being explored.

The main criticisms directed at the drug education funding brought to the attention of the Commission were contained in two reports, the 1978 Report on the NDEP by the Assessment Team of the NSCC Drug

Education Sub-Committee (Open Exhibit 541), and the 1977 Report of the Senate Standing Committee on Social Welfare entitled 'Drug Problems in Australia-- an intoxicated society?' (Open Exhibit 379).

The Assessment Team's report, which is dealt with in considerable detail later in this Chapter, recognised that on a national basis the annual allocations of the previous seven years were insufficient to enable a comprehensive national drug education program to be

implemented. The Senate Standing Committee's report recommended that sufficient Commonwealth funds be made available for evaluation work, done preferably along the lines adopted by Dr R. P. Irwin in his

Canberra studies. If programs were found to be ineffective then funds should no longer be allocated to them, the report said. The report also noted that annual Commonwealth expenditure of $500 000 for anti-smoking education ceased in June 1975 and subsequent anti-smoking information was meagre.

One witness in confidential session suggested that, apart from the amount of funds being sufficient only to maintain programs at present levels, allocating funds annually caused problems. The witness said that although a triennial method was now used, short-term allocation methods did not allow for forward planning and in at least one State

doubts about the availability of funds nearly resulted in the

termination of that State's drug education program in 1977.

Other Commonwealth Involvement

Apart from financial support, the Commonwealth Department of Health submission said, the Commonwealth also contributes to NDEP in matters which are most efficiently dealt with at the national level. These include:

* administration of NDEP at the national level which is carried out by the Drugs of Dependence Section of the Commonwealth Department of Health;

* organisation and production of material for use by the National Information Service on Drug Abuse (NIS0DA); *

* the making of. films;

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* provision of information; and

* the conduct of national seminars and research projects.

NDEP Implementation

At the State level, the Commonwealth Department of Health's submission said, local activities are carried out by State health or drug education units (known by various names, depending on the particular State Government administrative arrangements). The State units are responsible for developing and conducting drug education programs in accordance with the Philosophy Statement of NDEP. Pointing out the importance of the Drug Education Sub-Committee in its role of co-ordinating influence throughout the country, the submission said:

Without the co-operation of the States on the Sub-Committee, drug education activities would be fragmented and efforts in this area would be dissipated.

(OT 20313)

The NSCC set up an evaluation body in 1973 to monitor drug education programs in the States and Territories, particularly with a view to assessing these programs in relation to the objectives of the NDEP. This body, known as the Assessment Team, reports to the Drug Education Sub-Committee. It undertook its first nation-wide assessment in 1974 and its second in 1977. The report of its 1977 assessment, dated April

1978, was tendered in evidence to the Commission as Open Exhibit 541.

The Team's observations concerning the individual State programs are discussed later in this Chapter. However, on a national basis, the Team made the following points:

The Team recognised many problems in planning and implementation of programs had arisen in the States through lack of security in relation to ongoing funds (since Commonwealth funds are allocated on an annual basis) and that funds allocated over the past seven years had not been sufficient for wide implementation of a comprehensive program. However the Team also considered greater use could have been made in most States of resources already available in the

community.

There had been few changes in the content of many drug education programs since the inception of NDEP and there was still a heavy emphasis on the physical appearance and pharmacological actions of drugs with little or no reference to psychosocial or socio-cultural aspects of the problem. In some instances people designing programs had been given little guidance.

While the Assessment Team recognised the limitations caused by staffing and administrative re-organisation difficulties and the fact that all categories of health workers in the course of their routine duties were engaged in health education, including drug education, there was need for a continuing effective drug education program for all age and sectional levels within the community, and a

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need for Departments of Education to increasingly accept the responsibility for health education, including drug education, within the schools.

For better cohesion and co-ordination of local programs the Team recommended (Open Exhibit 541, p . 11):

i. one professional health officer in each administrative unit (State, region, district) be responsible for co-ordinating the drug education programs within the administrative units; and

ii. in each State a centrally located unit be responsible for the provision of consultative services in respect of the overall direction of drug education programs, for the planning and conduct of training courses for community staff engaged in drug education

(including, when requested, courses for teachers) and where appropriate, assist in the evaluation of drug education programs within the State.

The Team stressed that the abuse of legal drugs (including alcohol and tobacco) and the use of illegal drugs were extremely complex issues and that emphasis needed to be given in drug education programs to the significance of drug use and abuse to the user and the factors in the

lives of individuals which attract them to drug use. It then

recommended that in order to achieve this emphasis:

Each drug education project should include a statement of the specific aims, the target populations for which the project is intended and the methods to be used, and periodically through the course of the project a written account should be made of the extent in both quantitative and qualitative terms to which the project has fulfilled the initial aims...

(Open Exhibit 541, p. 12)

The Assessment Team pointed out that evaluation was very much an integral part of any instructional enterprise and that 1 the same emphasis for training in evaluation is required as are seen in the emphases given to other aspects of the training of health educators'. As a further method of evaluating-- and improving---drug education programs at the State level, the Assessment Team recommended:

In each health unit (State Health Department, Health Region or Health District) a small professional group be established for the specific task of monitoring the content, methods of presentation, target population of each individual program in

the health unit.

The aim of this monitoring service should be to verify that each program is within the guidelines set down in the

Philosophy document and is in line with modern concepts.

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When the monitoring indicates, refresher courses should be conducted by the appropriate authority in the State. (Open Exhibit 541, p. 14)

Recent Initiatives

When Mrs J. M. Nolan, Acting Senior Executive Officer of the Drugs of Dependence Section of the Commonwealth Department of Health, appeared before the Commission in February 1979, she gave details of recent Commonwealth initiatives associated with NDEP. These included launching of a poster campaign using the theme 'Life. Don't Waste It' to be directed towards teenagers, young adults and young families, and an allocation in 1978— 79 of $200 000 for promotion of an awareness of NDEP philosophy and objectives through media publicity in addition to the on­ going NDEP funding commitment.

Mrs Nolan also said preparation of national guidelines on drug education in schools, for use by teachers with parents and students, being undertaken by the national Curriculum Development Centre in conjunction with Federal and State education and health authorities was expected to be completed in 1979 (OT 20400).

The Commonwealth Department of Health's submission also contained details of a survey on drug usage which it had commissioned with the Australian National University Survey Research Centre's Omnibus Survey of A.C.T. residents.

STATE AND TERRITORY PROGRAMS

The Commonwealth Department of Health's submission to the Commission of February 1979 listed the following examples of the types of

activities conducted by State and Territory drug education units as part of the National Drug Education Program (0T 20332):

activities in conjunction with community organisations such as Rotarians ;

consolidation of programs in schools;

provision of drug awareness programs at the request of industrial and commercial organisations for employees at all levels;

fulfilment of program commitments with defence forces;

provision of in-service training for drug educators;

continuation of seminars, workshops, lectures for professional and non-professional groups, e.g., medical and para-medical professions, judiciary, community groups, etc. to develop a greater public awareness of the problems of drug abuse;

distribution of drug education literature on the various aspects of drug abuse prevention;

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* conduct of research such as alternatives to drug use and surveys of patterns of drug usage in the community;

* training of approved drug educators;

* setting up of drug information centres with counselling services.

In addition to the above-mentioned 1978 report of the Drug Education Sub-Committee's 1977 Assessment Team (Open Exhibit 541), the Commission also received evidence from qualified individuals associated with State and Territory drug education programs either in a government capacity or

a private capacity. The Commission noted that in the preparation of its report, the 1977 Assessment Team forwarded draft copies of its observations to the individual State and Territory authorities concerned for their comments. These comments, incorporated into the report, are

recorded below where appropriate.

New South Wales

Before dealing with individual aspects of drug education in New South Wales the Assessment Team expressed concern about:

* confusion in drug education activities which the Team believed had resulted from regionslisa Li on of health services in the State into 14 regions; and

* the production by the NSW Health Commission of a series of booklets on community health in June 1977 without consultation with the State's drug education unit. These booklets, the Assessment Team reported, contained guidelines which were 'inadequate and even misleading in the light of modern sociological and educational

concepts of behaviour modification'.

Examples of what it saw as the confusion resulting from

regionalisation were mentioned often by the Assessment Team, which also reported:

The task of the Assessment Team was made more difficult by this situation. (Open Exhibit 541, p. 14)

The Assessment Team explained that the NSW drug education unit, referred to as the Central Drug Education Unit, was attached to the NSW Central Drug and Alcohol Advisory Service at the time of the Team's visits in June and November 1977. The unit had developed a policy

statement with guidelines for alcohol and drug dependence service units set up in each of the NSW Health Regions and it was making efforts to bring some conformity in policy and approach. But, the Assessment Team added:

This appeared to be a long slow process with many problems being encountered because of the autonomy of each region.

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Further confusion concerning roles had developed with the establishment of the NSW Alcohol and Drug Authority. (Open Exhibit 541, p. 16)

Referring to schools, the Assessment Team noted that a joint NSW Health Commission/Department of Education policy statement for education in drug-related issues had been developed but at the time of the Assessment Team's report had not been accepted by the NSW Department of Education. (Evidence was given in 1979 that the joint policy had

subsequently been agreed to and had been made available to those working in drug and alcohol education programs.)

In discussing the role of the Central Drug Education Unit in general, the Assessment Team noted that it had been involved in consultations on 106 occasions during 1977, had provided advice to government and community groups in the regions, and had organised training programs and workshops on demand. But the Team also said:

The Unit did not have the power to ensure that program policy objectives and guidelines were interpreted and implemented appropriately in the regions. The unit was concerned with preventing counter-productive measures being undertaken...

(Open Exhibit 541, p. 16)

After giving details of a four-day workshop which the Central Drug Education Unit had staged for three representatives from each of the 14 NSW Health Regions, the Assessment Team noted that while NSW Health Commission participants had considered the workshop successful:

According to Central Unit reports, there appeared to be 14 different drug education programs in the regions with emphasis on different aspects dependent on local needs. (Open Exhibit 541, p. 17)

The Assessment Team reported that, because decisions concerning specific education programs were taken at the local level by Regional Directors of Health, programs on health education and especially education of the public in respect of 'drugs' and 'alternative life styles' varied widely. Although programs existed in all 14 regions, the Team reported, there was emphasis on the alcohol education component or on alcohol and drug addiction services:

Educational programs which implement the guidelines suggested by the National Drug Education (Program) Philosophy Statement appear on the evidence available to the Assessment Team to be limited.

(Open Exhibit 541, p. 18)

The Assessment Team noted as examples of regional activities that 130 talks or discussion sessions had been held for community and professional groups in the last seven months of 1977 in the Murray Health Region and that 126 similar sessions had been conducted in the South-East NSW Region in 1977. The Assessment Team also mentioned that

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a NSW State Police program on safety, citizenship and personal responsibility also offered to school principals a further unit on 'alternatives to drugs, a better way of life'.

The Assessment Team singled out for special mention specific programs being carried out in Sydney's Northern Metropolitan Region and the Hunter Region.

The Northern Metropolitan Region programs mentioned were a seven- segment program for drivers charged with driving with more than the prescribed level of blood alcohol; five-segment programs for community groups in which the emphasis was on life style, interpersonal relations

and personality and sociological factors in relation to drug use and abuse, and a pilot study being conducted in schools as a joint project organised by the NSW Department of Education and the NSW Health

Commission.

The Assessment Team reported that demand for the community program had been high, that the program was sufficiently flexible to meet particular group needs and that it closely followed the NDEP guidelines. The Assessment also noted that the pilot study programs for schools, which included two high schools and 'feeder' primary schools, would be

evaluated. The Team considered that 'this development will be of great interest to all personnel engaged in health education'.

Dr P. J . J. O'Neill, Co-ordinator of Addiction Services for the Hunter Health Region and chief administrator of the service with whose programs the Assessment Team had indicated it had been impressed, gave evidence to the Commission in May 1978. After explaining that the Hunter Health Region encompassed 500 000 people he said the Community Addiction Service operated with a team of eight people---himself, a

medical practitioner, a psychologist, a health education officer and community nurses and counsellors. The team was based in a centre in the Newcastle suburb of Hamilton. While counselling services were provided at the centre, the centre was used mainly as a headquarters for a task

force which operated throughout the region. Dr O'Neill stressed that:

The thrust of this service has been further and further into primary intervention. (0T 11746)

Dr O'Neill explained that while 'tertiary intervention' could be defined as that directed to 'drop-outs' and 'secondary intervention' as that aimed at influencing persons showing early symptoms of drug abuse, 'primary intervention' addressed itself to:

...a problem (which) lies in some faults in society-- perhaps the excessive stresses, perhaps the excessive availability, perhaps the excessive peer pattern and pressure to use, perhaps the lack of knowledge about some of the drugs which we have. These factors combine to cause some people to start running

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into strife, become early symptom bearers, and some of those in turn progress to become casualties, the tertiary problem. (OT 11746— 47)

Dr O'Neill explained that the two major areas of primary

intervention where his organisation worked were schools and industry. In schools most contact was with personal development teachers with the aim of assisting the teachers themselves to institute programs:

We don't talk directly to school kids. This is not only

inappropriate; the experts in doing that are the school teachers involved in personal development. (OT 11747)

Dr O'Neill said the Community Addiction Service had been involved with about 12 industrial establishments in the Hunter Region in two years. The first programs looked particularly at alcohol but later programs examined the whole concept of dependency:

Where we move in-- firstly talking to management and unions and then to middle-grade executives and then finally to people in the workforce-- we have educational discussions but with involvement, not just didactic, about the concept of coping with chemicals in our society, which allows people to become more comfortable.

(OT 11747)

When questioned by the Commission Dr O'Neill confirmed (OT 11747 — 48) the industry programs had been well received and supported by management, trade unions and employees. 'These things have taken off so well that we now have a long waiting list of industries to get this type of input’, Dr O'Neill said. Some managements had reported reduced absenteeism and accident rates.

Dr O'Neill expressed the general philosophy behind the approach to drug education in the Hunter Region in the short paper tendered in evidence at OT 11754. An extract from the introduction of this paper, entitled 'Drugstrife Intervention-- an Eclectic Approach', appears below:

In a community the major factors involved in the level of drug use, abuse and strife can be listed as follows:

Availability. Peer Pattern and Pressure. Poor Self-esteem. Stress. Ignorance. Advertising. Background influence-- Parental.

-- Religious. -- Cultural.

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- Sanctions-- legal. -- social.

- Experimentation fads crazes. - Alternatives.

Drug Education even in its broadest context is merely part of primary intervention. Some factors influencing drug use and strife are beyond the scope of local educational change e .g . state and federal laws.

An intervention program directed at only one factor or a narrow range is probably doomed to failure. Attempts at control by prohibition and punitive legislation have been outstandingly unsuccessful and some honest workers report that after factual

education programs there has been a significant increase in use. Empathic programs designed to increase comfort and self­ esteem do not appear on their own to alter the patterns of use and strife.

It is probable that an approach designed to modify as many as possible of these factors will be more successful. This is likely to be the case both in individual drugstrife

intervention, and with primary intervention in a community. (OT 11754)

The Commission also received a substantial submission from Dr R. A. J . Webb, Senior Psychiatrist-in-Charge at the NSW Drug Education Unit. The submission included a report on the First International Congress on Drug Education which he had attended in October 1973 in Montreux, Switzerland. In part of this report (OT 19426), Dr Webb had reported what he regarded as the Congress's re-affirmation of NSW drug education policy, that 'proper drug education need not mention drugs, but must

involve people'. Colleagues at the Congress had seen the NSW program as doing what other countries at the time were only recommending, Dr Webb had reported.

Victoria

The Drug Education Sub-Committee Assessment Team's report together with evidence to the Commission by Dr D . W. Rankin, then Chief Health Education Officer of the Victorian Department of Health, explained that drug education activities in Victoria had been co-ordinated since 1970 by the Health Education Centre of the State Department of Health. The

Centre was answerable direct to the Permanent Head of the Victorian Department of Health and the Victorian Minister of Health. It had four full-time officers-- two medical staff, one psychologist and one administrator-- and engaged on a part-time basis 13 health educators

including doctors, nurses, pharmacists, primary and secondary school teachers and school counsellors.

Dr Rankin, who was also a Victorian representative on the National Drug Education Sub-Committee when he gave evidence to the Commission in

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February 1978, described the functions of the Victorian Health Education Centre as:

...to ascertain health needs within the community and to plan

and implement health education programs in response to these needs. It also serves as a resource centre for health

education personnel elsewhere in the Department, in other

departments, both Commonwealth and State, in voluntary

agencies, and for the Commonwealth at large.

(OT 3053)

Dr Rankin explained that drug education was included in the Centre's health education program and added that:

In accordance with the policies of the Drug Education Sub-

Committee, no drug or group of drugs is dealt with to the

exclusion of another.

(OT 3053)

Dr Rankin said the 'central philosophy' of the National Drug Education Program was flexible enough to meet the needs of each State, and he

added:

Very importantly it is seen that the drug abuse problem should be regarded as a problem of persons rather than of chemicals,

and that always a low key approach is maintained. This is in marked contrast to some agencies outside the Health Education Centre which maintain a high fear content and a sensational approach.

The Health Education Centre's program of drug education is carried out along the lines recommended.

(OT 3059--60)

The Assessment Team reported that the Victorian program had changed in recent years from 'a largely information-giving one to one where

social involvement and question is encouraged' (Open Exhibit 541, p.

23). It cited drug information services established in Geelong in 1970

and Warrnambool in 1976 as being examples of what appeared to be 'an

acceptable model of a community-supported facility'. It also noted the Centre had received the utmost co-operation from the Victorian

Department of Education in establishing school programs and that

specialised courses had been directed to State Health Department staff, the medical profession (including students) and other groups such as nurses .

Referring specifically to school programs the Assessment Team noted that a November 1977 survey of the 395 Victorian Education Department

high schools and secondary schools, sponsored by the Education and

Health Departments, had had a response rate of 79 per cent. The

responses had indicated a total of 275 of these schools had incorporated drug education into their education programs, 95 in health education and

the remainder in other subjects. In its comments on the Assessment Team's report, the Victorian Health Education Centre estimated 2000

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teachers in government and independent schools in Victoria had become committed to drug education. The Centre was providing assistance and advice to teachers conducting their own training seminars. In 1977, the Centre added, it had conducted thé following sessions with students:

School Sessions Students

Government: Primary 14 941

Secondary 168 .6 552

Independent: Primary 1 40

Secondary 59 2 777

In assessing the Victorian drug education program generally, the

Assessment Team reported there seemed to be a large number of individual

talks which were mainly drug-oriented. Lack of staff had not allowed

for evaluation in depth of individual programs, although 'feedback' from target groups had indicated expectations had usually been met and

requests for programs of all kinds had increased each year. The

Assessment Team believed there was little overall planning for a total

program and thought the Health Education Centre staff should focus less

attention on work of a 'workforce' type and more attention on developing and training resources in the community to permit more economic use of staff and facilities.

In its comments on the Team‘s report, the Health Education Centre replied that it would seem the Assessment Team had made some unwarranted assumptions on the basis”of its attendance at two of approximately 500 sessions carried out by Centre staff in 1977 (Open Exhibit 186, p. 2). The Centre also pointed out that although it attempted to co-ordinate drug education activities in Victoria and to act as a resource centre,

it had no exclusive claim to the field. The Centre said it was actively encouraging community agencies in drug education activities. Apart from the co-operation and assistance between the Centre and the Victorian Alcoholic and Drug Dependent Persons Services Branch (ADDPS), another organisation within the Victorian Department of Health which conducted a program of rehabilitation and education for drinking drivers, the Centre

endeavoured to maintain contact with such voluntary agencies as the

Seventh Day Adventist Church, Drug Users Parents Association and

Narcotics Anonymous. The Centre also drew attention to its increasing involvement with such community service organisations as Rotary and the Centre's provision of drug education assistance to such groups as the Royal Australian Air Force and Victorian Railways management.

When Mr N. E. Bavington, Victorian Department of Education Inspector of Secondary Schools, gave evidence in April 1978, he said the

Department had regarded drug education programs with some caution,

because of uncertain and incomplete knowledge about ways in which. drug education should be organised and presented in curricula. Areas of

uncertainty included (OT 8878--79):

* whether drug education should be a component of a comprehensive health promotion program or be dealt with by means of a topic

approach;

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* whether, as suggested by some evidence from the United States, drug education programs may even increase drug usage; and

* the question of teacher training and the sensitivities of parents, particularly after the experiences of the first Victorian health education programs when it was found many people were not ready to accept frank classroom discussions on alcohol, smoking, drugs, sex and venereal disease.

Mr Bavington referred to a June 1977 'Report on Health Education in Primary Schools' prepared by Mr G. Preston of the Victorian Education Department's Curriculum and Research Branch. This report, incorporated into evidence as Open Exhibit 273, included results of a survey which

indicated that of primary teachers polled, 81 per cent thought education in the use and abuse of drugs (including alcohol, cigarettes and common pain killers) had a place in primary school curricula.

Mr Bavington regarded this as indicating support for the

Department's own conclusion that 'if we are to undertake massive drug education programs they must be aimed at younger students' (OT 8888). Mr Bavington pointed out that no firm policy decision had been taken about the matter and that Victorian school principals had considerable autonomy in such matters. He also produced two other Curriculum and Research Branch publications entitled 'A Guide to Drug Education' and

'Health Education Services Directory' (Open Exhibits 274 and 275) which were available to teachers to assist them in gathering resource material on health and drug education.

Queensland

The Drug Education Sub-Committee Assessment Team reported that during its visit to Queensland in June 1977 the Queensland drug education unit and the Queensland Health Education Council were in the process of being incorporated into the Queensland Department of Health's Division of Health Education and Information. Despite this a wide range of program activities was being offered to community groups, the Team said.

The Team observed that since its previous Queensland visit in 1974 emphasis had turned from information-type programs to a more flexible approach following the National Drug Education Program (NDEP) Philosophy (Open Exhibit 541, p. 31). The unit appeared to have good 'back-up' support such as printing facilities and with the assistance of media publicity was well known and apparently well received in the community. Special initiatives the Team mentioned (Open Exhibit 541, p. 32) were:

* more investigation of target audiences' needs and evaluation of whether these needs were being met; *

* introduction of innovative approaches such as weekend camps for students, programs to increase self-esteem among delinquent girls and use of students as group discussion facilitators; and

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* extensive travel by unit staff to country areas to organise or

provide programs for such groups as community health nurses, Juvenile Aid Bureau officers, social workers and prison officers.

The Team reported the following statistics concerning the unit's activities (Open Exhibit 541, p . 33):

1975 1976 1977

Seminars 32 15 10*

Workshops 9 2 6*

Talks and discussions 1 064 1 344 532*

("-nine months only)

The Assessment Team also noted that following its visit the drug education unit had advised that to maximise the potentialities of a small staff it would concentrate on developing strategies for others to implement and that greater emphasis was to be placed on program development and research. While some direct monitoring would be carried out to enable programs to be constantly adjusted, any long-term evaluation would depend on future staffing. The Assessment Team also

reported that in 1978 seminars were being held for pharmacists participating in an auxiliary education program from which a pharmacist kit was being developed, and that the unit was developing a large-scale project with Queensland Rotary clubs.

Mr J. D. Hatch, Senior Information Education Officer of the Queensland Department of Health's Alcohol and Drug Dependence Service, gave the Commission details of the development of drug education in Queensland when he appeared as a witness in September 1978. After

submitting a series of year-by-year summaries of Queensland drug education activities which he believed illustrated the gradual refinement of approach in accordance with NDEP philosophies, Mr Hatch described 1975 as a turning-point because of the first State visit by

the 1974 Assessment Team and the resulting awareness of information on drug education. He said that, while programs had begun with an aim of eliminating illegal drug use by publicising dangers associated with drugs, by 1978:

Programs were jointly and co-operatively planned, implemented and assessed with target groups to see what could be done to improve the health status of the target group and the quality of life in the community. Thus, the object of the 1978 program was to help people find out for themselves what they could do

to attain and maintain a high level of health, rather than looking at the avoidance of ill health. The research collected thus far indicates that the community development type drug education programs are the only programs which have

demonstrated any significant success. (OT 15919)

Mr Hatch also gave details of a Rotary project referred to in the Assessment Team's report. He said that, following an approach by prominent Rotarians in late 1977, a plan had been developed for a long­

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term drug awareness project based on utilising community participation and the trend toward community self responsibility and awareness of the social factors which contribute to drug abuse. The State Department of Health had given an assurance it would support the project and at the

time Mr Hatch gave his evidence, a number of Rotary clubs in Brisbane and in country areas were in the process of developing individual working committees. Other service clubs had expressed enthusiasm for

the concept including some at the national level. 'We see this as our major thrust into community drug education for the future1, Mr Hatch added (OT 15910).

In his evidence to the Commission concerning drug education in Queensland schools, Mr W. L. Hamilton, Queensland Deputy Director- General of Education, said that before a study in 1974, Queensland schools had offered fact-oriented alcohol and drug education programs of very short duration, but since that time:

There has been a tendency to adopt a broader, more integrated approach with a stronger value and effective orientation than previously. This is similar to current trends in some other States. For instance, both South Australia and Western Australia have incorporated alcohol and drug education in broad health and human relations programs with an emphasis on values.

(OT 2240)

When asked for more detail on drug education programs in operation or being planned for Queensland schools, Mr Hamilton said that while the State Education Department was developing a new program of alcohol education:

We are not sure about the drug education side of things because I might say that educationists in general are not very sure about the effects that such programs have... (OT 2240)

In discussion with the Commission he said his Department believed confining drug education to a specific area would not have the desired effect and the Department wanted to try to integrate such programs throughout all subjects. He agreed with the proposition that education concerning alcohol and drugs was now widely accepted as being part of a wider educative concept of 1 life' and 'living'.

South Australia

The Assessment Team reported that the South Australian drug education unit, with the rest of South Australian Health Department, had joined the South Australian Health Commission in January 1978. The Team said at the time of its South Australian visit in June 1977 the unit offered programs varying from a widely based total health program to those specifically oriented to drugs such as analgesics. Staff consisted of three full-time health education officers and six part-time health educators.

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After reporting that optimal liaison with the State Education Department had resulted in substantial involvement by the unit in development of school curricula and in-service teaching training, the Team noted that the unit also offered programs to government and

independent primary and secondary schools with impressive results. The unit had conducted 290 sessions in government secondary schools involving 8700 students, 29 sessions in government primary schools involving 870 students, and 109 sessions in independent schools

involving 3270 students. The unit had also conducted 20 parent programs involving 740 people and 67 sessions for community groups involving 1426 people.

Other unit activities had included programs for Health Department staff, school nurses and inspectors. Thirty-five sessions had been held in 1977 for 1050 RAAF personnel, 19 sessions for a total of 490 trainee nurses and 40 sessions for 702 State Correctional Services personnel.

Dr B. C. Lindner, the Professional Assistant to the South Australian Education Department's Director of Research and Planning, and Mr N. R. Wadrop, Co-ordinator of the South Australian Education Department's Health Education Program, gave detailed evidence to the Commission in

June 1978 about health and drug education in South Australian schools.

As part of their evidence they presented a submission on behalf of the South Australian Education Department which had previously been submitted to the South Australian Royal Commission into the Non-Medical Use of Drugs in August 1977. The submission, incorporated into the

evidence of the Australian Royal Commission as transcript pages 0T 14140--70, explained that a full-time Health Education Project Team had been established in the South Australian Department of Education in 1973 and by 1977 consisted of nine full-time staff and one part-time

secretary. Initial work of the Project Team had focused mainly on health education curriculum development work and it was expected that the basic tasks in this area would be completed by 1980 (OT 14144-­ 45).

The submission said teachers were being released from schools to participate fulltime in intensive 13-week health education courses which included a drug education section. By August 1977, 85 teachers, including 32 from primary schools, had participated and further courses were planned depending on funding. The submission pointed out the health education program had focused first on junior secondary students

(years 8 to 10) and was progressively being expanded to other class levels. In 1977, the submission estimated, 14 000 secondary students and 1000 primary students were attending health education classes. The submission included the following breakdown of secondary classes in which health education was taught:

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Year Metropolitan Country TOTAL

8 197 91 288

9 121 58 179

10 54 23 77

11 13 4 17

12 2 - 2

387 176 563

The submission pointed out that although individual schools could determine their own particular needs and interests in the 10-unit health education programsschools almost invariably included drug education as one of the units. The submission also stated that apart from a 'formal' drug education program within the health education program described above, other 1 non-formal1 drug education was conducted at the discretion of the teacher, particularly in secondary schools not conducting the

formal health course, in such subjects as biology, chemistry and general science. The submission said the South Australian Department of Education also regarded its general counselling and guidance services as an important source of assistance to students, although cases calling

for medical or psychiatric attention clearly would have to be referred to the State Alcohol and Drug Addicts' Treatment Board (OT 14156--57).

Mr Wadrop gave the Commission details of a booklet entitled 'Schools and Drugs-- Some Guidelines', which the Education Department had distributed to secondary schools in 1978 after a detailed review of policy regarding student drug abuse carried out in 1977 in association with representatives of independent schools and the State Police Department, Health Commission, Crown Law Department, Alcohol and Drug Addicts' Treatment Board and Service for Youth Council. The booklet, a copy of which was incorporated into evidence as Open Exhibit 432, contains detailed information to enable schools, in close consultation with parents and students, to formulate school rules on drug abuse. It also contains detailed information on how to recognise drug abuse symptoms, where to find assistance in identifying such substances and a list of bodies providing specialist treatment services. Mr Wadrop said the book had been very well received. Original stocks of 2000-- based on a distribution of five copies per secondary school-- had been exhausted within two months.

Western Australia

The observations of the Drug Education Sub-Committee Assessment Team following its June 1977 visit to Western Australia contained several general criticisms of the program being conducted by the Health Education Council in that State. The Council subsequently commented

strongly and at length on these criticisms and the Assessment Team incorporated these comments both in part in the body of its report and in full as Attachment Three to the report. In general comments about the Western Australian program, the Assessment Team reported:

A large staff funded from various sources at the Health Education Council has provided a wide range of back-up

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facilities to allow its effective development as a resource centre. Six health education officers are funded from the Commonwealth Drug Education allocation. However, in spite of the large staff, the Assessment Team considered that

insufficient attention had been paid to evaluation of programs conducted. (Open Exhibit 541, p. 40)

The Council replied that some members of the staff were only part-time and a lot of time had to be spent in training new staff. It added:

...evaluation of programs has been hampered by lack of funds to employ a research officer and funds provided by the National Drug Education Program in no way allow for effective

evaluation. The 'large staff' of which the report speaks is paid almost entirely from funds provided by the State

Consolidated Fund and the Commonwealth Health and Hospitals Commission Community Health Program. (Open Exhibit 541.3, p . 2).

The Council also said:

...funds for drug education work have not increased

significantly during the three-year period but staff, transport, and other costs have been seriously inflated. (Open Exhibit 541.3, p . 19).

The Assessment Team reported that the Western Australian program had always stressed a broadly based program in relation to drug education, but added:

However, the Team was not convinced that the total WA Program followed sufficiently closely the principles, guidelines and content laid down for the National Program. (Open Exhibit 541, p. 40)

The Council replied:

We fail to see on what grounds the Assessment Team bases its comments that Western Australia is not meeting the stated objectives of the drug education program.

It further stated:

When drug education first became an issue the Health Education Council adopted the following frame of reference for the program in Western Australia: 1

1. The drug issue would not be separated from education on other social issues such as alcoholism, V.D., sexual promiscuity, smoking, and other patterns of health behaviour with a similar aetiology. Nevertheless, people

need reliable information about drugs and this should be provided.

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2. It is useful to offer and to conduct special programs on the drug issue, but these should embody enough sessions so that information on the effects of drugs would not stand in isolation from the human factors involved.

3. Fear-arousing propaganda of any kind was to be rejected.

We have kept to this frame of reference which we believe

accords with the philosophy of the National Drug Education Program. (Open Exhibit 541.3, pp. 41--42)

Details of field work conducted by the unit in schools and among teachers supplied by the Assessment Team and the Health Education Council included the following statistics:

Secondary Schools

1975 -343 sessions for 9750 students 1976 -240 sessions for 9682 students 1977 -211 sessions for 8462 students (The Assessment Team noted that the drop in sessions in 1977 reflected the Council's efforts to educate teachers to run their own programs in schools.)

Primary Schools

1975 -18 sessions for 268 students 1976 -66 sessions for 550 students 1977 -84 sessions for 700 students

Technical Schools

1975 -60 sessions for 1400 students 1976 -75 sessions for 1450 students 1977 -92 sessions for 2100 students

Teacher's Colleges, other Tertiary Institutions

1975 32 sessions for 950 students 1976 36 sessions for 990 students 1977 -28 sessions for 1020 students

Nurses' Schools

1975 -62 sessions for 850 students 1976 -60 sessions for 750 students 1977 -58 sessions for 750 students (The Council pointed out that some nursing schools had commenced their own courses based on Council Courses.)

The Assessment Team also reported, however, that it had left Western Australia with the impression that the total Western Australian program in schools, although an active one:

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...lacked co-ordination and integration into total health proj ects. (Open Exhibit 541, p. 41)

Community talks were categorised by the Council into two groups, those in a program format conducted for groups of informed people who could be classified as 'opinion leaders' and single-talk sessions on specific health topics, basically aimed at defining the issue and encouraging people to make informed decisions about their health behaviour. In 1977, 50 program format sessions had been conducted for 580 people and 168 single-talk sessions had been conducted for 3509 people. Other programs were conducted for auxiliary health workers, the

Council added, including workshops for teachers, school health nurses, police, youth leadership groups and medical students (Open Exhibit 541.3, pp. 12— 17).

The Council cited July 1977 as a typical month for single-talk sessions for schools and community groups. Of a total of 58 sessions, 15 were devoted to 1 the drug issue', five to 'health education' and one to 'human relationships'. Others were concerned with sex education or sexually transmitted diseases, nutrition and cancer.

The Council emphasised that it was also a resource centre for publications, audio-visual productions and films of a general health nature. This included drug education material either produced by the Council itself or obtained from other sources such as the National

Information Service on Drug Abuse (NISODA). It said that in one month (July 1977) 28 149 publications were distributed by the Centre to individuals such as doctors, nurses and teachers, and professional and private organisations such as hospitals and school libraries (Open Exhibit 541.3, p . 24). Among those publications were monthly 'Health Education Reading' leaflets; special leaflets which in 1978 included

five drug topic leaflets; information bulletins consisting mainly of reprints of journal articles, including those on drugs; and a quarterly review guide to health education literature for professionals and students including a special issue on drug education in December 1977. The Council added that its audio-visual production and film library

included material on drug topics or drug-related topics.

The Assessment Team noted that the Health Education Council in 1977 had been carrying out a pilot project to provide teachers and students with self-contained 'trigger kits' of information on health education topics, including drugs, alcohol and smoking. The Team expressed

reservations about the scheme, reporting that from observations it had made at two schools there seemed little evidence of the kits'

effectiveness or of them being integrated into 'a total program' (Open Exhibit 541, p. 41).

The Council replied that at the time of the Team's visit to Perth the kits were in the process of being tried out and evaluated.

Subsequent findings to some extent conflicted with the Team's views and led the Council to support the development of further kits (Open Exhibit 541.3, p. 30). ,

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When commenting on the development of regional Health Education Council offices, the Assessment Team reported that it was impressed with the work being done by the Council officer in Busselton. The officer's efforts to motivate community groups to develop and conduct programs promised worthwhile results (Open Exhibit 541, pp. 42--43). After noting that the Busselton officer was working under instructions from the Council, the Council expressed the view that the type of community development work being done could only work if a network of regional officers were established (Open Exhibit 541.3, pp. 2--3). The Council added that it now also had officers at Fremantle and Mandurah and hoped that a regional system of country and metropolitan health education resource centres could be extended through Western Australia.

When he gave evidence to the Commission in June 1978, Mr J. T. Carr, Executive Officer of the Health Education Council of Western Australia, explained that the Council, a statutory body, was a 'kind of neutral meeting ground' between the State Departments of Health and Education,

'not big enough to threaten anybody and not wanting to have the ultimate power, as it were' (OT 13726). Half of its funds came from Western Australian Consolidated Revenue and the remainder from the

(Commonwealth) Community Health Program and Drug Education Fund.

Tasmania

Following its visit to Tasmania in April 1977 the Assessment Team summarised the activities of the Tasmanian Health Education Unit as follows (Open Exhibit 541, p. 46):

1975/76 1976/77 1977/78

No. Attended No. Attended No . Attended

Seminars 4 135 2 70 6 155

Talks 7 121 1 44 2 59

Teaching sessions 16 781 18 417 6 246

Training programs 2

(19

50*

sessions) 2 (2 30**

sessions)

Teachers' consultations 35 40 23

* Health Department sisters. ** Citizens Advice Bureau trainees.

The Team noted that unit staff at the time of the Team's visit consisted of only one officer who was mainly engaged in conducting programs for schools and child health nurses and providing advice and resource material to College of Advanced Education lecturers. Although

it was planned to conduct up to seven seminars for police, Customs, health, education, and social work personnel and other concerned groups with a view to their becoming discussion group leaders and other steps were being taken to improve the situation:

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During the past two years, there appears to have been

insufficient agreement about the kind of activities to be conducted which would be the most effective for the State. The program conducted by the Health Education Unit had lost its impetus with most of the action in relation to community talks being carried out by the Drug Squad. Demands for talks from

the Health Education Unit Staff are now rare. The Drug Squad as a public relations promotion exercise has given talks to service clubs, community organisations, church groups, parolees

and probation officers, parents and citizens groups, trainee nurses and students at matriculation colleges. The police specifically stated that they avoided school groups because the kind of talk provided might stimulate experimentation. It

appears that these talks concentrate on the pharmacology of drugs, toxic effects and the legal implications. (Open Exhibit 541, pp. 43--44)

Commenting specifically on drug education activities in Tasmanian schools the Team reported it had been advised that drug abuse was at a low level compared with other Australian States. However, the Team added:

The inclusion of health education in the school curriculum is left to the discretion of the Principal. Programs in the schools are developed and carried out by Education Department

personnel with the Health Education Unit conducting some teaching sessions and providing advice and resource materials for teachers. The Team was given to understand that health education including drug education was not a curriculum subject

in most primary and secondary schools. There is little health or drug education component in the course for the great

majority of trainee teachers. (Open Exhibit 541, p. 45)

The Assessment Team recommended steps should be taken to increase unit staff, if only with part-time employees. It subsequently noted that following its visit another full-time member had been added to the staff. When Mr J. G. Scott, the Tasmanian Education Department's Director of Schools and Colleges, gave evidence to the Commission in February 1978 he said:

The view is held very widely among principals that the fears of some years ago of drug-taking becoming a major problem in the schools has not been realised. (OT 4246--47)

He said the Tasmanian Police Drug Bureau had maintained close and personal contact with the Education Department in problems that students or teachers had with drugs. The Drug Bureau had been a useful source of information and advice to school principals. In answer to questions

from the Commission Mr Scott said the Department believed drug education was important, that it was taught largely through social science courses and in some schools through pastoral care programs. He agreed it was

integrated in such courses but not highlighted.

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Other evidence received in Tasmania concerned an experimental drug education program undertaken at 17 high schools in the Hobart area in 1977 by social work lecturers and students who had formed a group known as the Drug Information and Advisory Service (DIAS). One of the originators of the program said one reason for the program had been that the group had been told some schools were not 'all that happy' about the drug education being conducted in the schools (OT 4291--92).

During the Commission's first visit to Tasmania in December 1977 it received evidence from Mr J. E. Forster, speaking on behalf of the Australasian Society of Engineers and other unions, including the Musician's Union of which he was president. His submission included

the following statement:

We would also like to bring to the Commission's notice the activities of this branch in regard to the way as a union we are endeavouring to reduce the incidence of illicit drug use. Our society sees that the trade union movement can actively engage in both educating our members and co-operating with those responsible for the community's safety, health and welfare in regard to drug matters.

(OT 1142)

Mr Forster's appearance before the Commission was the first of several on behalf of union representatives who indicated the interest of the unions in health and drug education.

Northern Territory

(The copy of the Drug Education Sub-Committee Assessment Team's 1978 report incorporated into Commission evidence as Open Exhibit 541 did not include the Team's report on the Northern Territory program. This report was subsequently incorporated into evidence as Open Exhibit 541A.)

The Assessment Team noted the staff of the Health Education Branch of the Northern Territory Division of the Commonwealth Department of Health consisted of an officer-in-charge and supporting staff including a journalist and three health education officers. The Branch had divided the Northern Territory into three regions-- Northern, East Arnhem and Southern-- with a health education officer in charge of activities in each region.

Although the Team expressed reservations on some issues such as evaluation of programs,it considered the Branch had developed a good understanding of the factors involved in the use of drugs and associated problems, that it had developed an effective network among community groups and that it was co-ordinating resources available in the com­ munity (Open Exhibit 541A, pp. 4— 5). The Team reported that at the time

of its visit the Branch did not appear to have undertaken much long-term planning, particularly in relation to schools. The Branch had been involved in establishing in November 1977 the Northern Territory Health

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Education Council which could lead, in the Team's view, to the

development of a long-term plan in a practical and comprehensive form. The Team noted particularly that one of the principal aims of the council was to encourage introduction of health education programs to Northern Territory schools based on the South Australian syllabus.

When Dr C. H. Gurd, Director of Health of the Northern Territory Division of the Commonwealth Department of Health, gave evidence to the Commission in March 1978 he said the Department in the Northern

Territory had received an allocation of $8000 from the National Drug Education Program in the financial year 1977--78. Of this, $2000 had so far been committed for films and drug education information material. The remainder would be used for drug education workshops in Darwin and

other Territory centres.

When asked if any of this material had yet been introduced into schools Dr Gurd replied:

Not at all. There is some doubt about moving into schools with drug education. There are two schools of thought and the stronger one seems to be that you can do more harm than good from exciting curiosity, and perhaps the experimentation with drugs rather than their control.

(0T 5886)

Dr Gurd said this 'stronger' school of thought was shared by both his Department and the Northern Territory Department of Education. He confirmed, however, that the two Departments were agreed on the introduction into Northern Territory schools of a health education

curriculum based on the South Australian approach. In answer to the Commission's questions Dr Gurd pointed out that although health education in the Northern Territory had been 'rather backward' it had 'begun to move' in recent years. Although one could never be satisfied

about the speed of development of almost anything because of government staff ceilings, he was sure health education and drug education were headed in the right direction (OT 5887).

Australian Capital Territory

The Assessment Team reported the following statistical summary of activities carried out by the A.C.T. Health Commission's Health Education Unit in 1977:

480 teacher sessions for 900 people; 14 parent groups sessions for 700 people; 109 primary school sessions for 5313 students; 629 secondary sessions for 8503 students;

However, the Team, which made two visits to the A.C.T., in

February/March and November 1977, reported that a substantial re­ organisation of the Health Education Unit had taken place between the two visits. In its February/March visit the Team had observed what it

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considered as little overall planning for a comprehensive, progressive and continuous program along guidelines set down by the National Drug Education Program (NDEP) Philosophy Statement (Open Exhibit 541, pp. 46— 47).

While the Unit had offered a wide range of health education programs for women, the Assessment Team considered insufficient emphasis had been given to drug information, and while programs in schools had been considered reasonably successful, they were too dependent on school staff and were expensive and demanding on Health Education Unit staff. Liaison with schools and health and community workers including police was well established and the 30 part-time educators employed by the Unit were well selected and trained. However, demands for the Unit's

services could not be fully met because of financial restrictions and little evaluation work had been done because of lack of staff (Open Exhibit 541, pp . 47 — 48).

The Team reported after its second visit, however, that considerable changes had been made and several new initiatives had been undertaken. These included the development of an 'apprenticeship' system whereby teachers and other qualified community people were taking over on-going programs from Unit staff, a division of the A.C.T. into seven areas each with a health educator responsible for liaison with key community

leaders, and more training by the Unit of voluntary community leaders.

The Team also reported that co-ordination between the A.C.T. Health Commission, Schools Authority and voluntary organisations involved in health education had been assisted by the newly formed A.C.T. Health Education Association.

A survey of community resources in the drug area had been conducted and a plan devised by the Alcohol and Drug Dependence Unit (in

conjunction with the Health Education Unit), and accepted by the Health Commission involving the two units and non-governmental services concerned with health promotion and drug prevention, in a joint 1 Health Promotion Centre' to become operable in April 1978 (Open Exhibit 541, P- 51).

NON-GOVERNMENT ORGANISATIONS

Some individual local drug education programs mentioned in previous sections such as the Rotary-sponsored Community and Drug Awareness Project in Queensland, are undertaken by private bodies working in close co-operation with government agencies under the broad aegis of the National Drug Education Program, the Philosophy of which stresses the utilisation of existing community groups. The Commission, however, also

received evidence from some other private bodies which conduct their own drug education programs or, in some cases plan to do so, without specific or close co-operation with government bodies. Some of these organisations had strong opinions about how such programs should be conducted.

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Details of a Hospital Benefits Association (HBA) of Victoria program conducted in 1977 — 78 were given to the Commission when two HBA

executives, Assistant General Manager (Marketing) Mr E . W. Whiting and Publicity Manager Ms E . R . Sheppard, presented a submission to the Commission on behalf of HBA in June 1978. The submission explained (OT 13497--99) that HBA had carried out extensive research, including

reference to a clinical psychologist and a clinical psychiatrist and an assessment of parental attitudes using market research techniques. Two publications, entitled 'Drug of Addiction and You1 and 'Alcoholism--It's Closer than You Think' were printed and distributed and two television

commercials commissioned and telecast. Following the launching of the campaign by Mr V. Houghton, the Victorian Minister for Health on 9 March 1978, . 1837 phone calls had been received by HBA praising the campaign and placing orders for the publications (copies of which were

incorporated into Commission evidence as Open Exhibit 415). The submission stated public reaction to the campaign had been 'over­ whelming ' (OT 13502). Only six phone calls had been received

criticising the campaign mostly on the basis that the money spent should have been used to reduce health contribution costs. Although HBA had received the Victorian Health Department's blessing for the project, HBA request for financial assistance to continue the campaign had received

no response at the time the submission had been presented to the Commission (OT 13504).

Community self-help organisations which made submissions to the Commission included WHOS (We Help Ourselves) Fellowship, a private voluntary organisation for the care, rehabilitation and counselling of drug addicts, and GROW, an Australian-based community mental health

organisation of people who hold regular meetings with the aim of developing their own personality resources to achieve healthier and happier lifestyles and attitudes.

Mr D. Gordon, Executive Director and founder of the WHOS Fellowship, and two WHOS staff members, Messrs J. R. Fryxell and J . McCrudden, presented to the Commission a submission which included strong criticisms of government drug education programs. The submission

contained a section headed:

There is no Drug Education Program in Australia. There is only a drug identification program mixed with a vague system of situation ethics and free will. (OT 10135).

Other extracts from the submission included:

WHOS Fellowship has found repeatedly, when dealing with parents of addicts, addicts and general members of the public, that on­ going educational programs being offered are unco-ordinated, confusing and unrealistic...When talking to persons associated

in any manner with a drug problem, these persons, while having some knowledge of drugs are totally ignorant of addiction.

Cl 11

Education programs should not be speculative, but rather based on what is fact, what treatment can be given, and what

treatment gives an answer. WHOS Fellowship does just this. Its concepts are to educate persons on addiction as a

personality problem in such a manner that is understandable and helps reduce the curse of stigma.

Drug addicts are educatable and this education can only be done if one accepts and understands the nature of an addict's personality.

(OT 10136 — 37)

In summing up, the WHOS submission offered the view that:

Education has to be delivered by people with sincere insight. In this educational area, delivery of information is as important as the information itself. (OT 10143)

Mr Gordon said that WHOS, at the time of his evidence, was

formulating a drug education program for schools. He said that while WHOS knew the type of material needed in schools, the Fellowship was seeking to establish connections with teachers since the Fellowship realised that teachers were the ones who would have to 'deliver' the education.

The Commission received a lengthy submission concerning drug dependency from GROW, a body which its National Director and co-founder, Father C. B. Keogh, explained had developed from his own experiences. The submission included the text of an address by Dr C. Sprague, a physician and Leadership Training Co-ordinator of the organisation. In the address, entitled 'Prevention of Abuse is Education for Living', Dr Sprague made the following point:

Education in the broad sense is really the only answer in a society that seeks to remain free and to become whole and which seeks the maximum freedom, health and wholeness for all of its citizens. We have no choice but to take the risk of falling flat on our faces, for the greater risk is to let disorders grow, giving over more and more responsibility to others, growing more and more apathetic, and hiding from the truth and evading (as we are being encouraged to do) our parental and teaching and health-promoting responsibility in life.

(OT 11519)

Dr Sprague referred to the assessment of evaluated drug education programs made by the First International Congress on Drug Education (1973) that positive attitude change occurs only in long-term programs based on active participation, that behaviour change occurs when a long­ term program changes values and that all other types of programs have failed. She then suggested an Australian education program should have the following scope:

Cl 12

1. Learning facts-- what drugs do to you health facts.

2. Learning how to learn-- how to reason---how to evaluate soundly and how to keep learning.

3. Learning how to live in harmony with others as equals--how to develop our own personal resources and to help others to do the same-- how to understand and regulate our own lives in the light of sound reason and enlightened heart and mind, and strong character.

All three of these are essential. They cannot be accomplished on their own; to learn how to live to become more of a whole, healthy person is very much dependent on 1 and 2. It can't be gained by chemicals or by outside influences alone. And no

amount of learning at level 1 will bear whole fruit unless 2 and 3 are learned along with it.

This is the education we and our children need so desperately; it must be personal, caring, and co-operative mutual education, for it must include education of the heart and character, as well of the mind.

(OT 11519 — 20)

The Reverend F . J . Nile, National Co-ordinator and NSW State Director of the Australian Festival of Light, presented a submission from his organisation which he described as a citizens' community-based organisation seeking to mobilise wholesome public opinion for purity,

for love and for family life. The submission recommended:

1. That all School curriculum include accurate Drug Education Courses to discourage drug usage.

2. That special Drug Education Officers be used to conduct these School courses along approved lines, based on Dr Hardin B . Jones' approach 'Sensual Drugs'.

3. That special Educational Programs be aimed at the 16 to 24 year old age group, which has indicated the most tolerant attitude to drugs.

4. That special Community Drug Education programs be

conducted along similar lines to the Retail Trade Association against shop-lifting, which achieved a 33-1/3% success rate e.g. use of dramatic photographs such as the 10 year journey of heroin addict to death.

5. That Community Education Programs be conducted for young people and parents by Local Councils. (OT 10377--82)

Educational material was presented to the Commission on behalf of the Seventh Day Adventist Church by Pastor D . E. Bain, director of the Church's Narcotics Education Service, who also made a submission in

Cl 13

which it was stated that in order for education to play its part in reducing drug abuse (OT 10782--83):

a. Health educators should be trained not only to disseminate accurate knowledge in schools, industry and in the community but also to provide education to develop a positive lifestyle. (The submission noted that a post-graduate health education course was being developed in New South Wales which would prove beneficial.)

b. Doctors needed to be educated to use drugs more conservatively. (The submission said that most 'post-graduate' education of doctors about drugs was performed by medical retailers promoting their products.)

c. A continuous public education program should be conducted in which alternatives to drug dependency were given and beneficial lifestyles were encouraged.

Publications presented by Mr Bain and incorporated into Commission evidence as Open Exhibit 338 included articles on drugs published in the monthly magazine 'Alert' and two pamphlets entitled 'Drugs can Destroy' and 'Pills-- What do They Mean to You?'. Some witnesses suggested to

the Commission that publications of this type represented an over­ emphasis on a 'scare' or 'high-fear' approach.

'LEGAL' DRUG USE EDUCATION

On the question of educating the community in the use of 'legal' drugs, the Commission noted a submission by the Proprietary Association of Australia (PAA), an organisation representing some 50 manufacturers of 'over-the-counter' medicines. This submission, made originally to the South Australian Royal Commission into the Non-Medical Use of Drugs in July 1977 and subsequently incorporated into the evidence of the Australian Commission as Open Exhibit 341, advocated a sociological study of all aspects of self-medication to ascertain the reasons why some consumers of analgesics are either unaware of risks involved in excessive usage or do not attach sufficient importance to dosage instructions. The submission added:

PAA has repeatedly stressed the importance of mounting educational campaigns aimed at persuading the consumer to use self-medication as directed, but until such times as we are able to pinpoint the geographical problem areas and the socio­ economic groups most affected we are unfortunately compelled to direct our efforts towards the total community. The wastage factor is considerable and the costs unnecessarily high.

In the coming year the PAA, in connection with the Pharmacy Guild of Australia, will distribute two million leaflets which explain, in simple terms, the safe and proper use of self­ medication. Additionally, we will employ the media, trade press, club and group meetings, schools, and the combined field

sales forces of member companies to convey a similar message.

(Open Exhibit 341, p. 12)

Cl 14

Chapter 3 Target Groups

One principle of effective drug education widely endorsed in evidence before the Commission was that drug education programs should cater for the needs of different individuals and groups. Many witnesses felt that a multi-faceted approach was needed with programs designed not only for

schools but also for particular formal and informal groups in the community. The basis for this view was that drug education had to be appropriate to the needs, interests and existing knowledge of specified 'target' groups, as well as allowing for individual differences in

values and beliefs.

In much of the evidence before the Commission target groups were viewed as falling into either a 'general public' or an 'occupation' category. The former included groups requiring drug education for themselves or their children and the latter contained persons whose

occupations involved them in some way with drugs or drug users, actual or potential.

As outlined elsewhere in this Part methods of 'targetting' drug education programs in some States were criticised by the Drug Education Sub-Committee Assessment Team.

GENERAL PUBLIC GROUPS

The 'general public' groups included young children, teenagers and young adults, and adults, the last especially in their role as parents. A number of witnesses generally believed that by late primary school, children should receive drug education as part of 'education for living'

health programs. This type of education should be modified for teenagers and young adults to allow for their levels of maturation and their susceptibility to peer group pressure and adolescent

experimentation. Evidence was given that this age group in the workforce needed to be approached differently from a captive student audience of the same age and that all successful approaches to the young required the reinforcement of suitable programs for adults.

The general nature of the above observations does not gainsay the substantial variations required in, for example, a school program involving pupils from an aboriginal community in the western part of New South Wales, pupils from an exclusive Melbourne college and others from a less affluent suburb of a large capital city. In his study 'Drug Education Programs and the Adolescent in the Drug Phenomena Problem',

1976, Dr R. P. Irwin of the Australian National University, Canberra, concluded that sex differences should also be taken into account. This was because boys were observed to benefit more from individual instruction and girls from group-led study (Open Exhibit 37).

Cl 15

OCCUPATION GROUPS

Persons considered to have a role to play in drug education because of their occupations are engaged primarily in fields related to health, teaching, the media and advertising.

The Medical Profession

The standard of drug education provided to the medical profession, especially to general practitioners, was the subject of much critical evidence presented to the Commission. This criticism was particularly directed at the standard of instruction given in pharmacology and clinical therapeutics. The Commonwealth Department of Health has supported initiatives in pharmacology training. Members of the medical profession confirmed the need for increased training of this kind.

Professor D. N. Wade, Professor of Clinical Pharmacology at the University of New South Wales, believed that too little time was devoted to training in therapeutics, a problem highlighted by the World Health Organization in the 1960s (OT 12768). That organization gave three main goals in stressing the need for development of clinical pharmacology in medical schools throughout the world. The first goal was to improve the

teaching of therapeutics and pharmacology given to medical students and doctors. The second was to show how drugs could improve patient management, and the third was to enable objective and critical

evaluation of drugs and drug problems (OT 12772).

The witness alluded to the dramatic changes in pharmacology which have presented the medical profession with a whole new range of very potent drugs since World War II. He said that not only were

practitioners who graduated before these changes occurred untrained in the use of many potent drugs but the very principles of modern

pharmacology and therapeutics had not been enunciated at that time. He asserted that despite the widespread concern expressed by knowledgeable bodies about the training in pharmacology and therapeutics given to the Australian medical profession, not nearly enough had been done to improve the situation. In his own words:

I don't know that it is profitable to outline all the very meagre resources this country has in pharmacology... it's a disgrace that pharmacology is so poorly developed in Australia. ~ (OT 12773)

Professor Wade stated that most universities graduated doctors with insufficient training in therapeutics and then 'let them loose1 with drugs whose safe and effective use involved skills acquired only by appropriate training. An increased awareness by doctors of proper drug use would also automatically lead to better patient education. He regretted that many of the best potential teachers in this field had already left for better opportunities overseas and, in answer to questions put by the Commission indicated considerable pessimism:

Cl 16

(Question) If there is an increase in the pharmacological content of medical courses are there people here to do it?--(Answer) Unfortunately we've had a disaster here because 10 years ago there was an enormous amount of enthusiasm amongst

the young people in the profession because they realised this was an important new frontier area of medicine, and we

attracted into this discipline some of the very brightest graduates. We trained them and trained them well-- but of course that training period ended about two or three years ago and there were no jobs available for them, and unfortunately

we’ve lost our best ones; there's a great shortage of these people in the United States and they're attracting very senior positions.

(Question) As clinical pharmacologists?-- (Answer) Yes; of course we're having trouble now attracting the good graduates, and rightly so. (OT 12779)

In summary he commented:

My plea is that the time has come to stop talking about this and to do something. I would hope that this Royal Commission would add whatever weight it could to support this very

important development which I think is critical to improving standards of therapy in this country. (OT 12772)

He added that:

In 1970 there was a Chair of Pharmacology at Sydney and there was one at Melbourne. In Adelaide there was a combined School of Physiology and Pharmacology, and there was no appointment in

therapeutics in Australian medical schools.

The University of New South Wales still has no Department of Pharmacology. There is my Chair, the first in Clinical

Pharmacology in Australia, hut not a separate Department. Since then, of course, there have been a number of Chairs in Clinical Pharmacology in the Universities of Western Australia, Flinders, Melbourne, New South Wales and one has just been

filled at Newcastle. The Chair at the University of Sydney has been advertised but has not yet been filled.

The course at New South Wales is good by most standards and Melbourne University also has a good course. There are moves at some Universities to improve their courses. Flinders and Western Australia are improving their programs in pharmacology.

Sydney has had no one in the Chair of Pharmacology for two years, and it is the second biggest medical school in Australia.

Young graduates in medicine are not let loose to do an

appendectomy without supervision, yet most universities

Cl 17

graduate doctors with insufficient training in therapeutics and let them loose with drugs which are far more dangerous than an appendectomy. Most of the drugs now available are potent agents, and their safe and effective use involves skills that can only be gained by appropriate training.

(OT 12772--73)

The New South Wales Branch of the Australian Medical Association (AMA) provided evidence of its concern about the present state of pharmacology education (Open Exhibit 308). A June 1977 letter to the Commonwealth Minister for Health requesting the urgent establishment of Departments of Clinical Pharmacology in all Australian medical schools produced the reply that, while the Minister shared the concern, the

impact of budgetary constraints on new initiatives and the competing demands for University funds had to be considered.

Dr R. C. Webb of the Commonwealth Department of Health also stressed the need for greater emphasis on pharmacology and tuition in the method of prescribing drugs, pointing out in his evidence that the present situation could lead young doctors into bad habits. Adequate controls on the prescribing of drugs were lacking in many hospitals. Dr Webb said changing a medical curriculum was difficult as no one liked his own special area to be reduced (OT 2841--42).

Professor I. W. Webster, Professor of Community Medicine at the University of NSW, observed (OT 14498) that if doctors knew more about pharmacology they would prescribe far fewer drugs or none at all.

Only 60 hours of instruction in clinical pharmacology were given to medical undergraduates at the University of Adelaide and the teaching was not as detailed or as good as it should be, according to the South Australian Branch of the AMA (OT 8787). A South Australian medical practitioner, Dr Η. B. Kildea, told his State's Royal Commission into

the Non-Medical Use of Drugs (OT 7820) that the average resident medical officer was poorly trained in therapeutics. Dr R. Chynoweth, Reader in Psychiatry at the University of Adelaide, felt that the onus was clearly on medical teachers to provide the right setting for doctors to develop proper attitudes towards drug prescribing. Continuing education during medical practice would reinforce the attitudes learned at undergraduate

level (OT 7492).

Dr I. H. Pitman of the Pharmacy Board of Victoria stated that in his view training in pharmacology was sufficient only if doctors had constant access to a pharmacist. He thought that the declining emphasis on pharmacology in medical education was world-wide, while tuition in all aspects of drugs in pharmacy education was increasing (OT 2718). One witness, an experienced drug counsellor, argued in confidential evidence for a watchdog organisation to check that doctors'

preoccupation with chemical therapy did not cause them to create and maintain drug habits. He said that education on a large scale was needed to cause a switch to behavioural therapy.

Cl 18

A pharmacist, Mr G. L. Wighton, pointed out to the Commission that there was great pressure on doctors from some patients, and referred to a 'pill for every ill' syndrome. He added:

I think the only way that perhaps one can try to overcome that is to place some firmer guidelines on the prescribing habits of doctors. (OT 4381)

The education of medical practitioners was also criticised for deficiencies in psycho-social areas. One confidential witness alluded to the multitude of problems in these areas faced daily by doctors without any basic counselling skills, although the Family Medicine Program of the Royal College of General Practitioners had made a start

in providing them. Individual and group counselling skills and an orientation towards preventive and rehabilitative medical education was required. In an answer which was particularly responsive to a question by the Commissioner seeking a medical practitioner's view as to whether

there was a proper balance within university courses, particularly in relation to matters such as pharmacology and patient counselling, the witness stated:

I spent two years dissecting a body and six weeks being told how to talk to live people, and I think that is typical of the old tradition that anatomy is a basic science of medicine so you spend two years in an autopsy room dissecting a dead body,

and no-one ever tells you how to talk to a live patient. (CT)

A submission by the Australian Council of Social Services (ACOSS) stated (OT 14603) that doctors were not adequately trained to assist people with social or emotional problems. Professor T. G. C . Murrell, Professor of Community Medicine at the University of Adelaide, remarked

in evidence given originally to the South Australian Royal Commission into the Non-Medical Use of Drugs (OT 7386) that because medical practitioners put into practice the treatment models they were taught, modelling in health education counselling should occur in training to

enable the doctor to respond properly to the needs of his patients. Similarly, the Australian and New Zealand College of Psychiatrists recommended (OT 7495) the inclusion of more/ information on the

psychological and sociological aspects of drugs, not only in medical training, but also in training for the legal, religious and teaching professions and for workers in social and law enforcement agencies of all kinds. Proper attitudes by doctors to drug prescribing were the

responsibility of medical teachers, according to the College (OT 7500).

A group of three doctors gave their personal views on the handling of psycho-social problems by the medical profession. Doctors V. D. Tottman, G. D. Wright and J. R. Graham submitted to the South Australian Royal Commission that as the group in society with most direct contact with people in psychic distress, the medical profession had to have more

formal education in counselling skills, social aspects of drug dependency, and non-drug methods of alleviating anxiety and tension so they could deal with the volume of emotional problems they encountered.

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To the three doctors, the medical profession's power and influence, and the credibility accorded its health pronouncements, meant that doctors, had to give consistently good information about drugs and to place illegal drug use within the context of total community drug use. Doctors had general knowledge of the relationship between alcohol and personal problems but no such knowledge existed about illegal drugs. In order to be seen as a valid source of help during drug-related problems,

the submission stated:

...the doctor needs to hold a solid technical base as to the nature and effects of drugs commonly used, as well as a grasp of the social meaning of the drug use. (OT 7866)

Pharmacists

Much of the evidence presented to the Commission by members of the pharmacy profession concerned the under-utilization of their skills. They believed they could play a useful role in influencing community attitudes to drugs and drug usage. On behalf of the Pharmacy Board of Victoria, the Pharmaceutical Society of Victoria and the College of Pharmacy Ltd, Dr I. H. Pitman said that significant changes occurred in Australian pharmacy education in 1960 (OT 2712). Much more basic

science was introduced into curricula and a quantitative approach was adopted. The three schools of pharmacy at Melbourne, Sydney and Brisbane began pharmaceutical degree courses designed to equip students

for industrial, hospital or community work after gaining practical experience. From then on pharmacy graduates were trained in

'quantitative technical expertness', according to Dr Pitman. Dr Pitman compared the old and new curricula in pharmacy to illustrate the reforms made in the academic content of the course but he asserted that reform within pharmaceutical practice had not kept pace.

Dr Pitman proposed that the community should be educated

continuously and systematically to deal with the highly technological aspects of drugs. A more active role by pharmacists in both drug counselling and consulting should be promoted. He explained that the former involved counselling people gratis when pharmacologically active, over-the-counter medicines or medical prescriptions were involved. Counselling rooms had already been designed for inclusion in some pharmacies. Pharmaceutical consulting involved pharmacists in paid

consultations with non-pharmacists concerning drugs, medicines and chemicals.

Two submissions from pharmacists' organisations incorporated into the evidence of this Commission from South Australian Commission evidence were in substantial agreement with the views expressed by Dr Pitman. The first was a joint submission from the South Australian Branch of the Pharmaceutical Society of Australia and the South Australian Branch of the Pharmacy Guild of Australia, and the second a

supporting submission from the Pharmaceutical Society of Australia. The latter submission (OT 8048) emphasised that pharmacists' qualifications best suited them to advise on the use of medicines, that they were the health professionals most readily accessible to the public and that they

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had a unique insight into the total drug intake of the community. That submission also advocated annual government remuneration for pharmacists in private practice when they engaged in bona fide public health education.

On the other hand, evidence was given that the role of the

pharmacist in drug education had been considered in detail by the Drug Education Sub-Committee (DESC) of the National Standing Control Committee on Drugs of Dependence in discussions with representatives of the profession. One difficulty the DESC saw was that the pnarmacist's

role as a drug merchandiser placed him in apparent conflict with the basic drug education goal of reducing consumption, thus giving rise to the suggestion that pharmacists should be paid for not prescribing. The DESC also suggested that participation in local drug education programs

by individual pharmacists should take place through State bodies active in the National Drug Education Program. A proposed program to enhance the professional image of pharmacists included a national public education campaign on the use and misuse of medicines.

Nurses

The Commission received evidence from several sources adverting to the responsible position occupied by the nursing profession in medical institutions. It was claimed that the nursing profession had an important role in ensuring not only strict compliance with the prescriber's directions, but also in avoiding unnecessary therapy, particularly with regard to psychotropic drugs.

In considering the drug education of nurses the Commisson

incorporated into its evidence two submissions originally made to the South Australian Royal Commission into the Non-Medical Use of Drugs. One submission, from the Occupational Health Nurses Section of the Royal Australian Nursing Federation (South Australian Branch), stated that

occupational health nurses, with adequate training in counselling skills and with the support and knowledge of referral agencies, could play a vital role in alleviating drug abuse in industry (OT 8001).

The other submission from Ms B . Bond on behalf of the South

Australian Branch of the Royal Australian Nursing Federation, concluded that the nursing profession had a role to play in preventive health care through teaching and example (OT 8637). The Branch stated that patients, the community and nurses themselves were owed a responsibility by the nursing profession to improve the education of nurses in drug use

and abuse. In outlining this role, however, the Branch warned that inadequacies in basic nursing and medical education programs, together with work pressures, could so mitigate against the development of good relationships with patients under stress that drugs might be resorted to

instead of a supportive, problem-solving approach (OT 8623). Taking South Australia as an example, the submission pointed out that the Student Nurse curriculum guidelines included material on pharmacology, drug storage, and the administration of drugs as well as some content on

drug abuse and overdosage. Trainee nurses in their one year program for the Roll received instruction in the administration of drugs but not in

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pharmacology. The social science section of the nursing curriculum contained material on drug use problems and Mental Deficiency Student Nurse programs included pharmacology. Increasing emphasis had been placed on the health teaching role of the nurse in hospitals and in the

community, the submission claimed (OT 8627).

The submission maintained that nurses were an 'at-risk' segment of the population from the viewpoint of personal drug abuse because of their access to drug storage and their work in administering drugs. Moreover, nurses encountered stresses throughout their working lives. As both a student and part of the workforce, young trainee nurses faced pressures to experiment with drugs and alcohol in their first job, a job which combined a reasonable salary with freedom from parental control.

In addition, considerable stress is experienced in working with the sick and the dying and their relatives, as nurses do for most of their working lives (OT 8624--2S).

Teachers

Although the role of teachers in drug education already has been referred to, the teaching profession itself is obviously an essential target group. Evidence was received on moves to improve teachers' skills in drug education by using such methods as incorporating drug education instruction in teacher training courses and promoting graduate workshops and in-service training courses on this subject. Various guidelines on drug education have also been published to enable teachers to develop curricula for drug education. Some education authorities, on the other hand, suggested that much more could be done in this area. These included Messrs. J. S. Cheetham and D. Call and Dr R. J. Ausburn in their paper presented to the 19th Annual Conference of the Australian College of Education in May 1978 (Open Exhibit 564).

Evidence concerning teacher education from Australian public officals directly involved in the implementation of drug education programs is dealt with elsewhere in this Report. However, one of the more detailed reviews of teacher education noted by the Commission was a December 1976 report on a Western Australian study conducted by the Education Sub-Committee of the Western Australian Alcohol and Drug Authority. This report entitled 'Education and Drugs' was incorporated as Open Exhibit 72 when it was given in evidence by the former Chairman of the Authority, Mr R. J. R. Williams, a Member of the Legislative Council of Western Australia. Some of the comments in the Report appear to have applicability beyond Western Australia.

The Sub-Committee stated that shortages in human resources meant that school teachers would have to take an active part in drug

education. Adverse effects resulted from the inappropriate use of speakers on health from outside the school. Many of the large number of non-school organisations involved in school drug education programs preferred to concentrate on teacher education in order that drug programs could be conducted within the school. The Sub-Committee observed, however, that there was only minimal pre-service training in

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health education throughout Australia, including Western Australia. The five teachers' colleges there offered little, with compulsory courses in health education ranging from 15 to 30 hours and electives between none and 240 hours. Only one teachers' college in the State offered a full major in health education, and only two included 'Drug Use and Abuse' in their core programs.

General support for the (13 weeks') in-service training taking place in South Australia was expressed by the South Australian Royal Commission into the Non-Medical Use of Drugs in its Final Report (Open Exhibit 586). That Commission also saw an important need for pre­

service training and for greater care in selecting suitable teachers to conduct drug education programs.

Mr T . J . McCaskill, Headmaster of Barker College, Hornsby, NSW, expressed similar views supporting the need for both pre-service and in­ service drug education for teachers. He believed that drug abuse and its identification were worthy of greater attention in teachers' education courses and recommended regular, more concentrated in-service

instruction for teachers, given by persons qualified for this task (OT 9868). Ms J. L. Buckham, Principal of Pymble Ladies College (Sydney) and President of the Association of Heads of Independent Girls' Schools in NSW called for greater use of expert outsiders to lecture in schools on drug education. She described an adolescent education course of

lectures at her school for third term Grade 8 and first term Grade 9 pupils (OT 9874--7S). These were given by one of a panel of woman

doctors who lecture regularly at the independent girls' schools. The panel chose the curriculum for the course, which has existed for a considerable period of time.

OTHER GROUPS

Evidence concerning the many target groups which could benefit from specific drug education programs was provided to the Commission. Indeed such programs have been introduced and were being introduced in various parts of Australia during the course of the Commission.

While the role of the media in drug education is considered in detail elsewhere in this Part of the Report, the Commission noted that in many instances evidence referring to 'targetting' drug information proposed that people working in the media industries themselves were a

target group for education in a wide range of matters such as the dangers of fear-arousing 'messages' and the incitement which certain information or entertainment programs and publications could engender. In stating that the media had an important role to play in drug

education, evidence from the Commonwealth Department of Health and other sources referred to what was seen as the responsibility of health educators to provide guidance to media representatives to enable them to make an effective contribution to community drug education.

The Report of the Education Sub-Committee of the West Australian Alcohol and Drug Authority entitled 'Education and Drugs' listed a

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number of target groups for community education. These included apprentices and their instructors, industrial workers, probation and parole officers, police cadets and the judiciary.

Mr B. J. Unsworth, presenting a submission on behalf of the Labour Council of New South Wales whose membership he said was in excess of 1 000 000, endorsed the declared strategy and recommendations of the Senate Standing Committee on Social Welfare 1977 in respect of the abuse of alcohol, tobacco and analgesics. He submitted that greater attention should be given to community education on the dangers to health of the use of all drugs. He considered that more had to be done to provide young people at an earlier age with an education in relation to the long term effects of drugs. The submission also recognised that as well as taking steps to reduce the supply of drugs by effective methods of prevention and detection, measures must be developed to

reduce demand. In this area increased education of the persons represented by the Labour Council was vital.

The submission showed that most of the 106 affiliated Unions recognised the value of disseminating more information to the community about drugs, their effects and the detection of patterns of drug usage.

The suggestions as to how this should be achieved included use of journals, circulars, newspapers, radio, television, seminars, meetings and word of mouth. It was also proposed that a bi-partisan approach be adopted between employer and trade unions on counselling, treatment and rehabilitation, and also to ensure that addicts' dependents are assisted during this process. The submission also urged politicians not to deal with the problem on party lines but to co-operate in the introduction of

legislation to prevent, deal with, and cure the drug problem.

The Commission also noted the Chapter entitled 1 Cannabis in Industry' in the Report of the New South Wales Royal Commission into Drug Trafficking. Mr Justice Woodward found that the complex problem of drug abuse in industry was virtually untouched and supported the dissemination of non-drug philosophies to members of the workforce, particularly apprentices and younger workers.

Identifying particular target groups within the community with special needs in drug education could continue indefinitely. For example, in the category of 1 industrial workers', it would obviously be beyond the resources of any drug education authority to provide programs designed for each of the many possible target groups, but the evidence

received by the Commission showed clearly that educationists should inform themselves about the characteristics and particular needs of various groups within the community. Moreover, in seeking to satisfy

the needs of the whole community for drug education, they should avoid standardisation of either programs or teaching methods.

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Chapter 4 R ole o f the M edia and Advertising

ROLE OF THE MEDIA

It is acknowledged that the various branches of the media have had a powerful and increasing influence over community attitudes. For this reason the media have figured prominently in bringing about, and

accelerating, social change. It is not surprising, therefore, that books, magazines, newspapers and pamphlets, radio, film and television have been subjected to close scrutiny as drug use and abuse increase.

Their role as society's primary information sources and transmitters of cultural values impinges upon the drug use problem through paid advertising, the expression of proprietorial opinion, the provision of news and information, and entertainment activities.

In the January 1975 edition of *The Annals of the American Academy of Political and Social Science' (Open Exhibit 39), F. E. Barcus and S. M. Jankowski wrote that the mass media were obvious targets when society looked for the causes of social problems, such as the wider

reliance on drugs which is a feature of modern lifestyles:

The mass media serve to carry the messages of society in their news, information and entertainment functions. Like the ancient emperors who killed the messengers conveying bad tidings, we tend to vent our own anger, borne of anxiety over

change, on the modern messengers of society-- the mass media. (Open Exhibit 39, p .87).

The impact of the media is discussed in the Final Report of the South Australian Royal Commission into the Non-Medical Use of Drugs (Open Exhibit 586, pp. 3S--39). The South Australian Commissioners stated that the tendency of young people to model themselves on drug­

taking heroes was exploited by the media and that the satisfactions displayed in the world of film and television and the emphasis on achieving happiness by purchasing goods and services such as drugs had an influence on drug-taking. The Commissioners felt that the use of

advertising in the media to encourage people to buy all manner of legal drugs created a climate of approval for all drugs. On the subject of news reporting the Commission pointed out that the media's concern with the more unusual or deviant aspects of human behaviour often undermined

the moral consensus that the media sought to reinforce. However the Commission was not convinced that popular styles of reporting unduly encouraged the use of drugs because the media were not the only sources of information and stimulation. The Commissioners felt that although

the media at times provided the final inducement, motivation was hard to assess. They concluded:

On the whole, however, we think the style of media reporting has more to do with perpetuating misunderstandings of the drug problems than in encouraging the use of drugs. (Open Exhibit 586, p .39)

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National Drug Education Program Viewpoint

The Philosophy Statement of the National Drug Education Program (NDEP) referred to in Chapters 1 and 2 stresses the importance of mass media in drug education. The section of the Statement devoted to the role of 1 The Press' (radio, television and newspapers) says:

The community needs information about the nature and extent of health issues. There is no substitute for accurate, up-to-date information and the Press is the cheapest, most effective method available for transmitting information to large numbers of people. The role of health workers should be to help the Press obtain accurate information.

The community needs information about the availability of services to help groups and individuals examine issues and find resolutions. The Press needs to be kept informed.

There is some evidence that some kinds of Press information provide models of behaviour for some kinds of people, leading to the copying of potentially dangerous behaviour (e.g. the effects of boiling lilies; glue-sniffing). Regular, helping contact with Press workers offers the only hope for a reduction in this kind of press activity.

There is a lot of evidence that fear-arousing messages have reverse effects from those intended. It is evident that Press workers examine social issues with a genuine desire to alert communities and improve situations.

It is the responsibility of health workers to develop in Press workers an understanding of the findings of fear arousal research; and it may be anticipated that incidents will diminish in response to contact.

It is essential that special effort be made to establish and maintain close working relationships with the Press. The responsibility for this rests with the health education worker. (OT 20329--30)

After pointing out that education aimed at not only providing information but also at reinforcing and changing attitudes and behaviour, evidence from the Commonwealth Department of Health pointed out that the media sometimes disseminated information in a way that stimulated an unhealthy interest in drugs or presented an attitude favourable to drug taking. However, the Department believed there was no reason why the media could not make an important contribution towards drug education, especially in a role which reinforced attitudes and practices previously instilled by school and community education programs.

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Radio and television, in particular, were important in providing information on health matters in a number of informal ways such as in regular news items, documentaries and even programs devised primarily for entertainment, the Department said (OT 20350). They could also play a supportive role in an integrated health education program.

Media Influence

The extent of media influence concerning drugs was illustrated in a number of surveys conducted in Australia and overseas (OT 20348--49). One survey conducted at Manly in Sydney in 1971 showed that the media were the most frequently mentioned source of information on drugs. Over

60 per cent of the people surveyed used media for information on

cigarettes, marihuana and heroin, and 50 per cent for information on alcohol. Bell, Champion and Rowe carried out a survey from 1971 to 1973 of senior school students in New South Wales and found that 77 per cent of students surveyed used radio and television as sources of information

on drugs, 78 per cent used reading and 35 per cent obtained information from drug users. A survey carried out on a sample of young people in Melbourne by the Victorian Institute of Mental Health Research revealed that 59 per cent of respondents obtained drug information from radio and

television, 66 per cent from magazines and newspapers and 31 per cent from drug users.

Overseas the relative influence of the various types of media were indicated by the findings of a 1973 UNESCO meeting held to evaluate mass media programs for the prevention of drug abuse. These findings showed children and adults used television most while adolescents and young

adults used radio most. Children were also influenced by radio and comics and adults by newspapers and radio. While radio and television were most important for adolescents, who also obtained a lot of information from friends, these media were an even more important

information source for adults who relied less on friends.

The Commonwealth Health Department's submission suggested the media’s role in drug education could most effectively be carried out by:

providing balanced news items and other programs relating to health matters;

adopting a low-key approach and not unduly highlighting problems in isolation;

providing information on sources of consultation and facilities available in the community;

giving recognition to community programs of health education;

providing information which reinforced that disseminated in community programs;

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- providing discussion panel type programs where the public can phone in to have their questions answered, both on and off the air. (OT 20351)

When discussing the media's capacity to incite copying of

potentially harmful behaviour, the submission made reference to experiences in the United States of America in relation to glue­ sniffing, experiences which are equally applicable to a large range of naturally occurring and readily available hallucinogenic substances. A submission to the Commission from Dr R . A. J. Webb, the Senior

Psychiatrist-in-Charge of the NSW Health Commission's Drug Education Unit, contained an article on 'Licit and Illicit Drugs: The Consumers Union Report' by E. M. Brecher and the Editors of Consumer Reports, New York, 1972. This article used incidents in Denver, Colorado, in the

1960s to demonstrate what the authors inferred were the disastrous results of a media campaign against glue-sniffing. It was claimed that a small problem changed into an epidemic because of a media compaign and, even if the authors did not firmly establish the cause and effect relationship between the publicity and the 'epidemic', the article showed what could happen with an incorrect media approach. The authors believed that the media-induced Denver glue-sniffing problem took on national proportions when major national publications, such as Time and Newsweek published the stories.

ADVERTISING

Mass Media Advertising

The community's use, knowledge and view of drugs was considered by many witnesses to be closely linked to advertising in the mass media. As there are only a few fringe journals advertising illicit drugs the vast majority of direct advertising concerns licit drugs such as alcohol, tobacco and medicines of different kinds. Government

regulations and voluntary codes place restrictions on the advertising of licit drugs and virtually eliminate all advertising to do with illicit drugs.

In evidence received by the Commission advertising was considered to affect the community in two major ways. These were the direct effect on community attitudes to, and consumption of, advertised licit drugs and the indirect effect on community attitudes to, and consumption of illicit drugs. The latter was seen as a consequence of the influence which advertising exerts on public attitudes to drugs in general. These effects were seen by critics of drug advertising as being generally harmful and, in the interests of rectifying this situation, some witnesses advocated extension of 'anti-abuse' advertising. Other witnesses argued that advertising's role in the drug scene had been distorted and felt that government legislation and industry self­

regulation guarded against abuses. For its part, the Commonwealth Department of Health commented on the effects of legislation and self- regulatory codes:

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...recent consideration has been given in the United States to the relationship between television drug advertising and drug abuse propensity. One researcher evaluating two studies involving over-the-counter drugs and youth suggested that the

relationship between drug advertising and drug abuse may only be detected if there are special predisposing elements present, for example, certain unhealthy family relationships. A second article looking at both proprietary and illicit drug use among

teenage boys in America, concluded that whilst findings do not establish a causal link between drug advertising and drug abuse, they suggest that drug promotion on television tends to encourage favourable attitudes towards drug use through

exaggerated claims and through failure to point out the need to exercise appropriate caution in drug taking. To some extent the criticisms of the latter study are being dealt with in Australia. A revised voluntary code is the basis for

Commonwealth censorship of advertising of goods for therapeutic use on radio and television. The Media Council of Australia will also base its approval of advertisements in magazines and newspapers on the code. 'Therapeutic goods' in this case

refers to any product making a therapeutic claim, and includes certain food products.

Among those who agreed to the revised code are media and

pharmaceutical organisations. The voluntary code aims to encourage responsible consumer attitudes towards the proper use of medicine by ensuring, for instance, that advertisements do not exaggerate the therapeutic claims of the product and do not

infer that using the product is a substitute for seeking medical/dental advice for a disorder. (OT 20349)

It was pointed out to the Commission that the Commonwealth's power to control advertising of drugs was restricted to the air media under the provisions of the Broadcasting and Television Act. Section 100 of that Act provides that a licensee may not broadcast or televise an advertisement relating to a medicine unless the text of the proposed advertisement has been approved by the Director-General of Health or, on appeal to the Minister under that Section, by the Minister. Advertising of prescription drugs on the air media is not permitted and all States prohibit the advertising of prescription drugs in publications intended

for circulation to the general public. There are also media councils in many of the States exercising control over general advertising of over- the-counter medicines.

Mr N. R. Kelly, Executive Director of the Australian Pharmaceutical Manufacturers' Association (ΑΡΜΑ), commented that controls over medical advertising in Australia were very strict (OT 12594). Both he and a submission from the Advertising Federation of Australia (OT 15932)

referred to the self-regulatory code mentioned by the Commonwealth Department of Health. This code, known as the Joint Committee--Voluntary Proprietary Medicine Advertising Code and dated 3 April 1977, is registered with the Trade Practices Commission. It obliges members

of media, advertising agency and pharmaceutical manufacturer organisations to conform to a set of advertising guidelines concerning

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advertising of substances for therapeutic use. It notes that all signatories should familiarise themselves with all Commonwealth and State Acts, Regulations and Standards and sets out steps which could be taken against those who breach the code. The code details the way all advertisements covered by the code should be submitted for censorship, in the case of 'air media1 to the Commonwealth Department of Health, and in the case of 'print media' to the Australian Newspaper Council.

Criticisms of Advertising

Despite the existence of these restraints strong criticisms were made in evidence about the way the use of drugs was promoted in the media. For example, the Australian Council of Social Service (ACOSS) told the South Australian Royal Commission into the Non-Medical Use of Drugs that advertising legitimised the acceptability of drugs as a way of life. Government-subsidised prescriptions indicated that drugs were good for one's health, and constantly placing drugs in the public eye made them seem a part of normal daily life. The Council also believed advertising gave the impression that it was impossible to cope with life without drugs, and that drugs enabled the user to solve social and emotional problems. The Reverend P. D. Ramsay of the Uniting Church

supported these views (OT 2120) as did the South Australian Alcohol and Drug Addicts Treatment Board (OT 8426).

Witnesses who believed tighter controls on the advertising of drugs were necessary included Dr D. Everingham, a former Minister for Health and now a member of the House of Representatives. He felt drug

advertising should be limited to balanced factual material approved by health authorities (OT 6521). Dr D. M. Phillips on behalf of the Festival of Light in South Australia asked (OT 6821) whether additional restrictions should be placed on advertisements for common

pharmaceutical drugs which harmed habitual users. The excessive promotion of drugs by the advertising industry had a bad effect on general health programs according to the Royal Australian Nursing Federation (OT 8017) and this view was supported by other witnesses such as Mr W. D . Crews of the Wayside Chapel Crisis Centre in Sydney (OT 11804), Mr S. Loosely, National Secretary of Australian Young Labour (OT 9858), and the Australian Society of Nephrology and Australian Kidney Foundation (OT 6912).

Complete prohibition of the advertising of selected types of drugs was proposed by a variety of witnesses. Analgesics and Schedule 3 drugs were two types of drugs mentioned in this regard. Other witnesses considered that a complete ban on the advertising of all drugs was needed. The Director of the Cannabis Research Foundation of Australia, Mr A. W. Parsons, stated his desire for a prohibition on advertising which encouraged the recreational use of drugs, including alcohol,

tobacco and marihuana (OT 2474). Apart from medical journals, no other section of the media should display advertisements for drugs, according to Sister P. Smith on behalf of the Occupational Health Nurses Section of the South Australian Branch of Royal Australian Nursing Federation

(OT 8017).

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Other Viewpoints

The Commission also heard strong expressions of opinion that advertising did not have a detrimental effect on community attitudes to drugs and their usage. This view was supported by those who felt that a lot was being done to ensure that the situation did not deteriorate as

far as drug advertising was concerned. Prominent among these witnesses were representatives of the pharmaceutical manufacturing and advertising industries. A submission to the South Australian Royal Commission by Nicholas Pty Ltd, which was incorporated into the evidence of this Royal

Commission (OT 7944--93), stated:

Advertising and cautionary wording on labels of mild analgesics do much to make the user aware of the dangers of abuse of these products. The total Australian volume market of all mild analgesics has remained static over the last four years.

(OT 7967)

Mr P. N. Daddo, Vice-President and General Manager of Nicholas Pty Ltd, speaking as a representative of a member company of the Proprietary Association of Australia (PAA), said advertising of proprietary medicines was not aimed so much at an increase in total consumption but was geared in a competitive sense more to causing changes in brands (OT

10972). Mr C. J. Tucker, the Assistant General Manager of Nyal Winthrop Divisions of Sterling Pharmaceuticals Pty Ltd, gave evidence in support of Mr Daddo to the South Australian Royal Commission. He rejected an assertion made by the Chairman of that Commission who stated that

studies by the Senate Standing Committee on Social Welfare had indicated that the advertising of compound analgesics tended to increase their consumption at the expense of single analgesics (OT 10972--73). In

other evidence to the South Australian Royal Commission incorporated into the evidence of this Royal Commission, Mr W. J. Guthrie, President of the Proprietary Association of Australia, submitted on behalf of his organisation that all advertising of medicines was thoroughly examined to ensure that it was informative and responsible and unlikely to mislead (OT 10944).

The views of leading members of the advertising industry on this issue were expressed by representatives of the Advertising Federation of Australia (AFA), Messrs D. C. Robertson, J. L. Clemenger and T. B. Wallace, who presented documentation on the influence of advertising

incorporated into evidence as Open Exhibit 466. A series of films and slides, including material on anti-abuse advertising was also viewed by the Commission. Details of studies included in Federation evidence contained findings which supported the viewpoint of the Federation that:

...overall the exposure of TV drug advertising neither directly nor indirectly leads young people to use illicit drugs.

...television and television advertising are generally not factors linked to usage of illicit drugs. For college

students, as for school children, peer group relations and

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family background appear to be important factors in usage of drugs.

...television and radio drug advertisements alone do not alone influence attitudes of students toward illegal drugs but the ads may be one more cultural prop in the maintenance of

favourable attitudes toward drug usage among the young.

...Western nations with no controls of proprietary drug

advertising do not appear, in the aggregate, to be either better or worse than nations with advertising controls, in regard to the scope of drug abuse among their youth. (OT 15930— 31)

Denmark was cited as an example of a country which permitted no proprietary drug advertising but had a drug abuse problem no different from that of countries which allowed such advertising. Research findings known to the Federation indicated that other Western nations with no controls on such advertising did not appear overall to be either better or worse off in terms of youth drug abuse than nations which had

such controls (OT 15948). The Federation witnesses also submitted (OT 15933--37) that their research showed that the results of alcohol and tobacco advertising were similar in that there was no factual evidence of a correlation between the advertising of these products and per capita consumption increases. They asserted that the fundamental reason for this was that the advertising of both products was aimed almost exclusively at attempts to maintain and change brand loyalties.

The Commission also obtained the Federation's views on the usefulness of anti-abuse advertising directed towards lessening drug, including alcohol and tobacco, consumption. The Federation

representatives commented that such advertising in North America and the United Kingdom produced results 'at best difficult to assess' (OT 15938). They stressed that extreme care had to be used in developing media anti-abuse programs because of the ’opposite effect' negative

results of some programs of this type in North America. Programs incorporating more stress on involvement in decision-making promised more chance of success and reasonable success was claimed for anti-abuse

advertising directed at parents in an informative, emphatic and helpful way. Targetting was a problem, especially as non-adults could become 'turned on' by adult-oriented campaigns.

The witnesses said that perhaps a way could be found 'to make it as attractive not to take dope as the media once made it attractive to take drugs' (OT 15942). Although the Federation had been unable to find firm evidence of a communications campaign which was clearly proving to have positive results, there was much activity in various parts of the world and the Commonwealth Government should seek information from other governments about such activities. The witnesses added, however, that the Federation believed anti-abuse advertising was of minor significance in the drug problem and that the main priority was to concentrate on the key causes of drug abuse with the aim of 'finding imaginative and successful solutions' (OT 15943). Perhaps the solution lay in the media

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depicting the absence of drug taking as an attractive alternative (OT 15942).

Not all representatives of the advertising industry agreed entirely with the Federation. Mr P. J. Gaffey of Fortune Australia Pty Ltd, who also had drug counselling and radio drug education experience, considered (OT A657--58) it necessary to have a national education program on drug abuse. His agency hoped for government assistance with

funding of a program which would analyse all aspects of drug addiction. Such a program could be financed and promoted through a Commonwealth Government instrumentality with additional roles for private creative

and placement agencies. Mr Gaffey gave an example of the negative influence of media advertising when he referred to the effects of glamorous advertising of an alcoholic beverage on Sydney youth-oriented radio stations. This campaign had been terminated after complaints were

received (OT 4663).

In their article quoted earlier, Barcus and Jankowski found that advertising of over-the-counter drugs on television was seen by many as a prime villain. They instanced (Open Exhibit 39) N. Johnson, a

former commissioner of the United States Federal Communications Commission, as describing television as the main pusher of drugs in American society, and R. Penna of the American Pharmaceutical

Association was quoted as saying that over-the-counter drug advertising was erroneous, out of control and a major health problem. Penna felt that the worst aspect was that drug advertising contributed to the drug orientation of modern culture.

The authors felt that prior evidence from research studies

indicated that people were encouraged to take substances for their psychological and medical well-being, but that the larger issue of whether the messages were translated into action was not clear. At one level it could be demonstrated that advertising increased the sale of

specific goods and on another level there was the question of

encouraging a tendency to use drugs as part of one's lifestyle. They concluded that the charges levelled against drug advertising as 'the cause' of the drug problem were oversimplified. Indeed they reported a view expressed by some that no evidence of cause and effect connections was available, and that such accusations were a reaction to society's

inability to control drug abuse.

Prescription Drug Promotion

The promotion of prescription drugs by manufacturers persuading doctors to prescribe their products was the subject of much criticism. The Final Report of the South Australian Royal Commission into the Non­ Medical Use of Drugs described this form of advertising as being

directed at the health profession by the pharmaceutical companies, involving advertising in specialist journals, mail campaigns or personal visits to doctors (Open Exhibit 586, p .38). They pointed out that although the target group was small, the part it played in establishing

a climate for drug use was not.

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One body which deplored this form of advertising was the Australian Council of Social Service (ACOSS). In its submission originally presented to the South Australian Royal Commission and later

incorporated into the evidence of this Royal Commission, the Council criticised all forms of advertising which encourage doctors to write more prescriptions (OT 14607). Dr C. Quadrio, a psychiatrist, agreed (OT 13742) with the council that overprescribing was heavily influenced by such 'bombarding' of doctors. Mr G. L. Wighton, Chief Pharmacist at the Launceston General Hospital, cited the use of handouts, free trips to seminars and the like by pharmaceutical companies as influences on the prescribing of drugs (OT 4381).

The Australian Pharmaceutical Manufacturers' Association view was put by its Executive Director, Mr N. R. Kelly, who said that doctors' decisions about prescribing stemmed from an amalgam of their own experiences with drugs, the views of colleagues, and articles in medical journals, as well as from any information they might receive from pharmaceutical companies (OT 12582). Some witnesses who wanted bans on mass media advertising excluded advertising in professional journals

from those bans.

Le Dain Commission Findings

The Canadian Commission of Inquiry into the Non-Medical Use of Drugs, the Le Dain Commission, devoted a chapter of its Final Report in 1973 to the influence of media on drug use (Open Exhibit 22). It

recommended that although a total ban on drug advertising was

undesirable federal authorities should exercise closer control over the tone of the advertising (Open Exhibit 22, pp.220--21). Accurate, matter-of-fact descriptions of the use of drugs designed to inform about availability rather than encourage use, were required. The Le Dain Commission saw pharmaceutical manufacturers' advertising as 'the most significant advertising of drugs today' and pointed out that the medical profession's education in drug use was mainly in the hands of these manufacturers. The Commission recommended that effective controls should be placed over the nature and quantity of such advertising, including controls over the use of samples. It further recommended that the pharmaceutical industry should be encouraged to reduce this kind of promotion generally (Open Exhibit 22, p .221).

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C h a p t e r 5 Evaluation o f Success

The success of a drug education program can only be judged by how efficiently its objectives are achieved. Education programs in general aim to impart information, change attitudes or influence behaviour. As far as drug education programs in particular are concerned, much evidence was received on the need to set specific objectives which were

capable of being properly evaluated. Even when the objectives are stated there are difficulties in measuring changes in behaviour, such as changes in the use of drugs, caused solely by education programs. It was widely held by witnesses before the Commission that before embarking on a drug education program it is necessary to ascertain the group or groups which are its target, why they are the target, and what methods would best inform or influence those target groups. After a reasonable period all programs should be evaluated against their objectives and a process of continual revision established.

Mrs J. M. Nolan of the Commonwealth Department of Health stated that measuring information retention is relatively simple but measuring changes in behaviour or attitudes is extremely complicated (OT 20392). Evaluation of the results achieved by a program should be accompanied by

an evaluation of methods and material used in the program. Armed with the appropriate information, the educator should then either modify or abandon the program. It is desirable that trained independent evaluators, working in conjunction with the organisation conducting the program, should give an impartial assessment.

The absence of proof that drug education programs on their own alter behaviour significantly was referred to by Mr J . R . Gusfield in relation to alcohol. He is quoted as remarking in his book 'Alcohol and Alcohol Problems: New Thinking and New Directions', Ballinger, 1976:

...it is doubtful that campaigns depending solely or largely on public information and education or even on school education are useful strategies for changing behaviour. Most have not been evaluated by careful study. Where they have been, the

results have been disappointing to their initiators or, at best, of limited value. (Open Exhibit 598, p. 114)

In its report, the Senate Standing Committee on Social Welfare made recommendations relating to the evaluation of success of drug education programs (Open Exhibit 379, p. 11). The Committee recommended that the objectives of the National Drug Education Program (NDEP) should be made well known in the community and all drug education schemes should be

evaluated against the NDEP aims. If evaluation found them wanting, funds should be withdrawn from ineffective programs. The Committee also felt Commonwealth funds for the NDEP should allow for proper evaluation. Moreover, the evaluation methods used by Dr R. P. Irwin in his studies

on Canberra adolescents in 1973 and 1974 were regarded by the Committee as effective models for evaluators of drug education programs.

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As one way to ensure a uniform, effective approach to drug education programs a body specialising in the regular assessment and monitoring of programs was set up in 1973. As outlined in Chapter 2, this Assessment Team of the Drug Education Sub-Committee undertook its first assessment

in 1974 and its second in 1977 with the aim of ascertaining whether State programs were in accord with the NDEP philosophy and guidelines. It consulted officials conducting programs and interviewed participants in State programs about their needs.

The Commission was told that the States had always been encouraged to document and evaluate their programs (OT 20394). This enabled a record to be kept of the aims and effects of drug education programs and, if not a scientific evaluation, it was at least a basis from which to start.

The findings of the 1977 Assessment Team in relation to State programs are dealt with in detail in Chapter 2. The Team in its Report of April 1978 (Open Exhibit 541) expressed the opinion that most States could have utilised community support to a greater extent. It was also noted that the content of some programs had changed little since the NDEP commenced. Emphasis in early programs was on appearance of drugs and pharmacological aspects while psychosocial and socio-cultural aspects were neglected. Moreover, the 1977 Assessment Team felt few programs had been effectively evaluated by the bodies conducting them.

According to the Assessment Team, all States should undertake on-going evaluation of their programs. In each program the objectives, target groups and methodology should be declared and periodic written assessments, both quantitative and qualitative, should be made of the achievement of the program. Feedback should be used as a guide for modifying programs before they commenced and while they were under way.

A study undertaken by Dr R. P. Irwin of the Department of Sociology at the Australian National University during 1973 and 1974 has provided a considerable amount of information concerning evaluation of the effectiveness of drug education programs. This particular study was conducted in 19 Canberra high schools and compared data relating to drug use before and after the implementation of a drug education program. The project was conducted in three phases. First a survey was made of the attitudes, beliefs and intentions of the students and the results were used to develop experimental programs. Next, three educational approaches-- peer-led, teacher-led and individual-- were introduced and the results compared with those for a control group which received no program. Finally a follow-up survey was conducted one year later to measure differences from the previously established baseline.

The net recruitment rate (the differences between current users in 1973 and 1974 expressed as a percentage of non-users in 1973) was used to compare the three educational approaches. From the data obtained it seems that in general boys would benefit from individualised

instruction, and girls would benefit most from group-led study. This may indicate that girls have a greater level of skills in group

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interaction. This explanation of the suitability of the group-led approach for girls suggests that more than educational factors may be involved in achieving a lower recruitment rate to drug use.

Dr Irwin drew a number of conclusions from his study:

* A simple educational approach to such complex and

widespread social behaviour is, at best, likely to have limited success. Our cognitive/conceptual educational approaches, though significantly different in their effect on drug behaviour and attitudes, had no significant long­

term effect. Programs of information alone, no matter how accurate or credible, are likely to be even more

ineffective.

* A single instructional technique is likely to fail in any long-term educational approach to the effect of drug use on the quality of living. Group discussions as a single educational approach would be an example of not meeting the multi-causal nature of drug use. The group discussion method without some sequence and progression becomes bogged down in the 1 feel good' awareness type of activity.

* A multiplicity of factors operate in the use of drugs.

Any' effective school educational program will have to incorporate this wide range of factors. To do this will mean that the home and community should be involved in the school's activities. While a greater openness in schools would help place social and health education programs into

a credible and relevant context, the teacher's

professional role must not be excluded.

* Education should not be concentrated on the medical,

legal, psychological or social misuse of drugs.

Educational institutions, as positive enterprises, should seek a better quality of living for their students as a means of avoiding the harmful effects of drug use. (Open Exhibit 379, p p . 182 — 183)

Dr Irwin's studies of the effect of drug education programs high­ lighted the need not only for different approaches for different target groups but also that inappropriate approaches could do more harm than good for certain age or sex groups. The Commonwealth Department of Health told the Commission that Dr Irwin's work was of great value and more research of this kind would be useful. However, it warned that

such research was expensive in terms of time and money and required considerable commitment from a skilled researcher.

The Commission received much evidence that some drug education programs would incite experimentation if not carefully presented. Emphasis on risk-taking in a program could appeal to the young who often experiment with new aspects of living.

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Another factor difficult to evaluate and referred to by some witnesses was the danger of alienation the creation of a generation gap dividing youth and adult into pro-drug and anti-drug factions. It was thought that emphasis should be on the widespread nature of drug use problems, including the use of illegal drugs and the misuse of socially acceptable legal drugs. These problems affect all levels of the community and there was a risk that adults could push teenagers into a defiant use of drugs by emphasising youth drug problems exclusively. Recognition of the obvious fact that drugs presented a wide social problem would enhance the credibility of educators, and credibility is most important when attitude changes are being sought. An educator who

is thought to have accurate, unemotive material and who is regarded as important, experienced or authoritative, or who can be identified with by the recipient, would generally be regarded as being more credible. Credibility is not always objectively assessed by recipients. Indeed, different types of recipients judge the educator's credibility from different standpoints. At times a former addict is accorded greater respect by some groups than a highly qualified expert would be.

Evaluation of fear-arousal techniques also posed difficulties and such methods are not generally regarded as successful in drug education. Positive suggestions, perhaps about alternative behaviour, rather than programs producing only concern or anxiety, were more likely to result

in changes in behaviour. Individuals have many needs which may be capable of being satisfied to some degree by existing socially

acceptable alternatives and these alternatives should also provide opportunities for participation and involvement and relief from daily routines. Alternatives should ideally spring from the individual's own resources but, when drug use is involved, the alternatives have to be capable of serving the function performed by the drugs or they will not replace them. The effects of using fear in drug education programs were regarded by witnesses as producing no desirable long-term effects on attitudes and behaviour. Long-term results were said to be achieved with the backing of factual information presented in a low-key, rational way.

A major difficulty in conducting public drug education programs is that they must be planned in terms of educating everyone, even though no single program can be expected to do this. Drug users or misusers are not always easily identified for selective education, but the success of a program must be assessed with reference to the particular target group whose behaviour it intends to change. Concerning the measuring of

'success' in drug education programs, the Commonwealth Department of Health said:

Determining the 'success' of a drug education program is a complex matter. It may be that for a program to have given people an understanding of the contexts of drug abuse is sufficient justification for considering it a success. However, the same program undertaken with a different group may be a failure due to the characteristics of the 'educator' or to the group's differing needs requiring different program objectives. Intended program consequences may vary from imparting a more accurate knowledge of the effects of drugs,

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reducing the vulnerability of youth experimenting with drugs, to decreasing the incidence of dependence on drugs.

Evaluation of programs in this area involves measurement of knowledge, attitudes and behaviour. Whilst the first two can be assessed relatively quickly, a longitudinal study, costly in terms of time and money, would be required to reliably

determine behavioural effects. Even then, it could not be assumed, for example, that changes in behaviour necessarily implied a change in attitudes, or that a change in knowledge had affected a change in attitude. In addition the costs and benefits of drug education have repercussions in many other

services, such as treatment and rehabilitation and law enforcement. (OT 20344--45)

A number of educators pointed out that drug education programs should be evaluated against the background of health education aims in general. They felt the provision of drug information alone was not ' drug education' because attitudes and values had also to be changed, and recipients of objective drug education programs must relate the

information received subjectively to their own ways of looking at life.

The Commonwealth Department of Health's submission said that, in its visits to the States and Territories, the Drug Education Sub-Committee 1977 Assessment Team had become aware that as a result of a general increase in community understanding of the complexities of drug problems

demand was growing among specific groups within the community for programs directed towards their needs (OT 20346). On the other hand, the public education programs with the wider community as the target group presented problems for evaluators because it was difficult to know

how many persons received the sundry material by way of the print and electronic media and distribution of posters, leaflets and the like. The effects of this material on the acquisition of knowledge or new attitudes produced by a program are thus difficult to assess.

The Final Report of the South Australian Royal Commission into the Non-Medical Use of Drugs (Open Exhibit 586) commented:

If evaluations are to be useful they should examine the fruits of a program rather than its workings. Since such evaluations involve surveys and assessments outside the school they are necessarily elaborate and expensive. For this reason, while

authorities often evaluate processes, they rarely evaluate results. In practice, however, even the attempts to evaluate the workings of a program only assess how smoothly the

program's organisation is working in the school. This is understandable because assessors can determine this by using impersonal questionnaires, or by seeking examples of redundant effort, clashes of interest or timetable problems.

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A rigorous evaluation of a program's results is not only more difficult, expensive and time-consuming. It tends, naturally enough, to be resisted by those involved in and committed to the program who react by criticising, circumventing or rejecting the assessment if it is unfavourable.

(Open Exhibit 586, p .135)

It is not only in Australia that little evaluation of drug education programs is being undertaken. Mrs J . M . Nolan of the Commonwealth Department of Health stated that it was a world-wide phenomenon that programs were set up without thorough examination beforehand, on-going

review, or sufficient evaluation afterwards (OT 20377).

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Chapter 6 C onclusions and R ecom m endations

CONCLUSIONS

Education is one of the principal means available to the community and governments in combating drug abuse. Other approaches dealt with elsewhere in this Report are treatment and rehabilitation of abusers and enforcement of the drug control laws. All of these activities are

interrelated. However education is perhaps the most difficult area in which to arrive at meaningful conclusions leading to precise

recommendations in respect of existing laws or the making of new laws or the taking of measures to remedy inadequacies. The problem is due mainly to the lack of empirical data which, if available, would permit the objective assessment of the implications and effectiveness of drug

education programs. The situation is further complicated because individual value judgments continue to play an important role in any assessment. Indeed the very meaning of the word 'education' is a topic of endless debate and argument. In the specialised area of drug

education the Commission recognises that 'a program draws its contents from the physical, biological, pharmacological, medical, and social sciences and presents it through the social and behavioural sciences'.

There are those who are all too ready to regard 'education’ as a universal panacea to solve society’s drug problems. Drug education in isolation will solve little and indeed may be counter-productive. Education based solely on the distribution of drug information is

inadequate and, on occasions, dangerous. Information does not necessarily change attitudes. Not only must the recipient of

information be equipped to appreciate the implication of that information he must also be in a position to make a balanced choice when faced with alternatives.

Education must be directed to equipping a person to do both of these things. However it must be recognised that there are people who can never be equipped. Carefully tailored education programs do have a role in reducing drug abuse but only in the context of equipping individuals to take their place in the community.

The possibility of negative effects being achieved by education, particularly education used in the sense of the indiscriminate supply of information, must be appreciated. There are circumstances where it would be preferable to do nothing rather than provide inappropriate drug

information to certain individuals. It is as important to recognise these occasions as it is to recognise occasions when education can make some positive contribution.

The Commission noted that the most recent publication of the 'Philosophy of the National Drug Education Program' of the National Drug Education Sub-Committee stated:

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A drug is understood to be any substance, that, when taken into the Living organism, may modify one or more of its functions.

This definition includes not only drugs such as heroin and marihuana but also alcohol, nicotine, analgesics and even mild stimulants such as coffee and tea.

In the context of Australian society it is practically impossible to isolate education in respect of drugs from education in relation to alcohol and nicotine, the most abused drugs in our society.

The National Standing Control Committee on Drugs of Dependence (NSCC) was formed in February 1969 with the prime aim of combating trafficking in drugs. The Committee had its charter limited by

agreement of the Ministers 'that a guaranteed national approach should be taken in relation to illegal drugs and the legal drugs excluding alcohol and tobacco'.

From time to time since its formation, suggestions have been made to remove the exclusion of alcohol and tobacco. Without entering into any debate as to the appropriate scope of the terms of reference of the NSCC, this Commission is of the view that no program of education in

relation to drugs can be credible unless it considers all drugs as defined in the 'Philosophy of the National Drug Education Program'. No program of education that is not factual and honest can possibly succeed.

The Senate Select Committee on Drug Trafficking and Drug Abuse chaired by Senator Marriott in 1971 concluded in relation to education :

4. There is a need for specialised planned programs designed to reach specific age groups and these overall programs should be co-ordinated by one national group which would:

- undertake curriculum research to establish guidelines for new school programs in all States and Territories of the Commonwealth;

- be a national resource centre for collection and

dissemination of factual information;

- develop programs for the training of teachers and

counsellors; and

- support program including seminars directed specifically to the adult population.

This recommendation for the establishment of a national education council representative of the Commonwealth and the States was implemented in the sense that the Drug Education Sub-Committee of the National

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Standing Control Committee on Drugs of Dependence has largely fulfilled the function envisaged by the Senator and his Committee. The exchange of ideas and the examination of programs both Australian and overseas, have resulted in the formulation of the 'Philosophy'. The Commission endorses the 'Philosophy' which has attained general acceptance

throughout Australia.

The principal difficulty that education now faces is the practical application of the accepted 'Philosophy' to a community comprising groups with varying needs and expectations. The very size of Australia, the great variations in the lifestyles of its people and differences in values and beliefs require that there must be considerable flexibility

in the application of the general principles of the 'Philosophy' to particular groups. However, the Commission sees the necessity to continually monitor the application of the principles of the

'Philosophy' throughout Australia. Experiences should be shared so that all can benefit from the lessons that are learned.

The Commission believes that expertise assembled in the State and national drug information centres recommended in Part XIV of the Report should be available for the purpose of making and providing evaluations of the success of programs in achieving their objectives. Evaluation

should be carried out in co-operation with the body implementing the education program. For example, if a State education authority introduces into its schools a program in accordance with the principles of the 'Philosophy', it will be desirable that the efficacy of that program is measured by approved statistical methods. The results of

that evaluation should be passed in this instance to the State

educational authority to assist in the formulation of future programs.

The practicability of imposing appropriate time restraints for reporting upon selected and differing programs should not be overlooked. There is too great a tendency in the community to support any sort of education program on the basis that it must achieve some good.

The media are at present disadvantaged in their attempts to report matters relating to drug abuse in Australia owing to the lack of ready access to accurate information and expertise. The result is that in some instances access is more readily gained to the most unfortunate

assortment of 'instant' expertise. These sources are ever ready to comment upon the drug situation in all its aspects, a topic upon which they have little real understanding, practically no first-hand knowledge and at times ingrained prejudices. This situation would to a large extent be overcome if an information officer were to be attached to each State and Territorial drug information centre. The person appointed to

this position should be expected, coherently and concisely, to convey to the public and to the media relevant information currently held by the drug information centre.

The Commission has noted with concern that the uncertainty of the continuation of Federal and State funding has inhibited the

implementation and progress of some education programs. Some assurance

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of permanence is necessary to attract the most suitable people to this career area. It is therefore desirable that Federal and State

Governments announce formally a continuing commitment to the implementation of education programs. The high staff turnover and lack of career structure due to the present uncertain nature of Government support will be avoided if this commitment is made.

The Commission is of the opinion that the development of a

specialised education unit in each State and Territory will be expedited if priority is given to the provision in appropriate institutions of formal training for drug educators. This training can be provided as pre-service and in-service programs for teachers and health educators. The persons actually providing this training, as opposed to

administrators, should be encouraged to exchange information with other persons providing like education in other States.

It is thought that the information available from the State or Territorial drug information centres will be invaluable for the persons who are presenting these programs of training.

The Commission finds itself in general agreement with the

recommendations of the Royal Commission into the Non-Medical Use of Drugs, South Australia, in relation to education. However, one observation must be made. That Commission recommended that officers of the South Australian Health Commission, the Alcohol and Drug Addicts Treatment Board, and the South Australian Police should not conduct school teaching sessions devoted substantially to drug use. It is appreciated that past experience has shown that some of the people who might fall within the categories mentioned have used methods in schools which would be inappropriate for a substantial number of children. The use of so-called 'scare tactics' is an example. On the other hand, within the parameters of a properly developed program, this Commission

sees no reason why Health Commission officers, persons in the employ of treatment boards, and police officers could not make a valuable contribution to education. In the case of the police particularly, because of geographical considerations and the size of the community

the local policeman may be the only informed person available.

In Part III Chapter 3, 'Why People Use Drugs', the Commission dealt with evidence concerning the effect of family influence relative to drug use. Not surprisingly there was a lack of unanimity on the relevance of family influence to drug taking. Most witnesses whose children had a drug problem could not be expected to concede that a major share of the problem lay with them.

The Commission repeats the reference to the evidence of Mrs P. L. Searles from the Drug Users Parents Aid Foundation (DUPA) in Victoria in which she pointed out that each young person who had attended the DUPA Foundation had had a background of family problems, including divorce, alcoholism, and lack of discipline. She commented:

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The conclusion put forward by the DUPA Foundation is that the problem of drug misuse stems from home environment pressures; this in turn is brought about by social pressures on the

parents.

(OT 3222)

Earlier, in discussing the form of treatment provided by DUPA, namely counselling and the provision of moral support, Mrs Searles said:

We liken drug addiction to a boil; it is useless to clear the top matter which is the addiction; we start working underneath for when the underneath problems are sorted out, automatically the drug addiction will begin to be resolved.

(OT 3220)

The Commission is of the view that many of the problems of drug abuse do emanate from home environment pressures: pressures which, as Mrs Searles says, are often brought about by social pressures on the parents. Very often the result of these pressures is that children do not have made available to them enough of the parents' time. Without

love and support from the family, the children will turn elsewhere for enjoyment, attention, and excitement. Too often today this means they turn to the drug scene.

To say that the parent is in need of education concerning drugs is to indicate again the necessity for community involvement. The school system cannot be expected to accept the responsibility for the parental role. If either or both parents are unable or unwilling to provide the time to prevent the child seeking the company of drug abusers and the

support of drugs, the community, for its own protection and benefit, must do so. This may involve a system of neighbour co-operation and support.

RECOMMENDATIONS

The Commission recommends that:

** Departments, authorities and organisations involved in drug education or having responsibility for decision-making in relation to drug education should:

- give continuing critical attention to drug education

activities, particularly in identifying target groups and adapting programs to the varying needs of the groups

identified;

- continually review the effectiveness of drug education as an overall means of combating drug abuse;

- regularly assess the effectiveness of individual programs against pre-determined objectives. A program which is assessed as not achieving its objectives should be discontinued and any financial or other support withdrawn.

0145

** Any program designed to educate the community or parts of the community in relation to the use and abuse of drugs should concern itself with all drugs, including alcohol and nicotine.

** Bodies implementing practical programs of drug education should be encouraged to submit details of their programs and their

achievements to the State or Territorial drug information centre. The provision of such details should be landatory in circumstances where public funds are involved.

** Information officers should be appointed to each State or

Territorial drug information centre, their most important function being to make available to the public in general and the media in particular all relevant information upon the situation relating to drugs.

** The present restricted advertising of drugs should be continued with appropriate monitoring of the effectiveness of both legal and voluntary sanctions.

** The extent and continuity of funding for education programs should take into account the necessity for forward planning and the retention of staff in an established career structure.

** Educators should direct increased efforts towards impressing on parents their responsibilities to their children and to the community in influencing young people to adopt healthy attitudes towards drug use. At the same time due acknowledgment and support should be given to stable families which contribute so much to minimising drug abuse and other social problems.

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Part XII

Drug Use Controls

Part XII Drug U se Controls

Chapter 1. General Considerations

Chapter 2. Alcohol

Chapter 3. Nicotine

Chapter 4 . Analgesics

Chapter 5. Heroin

Chapter 6 . Methaqualone

Chapter 7. Pentazocine

Chapter 8 . Methadone

Chapter 9 . Cannabis

It would be a prodigious exercise to take every drug

of dependence and consider whether the controls which the law places upon it are excessive or insufficient. The multiplicity of drugs which are presently available has undoubtedly contributed to the modern problem of drug

abuse. Certain drugs presently the subject of controls were mentioned often enough in the evidence for them to be

considered sep a r a t e l y .

This Part summarises the evidence relating to frequently mentioned drugs and the controls upon them. Three legal drugs---alcohol, nicotine and analgesics, are considered in Chapters 2, 3 and 4.

Heroin, dealt with in Chapter 5, is included because of submissions that it has unique properties in certain areas of medical practice and that it should be made available, subject to strict controls, for use in these areas. It was

also said that the prohibition against heroin should be relaxed to permit its use in the treatment of narcotic- dependent persons.

Methaqualone and pentazocine are included in this Part for slightly different reasons. There was a body of evidence that the controls in Australia over these drugs are insufficient. These drugs are considered in Chapters 6 and

7 respectively.

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Methadone is included in this Part because of its use in programs for treating opiate dependence. The main areas of debate were the efficacy of such programs and the logic of treating dependence on one drug by sub­ stituting another drug of dependence for it.

Cannabis appears in this Part because the public debate in recent years, upon whether the Australian pro­ hibition against its use should be relaxed or not, moved into the Commission's proceedings. The evidence on this drug was so voluminous that, even after severe summari­ sation, the Chapter is a very long one.

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Chapter 1 General C onsiderations

In Australia, as in most modern communities, the law is used to exercise control over a wide range of drugs. Both the nature and purpose of the controls differ widely between drugs, depending upon such factors as their recognised medical efficacy, harmfulness, traditional use, extent of misuse, taxing potential, and so on.

Elsewhere in this report detailed reference is made to the various sources of drug control legislation. It is perhaps sufficient at this point simply to note that Commonwealth drug legislation is primarily concerned with Uie importation of drugs into Australia, although

Commonwealth legislation implementing the Single Convention on Narcotic Drugs 1961 established controls on the manufacture of drugs subject to the Convention. State legislation is very much more diverse, ranging from the control of 'poisons' (most States following the Uniform Poisons

Schedules adopted by the Poisons Schedule Sub-Committee of the National Health and Medical Research Council) to controls imposed, for example, on distribution and sale (alcohol) or packaging and inclusion of warnings (tobacco).

THE BACKGROUND TO CONTROLS

Although much work has been done by historians on the historical antecendents of drug controls in the United States of America and some other countries, relatively little serious attention appears to have been given to this subject in Australia (this notwithstanding

considerable scholarly interest in the role of alcohol in the early colonization of this country). It is nevertheless useful to summarise very briefly something of the historical background to the emergence of drug controls in this country.

Several separate, though not altogether unrelated, strands can be identified as creating a community consciousness about drugs and providing motivation for the enactment of legislative measures for their control.

The first of these strands was the deep community concern at the turn of the century directed against the purported dangers of opium use by Chinese nationals who had come to this country principally during the 'gold rush' era. It has been contended, no doubt with some

justification, that the resultant prohibition of opium was as much a discriminatory act against the Chinese minority as it was a response to drug use per se. Nevertheless, opium use was represented in the public arena as a danger to the national moral fibre and recreational use was prohibited.

A second strand was the temperance movement, an international movement which sought to prohibit or restrict the sale and consumption of alcohol. Within Australia, the misuse of alcohol had created serious social problems from the beginning of European settlement, and the

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temperance movement was influential in having laws enacted restricting outlets and trading hours.

A third strand is to be found in a growing consciousness in the early years of this century among national governments of the dangers of the world traffic in narcotic drugs. This led to the convening in 1925 of two Opium Conferences under the aegis of the League of Nations to co­ ordinate international actions against illicit trafficking in narcotics. In the resulting Geneva Convention, signatory nations, including Australia, agreed to control the distribution and sale of various narcotic drugs. It is of passing interest that the Convention included

cannabis as a scheduled narcotic drug at the request of Egypt, Turkey and South Africa because of problems of hashish use within their borders. The Geneva Convention was the forerunner of the 1961 Single Convention on Narcotic Drugs and the 1971 Convention on Psychotropic Substances.

While all three strands already mentioned constituted influences contributing to a community attitude amenable to the restriction or prohibition of what were seen to be harmful drugs, a fourth strand emerged which played a most positive role. The discovery of life-saving drugs, and the proliferation of pharmaceutical products generaly, posed the need to ensure that appropriate drugs were made available for therapeutic purposes. At the same time, it was recognised that the uncontrolled use of these drugs or their diversion for non-medical purposes could in many instances be harmful. This particular scenario gave rise to administrative controls of which the Poisons Schedules are the most significant.

Although legal controls on drugs have tended to be a phenomenon largely confined to the present century, it is clear that they have their origins imbedded in community attitudes and movements of considerable historical and sociological significance. The Commission has accordingly had need to recognise that in approaching the question of drug controls it must take cognisance of the community's substantial and complex inheritance in this area. Notions that the community would be willing, or even able, to 'wipe the slate clean and start again' are unrealistic in the extreme. Furthermore, even if it can be shown that certain of the existing controls were wrongly conceived or implemented illogically, it may not always be open to legislators to impose simple and rational solutions at this point in time.

EXISTING CONTROL STANDARDS

Mention has already been made of the Uniform Poisons Schedules formulated by the National Health and Medical Research Council (N H & M R C ). The Schedules do not have any legal status. However, in the areas in which the Commission is concerned, the States have adopted the

recommended schedules in a reasonably uniform manner. The NH & MRC Schedules involved are schedules 2,3,4 and 8.

The following is a summary of the 'standard' Schedules:

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Schedule 1

Schedule 2

Schedule 3

Schedule 4

Schedule 5

- Substances which are extremely dangerous to human life, e.g., strychnine.

Substances which are for therapeutic use and which require supervision of their distribution, such that their retail sale should be restricted to pharmacies, and, where there is no pharmacy service available, general dealers in medical poisons e.g., codeine, compounded with one of more other medicaments, in preparations containing 1 per cent

or less of codeine.

Schedule 2 substances may not be supplied or sold except by, or under the control and supervision of a pharmacist or a medical, dental or veterinary practitioner in the lawful practice of his profession or by a general dealer in medicinal poisons.

Any person who supplies or sells Schedule 2 poisons shall keep such substances in such a way that customers do not have unrestricted access to them.

- Substances which are for therapeutic use and which are of a sufficiently dangerous nature to warrant their

distribution to be restricted to pharmacists and medical, dental and veterinary practitioners, e.g. , amyl nitrite.

Schedule 3 substances may not be supplied or sold except by a pharmacist or pharmacy trainee under the direct personal supervision of the pharmacist or supplied by a medical, dental or veterinary practitioner in the lawful

practice of his profession.

Any person who supplies or sells Schedule 3 poisons shall keep such substances in a separate part of the premises to which customers do not have access.

The person who supplies or sells Schedule 3 poisons shall make a record of the transaction, in a prescription book or other approved recording system, and shall label the container with his name and address and shall provide

adequate instructions for use, either written or verbal, at the time of supply or sale.

- Substances or preparations, the supply of which, in the public interest, should be restricted to medical, dental or veterinary prescription, together with potentially harmful substances or preparations pending the evaluation

of their toxic or deleterious nature, e.g., barbiturates and tranquillisers.

- Substances or preparations of a hazardous nature which must be readily available to the public but which require caution in handling, use and storage, e.g., methylated spirits.

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Schedule 6 - Substances or preparations of a poisonous nature which must be readily available to the public for domestic, agricultural, pastoral, horticultural, veterinary, photographic or industrial purposes or for the destruction

of pests, e.g., hydrochloric acid.

Schedule 7 - Substances or preparations of exceptional danger which require special precautions in manufacture and use and for which special individual labelling and distribution regulations may be required, e.g., arsenical weed killers.

Schedule 8 - Substances or preparations which are addiction producing or potentially addiction producing including those so classified by the United Nations Organisation or its agencies e.g., cocaine, methadone, pethidine.

For the purposes of the NH & MRC Uniform Poisons Schedules, heroin and cannabis are regarded as Prohibited Substances.

LIBERTY AND DRUG CONTROLS

In the course of extensive public hearings, the Commission received many submissions which at some level of detail addressed the subject of drug controls and the appropriateness or otherwise of the existing legislative and administrative control arrangements. However, in a number of submissions, the Commission was urged to look 'behind' the drug controls themselves and to consider critically the underlying philosophical assumptions upon which the whole legal control structure

is based. It might be mentioned that the occasion for raising the matter was most commonly the 'cannabis debate'; nevertheless, the principles involved apply equally to the control of a number of drugs.

It would be fair to say that all submissions agreed at least

tacitly, that as a matter of principle the criminal law has a legitimate function to perform in regulating certain forms of behaviour in the interests of the preservation of society. What did, however, become a matter of vigorous debate was what particular forms of behaviour should be subject to control by the criminal law and, more fundamentally, upon what criteria should a decision for the intervention of the law be based.

Several civil liberties organisations expressed their concern to ensure that the liberty of citizens was preserved to the greatest extent possible. This theme was representatively voiced by the Queensland Council for Civil Liberties when it stated that it:

...believes that individuals should have the greatest possible freedom to make their own decisions, consistent with the maintenance of a humane, tolerant and free society.

Consequently it is anxious to ensure that the law does not control individual freedom unless there is a vital and very tangible public good to be obtained which outweighs the interference with individual liberty.

(OT 15349)

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Consistent with the appeal for the greatest practicable maximisation of liberty, it was argued by some that there was a need to reduce what was referred to as 'the overreach of the criminal law'. Particular reference was made in this connection to removal of 'moralistic

excrescences', among which were included the 'peculiar and idiosyncratic elements in Judao-Christian morality'.

Appeal was made by some to the classic expression of the

'libertarian' ethic postulated by John Stuart Mill in his essay On Liberty in justification of the removal of drug use from the reach of the criminal law. Mill expressed a principle by which alone society might properly impose physical force (i.e ., legal penalties) or moral

coercion upon the individual, as follows:

...the only purpose for which power can be rightfully exercised over any member of a civilized community against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant. He cannot rightfully be

compelled to do or forbear because it will be better for him to do so, because it will make him happier, because, in the

opinion of others, to do so would be wise, or even right.

These are good reasons for remonstrating with him, or reasoning with him, or entreating him, but not for compelling him, or visiting him with any evil in case he does otherwise. To

justify that, the conduct from which it is desired to deter him must be calculated to produce evil to someone else... (Mill, J. S., On Liberty, Everyman edit, pp .72--73)

On the application of Mill's principle, so it was argued, the cultivation, distribution and possession of drugs ought not in themselves to be subject to any legal restraint.

Closely related to the Mill thesis is the distinction, which again was drawn consistently in the submissions of civil liberties groups, between crimes where there is a victim, and crimes in which there is no immediately identifiable victim. In a paper entitled 'Marihuana : The

Most Victimless Crime of All?' also tendered to the South Australian Royal Commission into the Non-medical Use of Drugs and incorporated in the transcript of evidence of this Commission, Professor Neil Blewett, past President of the South Australian Council for Civil Liberties,

stated:

In the case of murder, assault, robbery, rape, there are clearly identifable complainants calling for the protection of the criminal law. Consenting homosexual acts in private, private personal perusal of pornographic literature, consenting adult incestuous relations, and smoking pot are unlikely to bring 'victims' hurrying to the police with complaints from the participants.

(OT 8208)

Later in the paper Professor Blewett states:

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...as there is no immediate identifiable victim (associated with marihuana use) a peculiarly powerful case needs to be made to establish a justification for using the criminal law to protect others from the harmful consequences of an allegedly victimless crime. The consequences for others...must be substantial, not trivial, and the causal link must be

proximate, direct and clear. In addition a legal response must be appropriate and prudential. (OT 8209)

After further discussion Professor Blewett concludes that on any reasonable test, neither persons nor society at large can properly be regarded as victims, of the simple possession or use of marihuana.

In certain submissions, reference was made, not so much to the philosophy of what the law should or should not do, but rather to the practicality of what the law can and cannot do. Thus Dr R. A. J . Webb, an educationalist in the drug field, stated:

A realistic understanding of what laws can and cannot do is needed. Laws cannot work miracles. They cannot, for example, keep heroin away from heroin addicts, nor marijuana away from marijuana smokers. The most laws can do in these cases is to punish and to alienate. Accordingly laws and enforcement policies should be revised to concentrate on achievable goals... those goals that cannot be achievable by law enforcement

should be assigned to other instrumentalities such as education and social reform. (OT 19375)

In its report titled 'Drug Problems in Australia-- an intoxicated society?1 (p.162) , the Senate Standing Committee on Social Welfare also cautioned against regarding legal penalties as the one necessary and sufficient means of combatting drug misuse. Among a number of

observations along this line, the Committee stated:

We believe that any legal penalty on its own is ineffective in dealing with drug abuse. Unrealistically harsh or selective legal penalties are as inappropriate to the control of cannabis as they are to the control of other drugs. A major challenge confronts our modern community in its efforts to find more realistic and effective ways to discourage all forms of drug abuse in Australia.

(Open Exhibit 379)

Brief mention has already been made of the enjoinder by certain persons and organisations that individual liberty should be not subject to restriction by laws which are 'moralistic' in character.This view, as elaborated in several submissions, is based on the thesis that it is not the proper function of the law to enforce individual moral belief or behaviour. In this connection, the Council for Civil Liberties, Queensland, stated in its submission:

The Council believes that there is a danger that, under the pretence of protecting society from harmful drugs, the law may

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be used to enforce what are essentially moralistic views, based on religious and social attitudes, on persons of whom the proponents of such views disapprove. The Council is further concerned that the penalties to be imposed for breaches of

these laws may reflect the self-righteous zeal of those who wish to be seen to be pure. (OT 15349)

As mentioned previously, the varying arguments presented to the Commission touching upon the role of the criminal law in the drug field constituted something of a debate. Having briefly outlined the main views advanced on the one side of this debate, it is now appropriate to

set down a summary of the contrary arguments-- that is, those arguments offered in support of an active role for the criminal law in the drug field.

The Commission was invited to consider the libertarian postulations of J. S. Mill in their contemporary historical setting. It was pointed out, for example, that Mill's laissez-faire theories of political economy had been used to defend the sale by the East India Company of opium to China. Both Mill and his father, James Mill, had been in the employ of the company, and both continued to be articulate defenders of

the company's activities (see Brian Inglis 'The Opium War1, Coronet Books, London 1976, p p .92--93).

It was suggested to the Commission that Mill's principle was the product of an age characterised by an ill-developed social ethic. As such, it is inappropriate to the world of today in which deep social responsibilities are universally acknowledged.

In several submissions it was argued that while legal sanctions do place restrictions on the exercise of personal liberty, this is a price that is justified by the seriousness of the drug problem. In a paper titled 'Decriminalization of Marihuana is a Spurious Issue' by Dr C. B. Keogh, which accompanied the submission made to the Commission by the

GROW Movement, the author contended that the deprivation of liberty by the law is:

...negligible in comparison to the loss of liberty which

results from serious dependence on a drug like marijuana. And surely the effect on an individual's career and future which may come from a court conviction of this kind and resulting social discredit in the eyes of peers or potential employers is

as nothing when compared to the real ruination of personal growth and prospects of success in life which regular and increasing marijuana use causes. (OT 11332— 33)

On the question of the nexus between private conduct and the public good, some persons argued that the community had perforce to take a prudent, if not cautious, approach in order to safeguard the collective security. For example, after noting that modern governments play an

increasingly active role in the protection of society, Dr Gerald Milner,

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Director of the State Alcoholics and Drug Dependent Persons Services Branch, Victoria observed:

This raises the issue of individual freedom, but it seems reasonable for governments to exercise caution, for the sake of the community and the nation's future. (OT 2603)

It was argued by some that the State has a particular responsibility to safeguard the more vulnerable members of society against the dangers of drugs. Thus, while it could be contended that the mature, the intelligent, the experienced and the well-educated might be permitted to decide for themselves whether they would use drugs, the young, the disadvantaged and the handicapped could not realistically be held to be free to make rational choices in this area. Dr Hardin B. Jones,

Professor of Medical Physics and Physiology, University of California at Berkeley, in a submission to the South Australian Royal Commission into the Non-Medical Use of Drugs, which was incorporated into the transcript of evidence of this Commission, stated:

In my opinion, parental and governmental responsibility must be exercised to protect the young from hazards the young are not likely to perceive, and there should be steady legal pressure against the willful use of harmful substances in some degree of proportion to the degree of hazard.

(OT 7765)

Addressing the view that drug crimes have no victims, several submissions contended that there are in fact many victims of drug misuse. Reference was made, for example, to the families of users who suffer directly; there are the users themselves who, to the extent that drug use may destroy their power to choose whether or not they shall continue to use drugs, are victims; finally, there is society at large, which is frequently denied the positive contribution which drug users

could otherwise have made, and is further encumbered by the economic cost of trying to rehabilitate those who are being destroyed by drugs.

The foregoing paragraphs indicate the main thrusts of the arguments put before the Commission on the relative weights to be accorded 'liberty' and 'law' in approaching the drug question. Some of these arguments are further elaborated in the following chapters on individual drugs (particularly that on cannabis).

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Chapter 2 A lcohol

FEDERAL CONTROLS

A considerable amount of legislation is directly related to alcohol and the liquor industry. The Excise Act, the Distillation Act, the Spirits Act and some sections of the Customs Act are relevant Commonwealth legislation.

The alcohol content of various beverages is a matter for the States but the National Health and Medical Research Council, a Commonwealth body, has established a standard specifying minimum alcohol content for wines, spirits, beer and cider. There are no legal controls on maximum

alcohol content, nor are there any strict controls on the home brewing of beer or other alcoholic beverages.

Customs and Excise

Customs duties are imposed on beer, wine and spirits imported into Australia. Excise is collected on locally produced beer and spirits but not on wine. Customs duty on beer, wine and spirits is based on alcohol content. Excise duties are partially based on alcohol content. 'Beer',

for example, is defined as having an alcohol content of 1.15 per cent by volume. No duty is charged on beer with a lower alcohol content.

Federal excise revenue collected on alcoholic beverages has increased considerably in recent years, as illustrated in the following tabulation from the Australian Bureau of Statistics, 'Year Book, Australia 1977— 78', and personal communication. Data for 1978— 79 are preliminary and subject to revision.

Year Beer Spirits,

liqueurs etc.

$'000 $'000

1971 — 72 398 330 27 180

1972— 73 419 954 30 501

1973— 74 462 400 46 037

1974— 75 475 963 62 847

1975--76 694 014 66 941

1976--77 745 170 71 670

1977--78 757 815 75 951

1978--79 947 627 100 058

Other Controls

The Commonwealth imposes production controls on alcoholic beverages under the Spirits Act and the Distillation Act. The Senate Standing Committee on Social Welfare under the chairmanship of Senator Peter Baume, in its report 'Drug Problems in Australia an intoxicated

society?' outlined the provisions of these Acts:

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The Spirits Act contains requirements relating to the description of goods as 'Pure Australian Standard Brandy', 'Australian Blended Whisky' and so on in the course of trade and commerce with other countries or among the States.

In the Distillation Act, there are provisions prohibiting the distillation of any spirits or the ownership of stills without a licence. This legislation imposes no controls on the maximum alcohol content of spirits. A section dealing with the

fortification of wines prohibits wine containing more than 33 per cent by volume of alcohol. This provision appears to be an attempt more to control the use of wine spirits in the

fortification process-- and to protect the revenue than to prescribe a maximum alcohol content for wine. (Open Exhibit 379, p . 48)

The Federal Government may also control the advertising of alcoholic beverages on radio and television although to date it has not done so. However, the media subscribe to a voluntary code for the advertising of alcoholic drinks. This was authorised by the Trade Practices Commission and is monitored by the Media Council of Australia.

STATE CONTROLS

The two main areas of State government control relate to the licensing of commercial premises and driving while under the influence of alcohol. Other provisions under State laws cover the alcohol content of beverages, advertising in the print media, the conduct and conditions relating to certain professional occupations, treatment facilities, and the conduct of persons affected by alcohol in public places.

State laws relating to alcohol are discussed more fully in Part V. In this review of the controls open to State governments one State--Queensland-- is selected as the basis for discussion since the range of controls does not differ significantly from State to State although there are variations in the laws.

Licensing Laws

All States and the two mainland Territories have legislation controlling the distribution of alcoholic beverages. For present purposes it is unnecessary to examine the legislation of each place. A sufficient appreciation of this type of legislation is obtained by considering the scope of the Queensland legislation.

In Queensland the major legislative provision relating to licensing is the Liquor Act 1912. This Act empowers the Licensing Court to hear applications for licences and to determine cases where breaches of the Liquor Act or Regulations have occurred. The Licensing Commission is

responsible for the administration of the Act and for bringing relevant matters before the Licensing Court.

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The Liquor Act imposes certain conditions on licences, including corporate or firm licences, terms, types, number and fees for licences; the transfer, forfeiture, loss or cancellation of licences; compensation payable after the cancellation or surrender of a licence; and tenders

for the removal of licences from one premises and/or locality to another.

A range of obligations, duties and liabilities are placed on licensed victuallers under the Liquor Act. These include conditions relating to the premises, such as the display of specified signs, state of cleanliness and repair, beer gardens, gaming machines, art unions and games and music. The liquor sold on the premises must be by measure, in unadulterated form, in specified containers and at no more than the maximum price as fixed by the Licensing Commission. It is also an

offence to sell liquor to prohibited, intoxicated, under-age or insane persons.

Other provisions under the Liquor Act relate to the sale of aerated waters and food, and the provision of accommodation and meals. Hours of operation are specified in the Act, and these may be varied on special occasions such as Christmas and New Year by the grant of a festivities

permit. Licensees must also abide by conditions on disorderly conduct, offences committed by agents or employees, absence from or abandonment of the premises and the recording of convictions.

The Liquor Act also specifies conditions peculiar to the various types of licences granted. In all, 19 separate categories of liquor licences are mentioned in the Act, including victualler's, caterer's, limited hotel, spirit merchant, bottler's, packet (for sea-going vessels) and certain types of establishment licences such as clubs,

taverns, restaurants, airports, and the like.

There has been a steady increase in the number of liquor outlets in Queensland over recent years. The number of hotels has declined slightly, from 1090 in 1969 to 1080 in 1978. There has been a

significant increase in the number of licensed clubs, restaurants and function rooms, and premises holding limited hotel licences. Numbers of bottler's licences have fallen.

The increase in the number of licensed premises other than hotels is apparent in other States also; for example, South Australian figures quoted in the report of the Senate Standing Committee on Social Welfare, 'Drug Problems in Australia-- an intoxicated society?', showed a dramatic increase in the number of limited publicans, wholesale and

retail storekeepers, vignerons, club, restaurant and twenty-litre licences. The number of licensed hotels, as in Queensland, remained static (Open Exhibit 379).

Licensed premises are a major source of taxation revenue for State governments. The taxes levied on licensed premises vary among the States, and in each State among the different types of licences. In

Queensland fees may be a flat rate (e.g., bottler s licence), a

percentage rate of liquor sales (e.g. a victualler's licence) or some

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combination of the two (e.g ., a spirit merchant's licence). Annual rates charged in Queensland range from a flat $20, through various percentage rates, to a maximum of $400 and 12 percent of gross liquor sales. These rates may be, and are, varied from time to time.

State governments raise a large amount of revenue from liquor taxes. Data supplied by the Australian Bureau of Statistics showed a steady increase in the amount of liquor taxes collected in all States. The liquor taxes collected in Queensland over the period 1968--69 to 1977 — 78 illustrate this upward trend.

Year Amount

($'000)

Percentage change on previous year (%)

1968--69 5 218

1969--70 5 745 10. 10

1970--71 6 253 8.84

1971 — 72 6 902 10.38

1972--73 7 915 14.68

1973--74 9 531 20.42

1974--75 10 631 11.54

1975--76 13 484 26.84

1976--77 20 831 54.49

1977--78 24 379 17.03

(Source: Australian Bureau of Statistics 1977-78, Cat. No. 5506.0, Table 2, Taxation Revenue Australia Canberra 1979.)

Liquor taxes in each State represent between 2 and 8 percent of all taxes levied. Liquor taxes are also collected in the Australian Capital Territory and the Northern Territory. Data for 1977 — 78 are shown below for all States and Territories.

State or Territory

Amount collected

Percentage of total taxation

$'000 %

New South Wales 54 586 3.24

Victoria 34 088 2.59

Queensland 24 379 4.84

South Australia 10 941 3.08

Western Australia 12 850 3.74

Tasmania 3 774 3.91

Australian Capital Territory 1 181 3.18

Northern Territory 1 325 7.54

Australia 143 124 3.28

(Source: Australian Bureau of Statistics, Taxation Revenue Australia 1977-78, Cat. No. 5506.0, Tables 6, 9-15, Canberra 1979.)

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The New South Wales government also collects extensive revenue from poker machines-- in excess of $98 million in 1977--78. Those are situated almost solely in licensed premises. Tasmania collects gambling taxes from the Wrest Point Casino, which is a licensed establishment.

The Queensland Liquor Act also provides for payments to be made for specific purposes from a Trust Fund established under the Act. In August 1979, payment of $80 000 was made to the Minister for Education to assist in an educational campaign to discourage intemperance; $105

900 was allocated to the Minister for Health to assist in the health program in relation to alcoholism; and the Minister for Transport received $102 100 to maintain a publicity program to emphasise the

dangers in the consumption of liquor to users of the roads.

Traffic Laws

There are various provisions in State and Territorial legislation regulating the use of motor vehicles by persons who have consumed alcohol or drugs. Generally, all jurisdictions make it an offence to drive a motor vehicle whilst under the influence of alcohol. In

Queensland and Victoria it is an offence to be in charge of a motor vehicle whilst under the influence of alcohol.

In addition to these offences all States and Territories have legislation forbidding persons to drive or attempt to drive a motor vehicle when they have alcohol in their bloodstream in an amount equal to or in excess of a prescribed concentration. The prescribed

concentration is expressed in terms of a number of grams of alcohol per one hundred millilitres of blood which is frequently expressed as a percentage of blood alcohol. In South Australia the prescribed concentration is 0.15 grams of alcohol per 100 millilitres of blood

(0.15 per cent) while in Queensland it is 0.08 grams of alcohol per 100 millilitres of blood (0.08 per cent).

Blood alcohol concentrations are measured by a screening test. The Law Reform Commission in its report 'Alcohol, Drugs and Driving1 stated:

...Persons 'passing' the test are usually released from the liability to undergo breath analysis or a blood test (whichever may be appropriate). It is a quick and relatively informal test. Police consider this to be advantageous both for the

efficient working of law enforcement and as a means for quickly eliminating members of the public from suspicion. The

instrument used for this screening test in the States is a device such as the 'Alcotest', a patented instrument. This is a relatively simple equipment. It consists of a tube attached

to a plastic bag. The person being tested blows through the tube into the bag. The tube is filled with chemical reagent which will change colour in the presence of alcohol beyond a certain limit. If it does change colour in this way statutory

consequences follow to take the testing of the subject to the next and more rigorous stage. (Open Exhibit 600, pp. 22-23)

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Prerequisites for breath analysis tests: Each State law contains a provision for the determination of blood alcohol content by the use of a breath analysing instrument. In each case the 'Breathalyser' is in fact the breath analysing instrument used. It is the primary means of ascertaining blood alcohol concentration in each Australian State and Territory. The police in each State may require a person to submit to such breath analysis if it appears from the screening test that the percentage of alcohol in blood exceeds (or in some cases, equals) the prescribed limit. It may also be required if a person refuses or fails to provide a sample for a screening test.

(Open Exhibit 600, pp. 24)

Persons found guilty of driving with more than the prescribed blood alcohol concentration are subject to penalties which have been increased in most jurisdictions over the past few years. These penalties take the form of fines, imprisonment and loss of licence. The penalty for a first offence can be as high as a fine of $1000 coupled with six months imprisonment and a disqualification from holding a driver's licence until the court orders otherwise.

The relationship between alcohol and road accidents provides cause for extreme concern. Recent Queensland data show that between 5 and 8 per cent of all accidents involve persons who had concentrations of alcohol in excess of the legal limit, and more than one-third of all

road fatalities are associated with alcohol. These figures understate the total incidence of alcohol in road traffic accidents owing to delays in reporting accidents, severe injuries preventing testing for blood alcohol, and other conditions relating to the age and injuries of accident victims, length of time of survival, and the feasibility of, and facilities available for, conducting tests. The Commonwealth Department of Health has estimated that 50 per cent of all fatalities

are due to alcohol (Open Exhibit 379).

The majority of persons with positive blood alcohol tests are aged between 17 and 29 years-- 58.4 per cent of persons in 1977 — 78 in

Queensland. The age groups under 30 years also showed the highest incidence of positive tests in their segment of the population. In approximately 90 per cent of all positive tests blood alcohol levels were in excess of the legal limit. The proportion of positive tests with readings of 0.15 and above range from 28.‘6 per cent in the under 17 years age group to 74.3 per cent in the 30--39 years age group.

The dangers of driving while under the influence of alcohol are well known. However, many witnesses told the Commission that other drugs, both legal and illegal, may also adversely affect driving performance, especially if combined with alcohol. Dr D. G. Wilson, the Queensland Government Medical Officer, stated:

..the full effect of alcohol on driving competence was not appreciated until objective methods of measuring blood-alcohol levels became generally available. The same may well be true

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of psychotropic drugs, either alone or in combination with alcohol. It is suggested that this problem may be compared with the role of alcohol in traffic safety thirty years ago, and unless it is curbed now, could parallel the role of alcohol

today.

(OT 2074)

Dr Wilson said that addition of alcohol to therapeutic drugs already taken causes an adverse interaction and severe impairment of motor skills is predictable. Potentiation occurs and the impairment is greatly in excess of the simple additive effect of each substance taken separately (OT 2072).

Dr Wilson continued:

The most frequently seen instances of impaired driving skills caused by drug--aIcohol interaction are those involving prescribed drugs and alcohol. This is also the pattern

observed in Britain, Europe and the North American continent. As such, the problem has a large in-built preventive content....

Almost all psychotropic drugs interact with alcohol to produce adverse effects on driving skills. The use of alcohol and psychotropic drugs has been increasing steadily over the past few years, and continues to increase.

(OT 2084)

...Hence, the problem of drug--alcohol interaction and traffic safety is not likely to decrease without some positive action. As mentioned, the problem has an in-built preventive content. Legislation is not the sole approach to this problem, nor perhaps the most desirable approach. Educational programmes

are essential to a complete attack-- but they must be

programmes with a difference, directed to the prescriber rather than the consumer, for the adverse effects of alcohol--drug interaction may truly be described as an iatrogenic disease. It must be the duty of every doctor to fully understand the properties of each drug he prescribes, and to warn his patient

in relation to driving a motor vehicle, operating machinery and drinking alcohol whilst taking the drug. (OT 2084--85)

A psychologist with the Road Safety Research Section of the Victoria Department of Transport outlined a problem relating to the combination of alcohol and drugs in drivers:

It could certainly be the case that some drivers on the road with, blood alcohol levels below the legal limit, who have also taken one of these drugs, would have an accident risk similar to a driver whose blood alcohol concentration was above the

legal limit. , (OT 2893)

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Professional Occupations

Each State government has enacted legislation regulating the conduct of members of certain professions. Under most Acts alcoholism or drug dependence is considered as misconduct, and penalties are laid down for persons found guilty of such misconduct. These range from fines,

cautions and censures to suspension or cancellation of registration. The professions concerned include some or all medical practitioners, veterinary surgeons, optometrists, physiotherapists, nurses, dentists, architects, pharmacists, dental technicians and surveyors.

Public servants are also subject to penalties such as cautions, deductions from salary, demotion and dismissal if guilty of using alcohol or drugs to excess. These provisions may also extend to quasi­ government bodies-- for example, Hospital Board employees in Queensland under the Hospitals Act 1936.

Other State Legislation

There are numerous references to alcohol in State Acts. The legislation covers areas such as production standards, including minimum alcohol content and regulations on adulteration of liquor; voluntary and compulsory treatment and treatment centres; conduct in a public place; unlawful administration of alcohol or drugs; protection of children

falling or likely to fall into a life of alcoholism or drug addiction; protection orders for the management of the affairs of persons unable to manage their own affairs because of alcoholism or drug dependence; and custody of children and/or maintenance for one party to a marriage where the other party uses alcohol or drugs to excess.

While not all States have enacted legislation in the areas mentioned above, they have the power to do so. The States may also control the content of alcohol advertisements in the print media, to the extent of banning promotions for alcoholic beverages.

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Chapter 3 N icotin e

COMMONWEALTH CONTROLS

Commonwealth Government controls over tobacco are less wide ranging than those over alcohol. The legislation covers customs and excise, marketing and advertising.

Customs and Excise and Marketing

Customs and Excise duties are charged on loose tobacco, cigars, cigarettes, snuff, and cigarette papers. Excise collected on locally produced tobacco has risen in recent years. The Australian Bureau of Statistics Year Book No 62 and personal communication with the Bureau

shows that the total excise revenue from tobacco products increased from $309m in 1971 — 72 to $655m in 1978--79. (1978--79 data are preliminary).

The Senate Standing Committee on Social Welfare under the

chairmanship of Senator Peter Baume outlined other areas of Commonwealth Government involvement in the tobacco industry. The Committee's Report, Drug problems in Australia-- an intoxicated society?, stated:

From the 1930s, the Commonwealth made money available to the States to assist them to continue research and to expand extension work in the tobacco industry. The Federal Government itself, through the Commonwealth Scientific and Industrial Research Organization, gave similar aid directly to the

industry. Since 1955, further support has been provided by the Commonwealth through the Tobacco Industry Trust Account, into which are paid the proceeds of a system of levies on growers and manufacturers, together with matching contributions by the

Government.

In 1941, the Australian Tobacco Board was established; it lasted only until 1948. The Tobacco Marketing Act 1965 again established an Australian Tobacco Board, to administer a stabilisation plan which was based on agreement between the Commonwealth and the States and which commenced on an interim basis with the 1965 selling season. This plan allows the Board

to supervise the marketing of Australian tobacco, to set production quotas for individual growers and to fix minimum prices for leaf.

In 1975--76, the Commonwealth Government contributed $429 862 to the Tobacco Industry Trust Account, but it made no

contribution to the anti-smoking education program during that year. (Open Exhibit 379)

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Advertising

Since 1 September 1976, under amendments to the Broadcasting and Television Act all radio and television advertising of cigarettes has been banned. In addition, Commonwealth and States require cigarette packets to carry a warning that 1 smoking is a health hazard', although other tobacco products need not be similarly labelled. The Commonwealth Government has no power to legislate for the print media and to date there are no restrictions on tobacco advertising in this area, except for the voluntary code for advertising cigarettes which was adopted jointly by the industry and the Media Council of Australia.

Despite the ban on radio and television advertising, tobacco manufacturers have been able to publicise their products through sponsoring major sporting and cultural organisations and events, and have bought the rights to advertise at sports grounds where games and other events are televised. As the sponsor's name is in most cases

identical with the brand name of the product (cigarettes),it seems clear that manufacturers, while conforming to the letter of the law, are not complying with the spirit.

The health risks associated with tobacco use are now accepted generally. Therefore, it is considered desirable that sport, which demands a high level of physical fitness, should not be linked in the public view with tobacco smoking.

The ban on television advertising of cigarettes appears to have affected tobacco consumption in Australia. The Commonwealth Department of Health Annual Report for 1977— 78 showed a decline in per capita consumption of cigarettes since 1976. Per capita consumption of all tobacco products has declined since 1974, although in recent years both loose tobacco and cigars have fluctuated in popularity. The year 1976, when the ban was imposed, showed the only decline in total consumption

of all tobacco products in the 10-year period from 1968 to 1977.

The Commonwealth is also involved in a campaign against smoking, and has issued pamphlets warning of the health risks in smoking. Non­ smokers are encouraged not to start and advice is given to help smokers give up their tobacco use.

The National Health and Medical Research Council (NH & MRC) has made recommendations designed to preserve the rights of non-smokers. The following resolutions were affirmed by the 82nd session of the NH & MRC:

(a) To prohibit smoking in hospitals and other health care institutions, except in specially designated areas;

(b) To adopt regulations to protect non-smokers from exposure, without their consent, to tobacco smoke in the working environment;

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(c) To provide or extend non-smoking areas in public transport and other public places where smoking is not totally prohibited;

(d) To clearly define non-smoking areas in public transport and other public places where smoking is not totally prohibited, such as restaurants, cafes and bars; and

(e) To give special attention to the protection of infants from contact with persons who are smoking. (Open Exhibit 379)

The NH & MRC has a continuing role in the campaign to reduce the risks of smoking for all Australians.

STATE CONTROLS

The State Governments have powers relating to the marketing of tobacco, its sale to minors, health education, advertising and smoking in public places.

Tobacco is marketed in Australia by the Australian Tobacco Board. In addition, tobacco-growing States have established their own boards to regulate the production and distribution of locally grown leaf. The States also provide funds for research in various aspects of the tobacco

industry.

All States and the Australian Capital Territory have legislation prohibiting the sale of cigarettes and tobacco to persons under 16 years of age. The penalties provided are not severe— a maximum fine of $20 in most States-- and may not provide a substantial deterrent. The

introduction of cigarette vending machines into many public places presents a further reduction in the effectiveness of these laws due to the difficulty of policing sales from these sources.

Some States have partially or completely banned smoking on public transport and smoking is also prohibited in parts of theatres and cinemas and other public places. Many private businesses, in response to the publicity given to health risks associated with smoking, request

clients not to smoke while on the premises.

The States also conduct public health education programs which have concentrated on smoking. They produce anti-smoking literature and publish leaflets on the dangers to health and means of prevention. The States have the power to ban tobacco advertisements in the print media but to date they have made no moves in this direction.

Advertisers have accepted a voluntary code for advertising cigarettes in newspapers and magazines. The cigarette manufacturers lodged the code with the Media Council of Australia. The main points of the code are that cigarette advertisements should be aimed at adults

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only and be designed to effect a change of brand, not to increase consumption or entice non-smokers, particularly children, to start smoking.

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Chapter 4 A nalgesics

Analgesics are used in the relief of pain. For severe pain, narcotic analgesics such as morphine and its derivatives as well as synthetics are used. Minor analgesics such as aspirin and paracetamol are the drugs of choice for the suppression of mild pain. The narcotic

analgesics are considered elsewhere in this Part; this Chapter is limited to the minor analgesics.

The minor analgesics may be simple composed of a single active ingredient or compound a combination of two or more active

ingredients. The minor analgesics can include chemicals from the aniline group, such as paracetamol and phenacetin; the anthranilic acids; the phenylalkanoic acids; pyrazole derivatives; and salicylic

acid derivatives including aspirin and salicylamide. Caffeine, a mild stimulant, is often included in compound analgesics, as is codeine, one of the less potent analgesics in the narcotic group.

The Commission received evidence from the Australian Kidney Foundation about the incidence of analgesic nephropathy-- a renal disease-- in Australia. Professor Kincaid-Smith, Professor of Medicine in the University of Melbourne, told the Commission that Australia had a

unique problem in relation to minor 'over-the-counter' analgesic agents. Papillary necrosis, a condition associated with analgesic nephropathy, is far more common in Australia than in other countries. Professor Kincaid-Smith stated:

...whereas 0.1--0.2 per cent of autopsies in the United Kingdom and the United States show papillary necrosis, this lesion has been recognised in between 3.7 per cent and 21 per cent of cases in Australian surveys... there appears to be an increasing percentage since 1962.

(OT 3078)

Another indication of the serious extent of this problem in Australia can be seen in the data from the Australian Kidney Foundation Dialysis and Transplant registry. This shows that 20 per cent to 25 per cent of patients currently being accepted

for dialysis and transplantation patients in Australia have analgesic nephropathy. This figure compares with a figure of 3 per cent of cases in a similar registry of cases presenting for dialysis and transplantation in Europe. The percentage of

cases with this diagnosis in Australia appears to have

increased and have not declined over a period of nine years covered by the Australian Kidney Foundation Registry data.

Abuse of analgesics is almost exclusively confined to over-the- counter compounds and mixtures with a high caffeine content. These are often taken in the form of powders. (OT 3080)

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Data presented by the Australian Kidney Foundation to the Senate Standing Committee on Social Welfare indicated that Queensland and New South Wales (including the A.C.T.) had the highest frequencies of analgesic nephropathy in relation to both end-stage renal failure and population size. The data showed that the proportion of end-stage disease due to analgesics in the period 1 July 1971 to 30 April 1976 was 30 % in Queensland, 25 % in New South Wales (including the A.C.T.), 17 % in South Australia, 12 % in Western Australia and 5 % in Victoria. No cases of analgesic nephropathy were reported in Tasmania over this period. The number of patients per million population varied from 8.4

in New South Wales to 6.7 in Queensland, 4.3 in South Australia, 2.3 in Western Australia and 1.3 in Victoria (Open Exhibit 379, p. 109).

These data were confirmed by Dr J. H. Stewart, Chairman of the Analgesics Sub-Committee of the Australasian Society of Nephrology and the Medical and Scientific Advisory Committee of the Australian Kidney Foundation. Dr Stewart showed that, from the year commencing 1 November

1971 to the year ending 31 October 1977, 20 % of all end-stage renal failure cases were due to analgesic nephropathy. In Queensland the percentage was 29.6, and in New South Wales (including the A.C.T.) it was 27.9. Of the total of analgesic nephropathy cases reported to the Australian Kidney Foundation Registry during the period, Queensland

cases represented 20.1 % and those in New South Wales (including the A.C.T.) represented 64.3 % (0T 10648).

Data for end-stage renal failure are the most precise available. The incidence of non-terminal analgesic nephropathy is not known; however the Australian Kidney Foundation has estimated that at Sydney Hospital alone there are more than 10 non-terminal cases of renal

failure for each end-stage case (Open Exhibit 3 7 9 , p. 109).

Professor Kincaid-Smith pointed out that the frequency of analgesic nephropathy correlated with data obtained from surveys on daily consumption, by State, of minor analgesics. Consumption in Queensland and New South Wales for both capital cities and country towns was higher than in all other States (OT 3081; Open Exhibit 379, p. 110).

The Senate Standing Committee on Social Welfare in its report on 'Drug Problems in Australia an intoxicated society?' derived consumption figures for powders and tablets from data supplied by Reckitts Pharmaceutical Division, a division of R. and C. Products Pty Ltd. These data showed that Queensland (including the Northern Territory) and New South Wales (including the Australian Capital Territory) accounted for 24.5 and 44.2 % respectively of national sales of all analgesics. Sales of powders in these two States, especially Bex and Vincent's, accounted for more than 87 % of all analgesic powder sales in Australia. Consumption in these States for powders was 3--11 times greater than in the other States (Open Exhibit 379, pp. 112--113).

Renal damage and dependence on analgesics have been more closely associated with compound analgesics than with single analgesics. Proprietary medicines containing only aspirin (such as Aspro and

Cl 70

Disprin) or paracetamol (Panadol) are seldom addictive. Bex and Vincent's powders have been considered the major cause of analgesic nephropathy in the past owing to the incorporation of phenacetin.

Vincent's replaced phenacetin in 1967 with salicylamide, and there is evidence to show that there was a decline in the incidence of analgesic nephropathy. Beckers Pty Ltd replaced phenacetin in Bex with

paracetamol in 1975. In States where compound analgesics are no longer available on open sale (see later section of this Chapter dealing with State controls), Bex and Vincent's have been reconstituted as single­ substance products.

COMMONWEALTH CONTROLS

Some " components of minor analgesics such as codeine are subject to strict import and export controls under the Customs Act. Codeine is a prohibited import and export, except when specified conditions such as a permit from the Commonwealth Health Department are met. Other

components of minor analgesics including aspirin and paracetamol are subject to import controls on their quality.

The Therapeutic Goods Act 1966 allows for the determination of standards relating to the composition, strength, potency, stability, quantity, quality and method of preparation of therapeutic substances or articles. There are also requirements in relation to the labelling or packing of goods. In addition, the Commonwealth Department of Health

administers the Code of Good Manufacturing Practice in collaboration with the States to which the manufacturers of proprietary medicines, including analgesics, must conform.

The National Health and Medical Research Council (ΝΉ & MRC), as part of its function to monitor public health issues, set up a working party at its Eighty-Second Session in October 1976 to examine the evidence linking abuse of minor analgesics with analgesic nephropathy. As a

result of the Working Party's findings the Council made the following recommendations in April 1977:

That aspirin, paracetamol and salicylamide and their

derivatives should be available by open over-the-counter sale only when they are supplied as single substances, not combined with any other therapeutically active substances; packed in units containing not more than 25 tablets or 12 powders; or in

containers with suitable child resistant closures.

That aspirin, paracetamol, salicylamide and their derivatives, when combined with not more than 1% of codeine, packed in units containing not more than 25 tablets or 12 powders and supplied in strip packs or child resistant closures, be scheduled S2.

That a mixture of any two or more of aspirin, caffeine,

paracetamol, salicylamide and their derivatives should be scheduled S4. (Open Exhibit 382)

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Drugs classified as Schedule 2 can be sold only by chemists or licensed poison dealers while those classified as Schedule 4 can be supplied only on a doctor's prescription.

The manufacturer of Vincent’s powders and tablets, Nicholas Pty Ltd, was opposed to the ΝΉ & MRC recommendations on the grounds that there was no evidence that over-use of analgesics is a major problem, at least in the sociological sense. A representative of the Company told the Commission:

Over-the-counter products, which have for so long benefited so many in terms of personal health, have also been of significant benefit to the health care economy.

It is estimated that much of Australia's health care problems are treated by home medication, taking a considerable amount of the burden from our over-worked doctors.

Apart from a severe escalation in the cost of mild analgesics and denying the community access to these products, we believe that restriction of all mild analgesics to pharmacy only would have virtually no effect on consumption of the determined abuser.

Nicholas believes that there should be no further restriction of sales outlets for mild analgesics. (OT 7966)

Advertising on radio and television is also under Commonwealth control; however, advertising in all media forms is considered in a separate section of this Chapter.

STATE CONTROLS

State and Territory legislation contains provisions for the manufacture of proprietary medicines similar to those under Commonwealth legislation. State and Territory laws also regulate the retail and wholesale trade in these medicines. Analgesics containing codeine

combined with aspirin, paracetamol or salicylamide are listed as Schedule 2-- sale only by pharmacists or licensed poisons dealers. Several States also have special labelling requirements. Preparations containing more than a specified amount of codeine, or in pack sizes greater than the maximum limits, are further restricted. They must not be on open display in pharmacies, and there are proposals in some States and Territories for sales to be limited to those actually dispensed by the licensed pharmacist. This would place responsibility for sales of stronger preparations or large quantities in the hands of professional, fully qualified pharmacists.

Since the NH & MRC released its recommendations concerning preparations containing aspirin, paracetamol, salicylamide, caffeine, or any combination of two or more of these drugs all States and Territories have either made changes to the scheduling of these drugs or are preparing to do so.

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Queensland was the first State to adopt the recommendations. Since June 1978 compound analgesics have been available only on prescription (Schedule 4). Single-substance preparations containing more than a specified quantity of the drug, or in pack sizes larger than 25 tablets

or 12 powders, are in Schedule 2, that is, they may be sold only by

pharmacies or licensed poisons dealers. Single-substance products are available over the counter only if they contain less than the specified amount of the drug and are in pack sizes of 25 tablets or 12 powders or less. In all cases, tablets and powders must conform to strict

packaging and labelling requirements. Recent amendments allow the sale of aspirin and codeine compounds of specified strength and compound cold tablets containing analgesics, by pharmacies and licensed poisons dealers.

New South Wales introduced controls which, while subject to some variation in the schedules, are effectively the same as those that exist for compound and single analgesics in Queensland. The new scheduling which restricts the availability of analgesic preparations in New South

Wales was effective from 1 July 1979. The Australian Capital Territory on 24 July 1979 gazetted identical legislation to that existing in New South Wales, except that there are no special packaging requirements.

South Australia has placed compound analgesics on Schedule 2 of the Poisons list, thus restricting their sale to pharmacies and licensed country stores holding medicine sellers’ permits and imposed special labelling conditions on packs. Single-substance products containing more than a specified quantity of the drug, or in pack sizes of more

than 25 tablets in child resistant packages or 12 powders, are available only through pharmacies and licensed country stores. Products in smaller pack sizes, were still available on open sale. These changes were effective from 1 September 1979.

In Tasmania, the Minister for Health has recently approved the introduction of controls to take effect from 1 January 1980, which are effectively the same as those that exist in New South Wales, Queensland and the Australian Capital Territory.

There are currently no restrictions on the sale of minor analgesic products in Victoria. However amendments which will become effective on 2 June 1980 have been made to the Poisons Act 1962. These changes

substantially conform to the NH & MRC guidelines. Single substance products will remain available on open sale, provided that each tablet, capsule or powder contains less than a specified quantity of the drug, and conforms to packaging requirements. More concentrated products or

larger pack sizes are scheduled S2 and will be available only through pharmacies or licensed poisons dealers. Compound preparations will be available only on a doctor's prescription.

The Northern Territory also has no restriction on the sale of minor analgesics, but a draft ordinance which follows the NH & MRC

recommendations has been approved by Cabinet. The legislation is now awaiting consideration by the Legislative Assembly.

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Mr W. Griffiths, the Principal Pharmacist with the Medical Department of Western Australia, told the Commission that the government had gazetted identical legislation to that of New South Wales, to become effective by approximately 1 January 1980.

ADVERTISING

The Commission received conflicting evidence on the role that advertising plays in consumption patterns of over-the-counter analgesics. Professor P. Kincaid-Smith, Professor of Medicine at the University of Melbourne, and Dr J. H. Stewart of the Australian Kidney Foundation claimed that widespread advertising and unrestricted marketing had contributed to analgesic abuse and hence to analgesic nephropathy (OT 3081B; OT 10650). They cited the high proportion of Bex and Vincent's advertising directed at Brisbane and Sydney audiences

(Open Exhibit 379, p. 122), and the high levels of consumption and analgesic nephropathy in Queensland and New South Wales.

On the other hand, the Proprietary Association of Australia, Nicholas Pty Ltd, and Beckers Pty Ltd all claimed that advertising of analgesic preparations was carried out in a responsible manner and that warnings against excessive use of the products were clear and specific. The manufacturing companies stressed that advertising was not designed to increase total consumption but rather to change brand preferences among existing consumers (OT 10944--45; OT 7967). Both manufacturers contended that restrictions on either advertising or sales outlets or both would not deter the small number of persons determined to abuse analgesics.

The manufacturers of minor analgesics co-operated with the Commonwealth Department of Health in accepting an approved Voluntary Advertising Code for Proprietary Medicines, effective from 1 April 1977. The Code specifies that the trade name and pharmaceutical form of the analgesic, the approved name of each analgesic constituent, the indications for use, and warnings against prolonged use should all be stated. The Code also gives minimum requirements in connection with warning statements in print, radio and television advertisements.

As compound analgesics are no longer available on open sale in some States, and restrictions are being considered in others, some changes to advertising strategies may occur. It is too early to determine whether the legislative changes will have any effect on the advertising or abuse of analgesics or on analgesic nephropathy.

CONCLUSIONS AND RECOMMENDATIONS

Conclusions

The Commission is concerned at the possible link between analgesics and renal diseases.

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As the manufacturers of analgesics distribute their products throughout Australia, uniformity of controls over these substances is in the best interest of the public.

Recommendations

The Commission recommends that:

** The NH & MRC recommendations of April 1977 on controls over

analgesics be uniformly implemented in all States and Territories.

’ . . ·"

-

: V)

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Chapter 5 H eroin

The pharmacology of heroin has been discussed in Part II of this Report. Heroin or diacetylmorphine hydrochloride or diamorphine hydrochloride, is a narcotic analgesic prepared by acetylating morphine. It is generally believed that addiction to heroin occurs more easily than

addiction to morphine because heroin produces intense euphoria and fewer side-effects (constipation, nausea, vomiting). Heroin is a more potent analgesic than morphine but has a shorter duration of action, its effect lasting only about three hours.

Heroin was originally manufactured for medical purposes by the Bayer Company of Germany in 1898. However, concern about the abuse potential of heroin led to a reassessment of its use in therapeutic medicine by the World Health Organization (W.H.O.). In 1949, the W.H.O. Executive Board recommended that the Director-General gather information on the

use of heroin and its possible discontinuance in medicine. The result of this action was the following recommendation of the World Health Assembly of the 23rd May 1953:

Having considered recommendations of the Expert Committee on Drugs Liable to Produce Addiction regarding the use of

diacetylmorphine and the action taken by the Director-General on these recommendations at the request of the Executive Board,

Being convinced that diacetylmorphine is not irreplaceable for medical practice,

Being convinced that the abolition of legally produced diacetylmorphine by Member States would facilitate the struggle against its illicit use,

1. Recommends that campaigns be undertaken with the assistance of appropriate bodies to convince doctors and governments that diacetylmorphine is not irreplaceable for medical practice;

2. Recommends that Member States which have not already done so abolish the importation and production of the drug; and

3. Requests the Director-General to communicate this

resolution to the Secretary-General of the United Nations for consideration and appropriate action at an early date. (OT 15320--21)

The Director-General of the World Health Organization notified the Secretary-General of the United Nations of this resolution. In accordance with procedure the Secretary-General transmitted this information to the Economic and Social Council for inclusion on the

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agenda of Lhe Ninth Session of the United Nations Commission on Narcotic Drugs.

In 1954 the Ninth Session of the United Nations Committee on Narcotic Drugs endorsed the W.H.O. recommendation.

Heroin is classed as a Schedule Four drug under the Single

Convention on Narcotic Drugs, 1961. Parties to the Convention are invited to prohibit production, manufacture, export and import of, trade in and possession or use of heroin, except for amounts that may be necessary for medical and scientific research under the direct supervision and control of the party.

Prior to this, following inquiries in 1952 by W.H.O. on Australia's attitude to the necessity of continuing the use of heroin in medical practice negotiations were held between the Commonwealth Department of Health, the Australian Branch of the British Medical Association and the National Health and Medical Research Council.

As a result of these discussions it was agreed that heroin was not irreplaceable in medical practice and the importation of heroin into Australia was prohibited absolutely in 1953.

The Commission was told that at the time of its prohibition in Australia in 1953 heroin was being widely abused by over-prescription. Australia had the highest per capita consumption of heroin in the world. In addition there was a high incidence of heroin dependence in the medical and para-medical fields (OT 20569). Following the prohibition of the importation of heroin by the Commonwealth, the Australian States, with the exception of Victoria, prohibited the use of heroin and ordered the destruction of existing stocks. It is understood that Victoria holds sufficient base to prepare approximately 12 000 ampoules.

Import and export of heroin is prohibited except with the express permission of the Commonwealth Director-General of Health. Since December 1974 it has been possible to import heroin for scientific research and small amounts have been imported, the use of which has been

confined to samples and standards for forensic purposes.

In the United Kingdom there was considerable opposition to the United Nations ban on heroin. Members of the medical profession claimed that heroin was irreplaceable in some situations. Articles submitted to the British Medical Journal also questioned the proposition that a ban on medical use would assist in combating illicit trafficking and abuse of heroin as there were very few addicts (54) in Britain in the mid

1950s (Open Exhibit 491). In the United Kingdom, the United Nations ban was not fully implemented. The import of heroin is still prohibited as is its export, except in small amounts for scientific purposes. Manufacture of heroin is limited to quantities actually required for domestic medical consumption and scientific use. Heroin is used in both

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clinical medicine and in the treatment of opiate-dependent persons in the United Kingdom (Open Exhibit 491).

The United Nations Commission on Narcotic Drugs has kept the status of heroin under review. It was considered by the Commission in 1976 at its fourth special session. The following recommendation was the result:

Resolution 3 (S-IV) Prohibition of the manufacture of heroin and its use in medical practice.

The Commission on Narcotic Drugs,

Expressing its concern at the fact that addiction to heroin and the illicit traffic in this preparation have recently been steadily increasing in various countries,

Considering that heroin represents a great danger to human health, that in most countries of the world the medical

profession does not regard it as of therapeutic value and that it had been omitted from the pharmacopoeia and from lists of medicaments,

Noting that, under the Single Convention on Narcotic Drugs, 1961, the strictest measures of control are to be applied to heroin,

Anxious about the health and well-being of mankind,

Recommends to any Government that has not yet done so that if, in its opinion, the prevailing conditions in its country render it the most appropriate means of protecting the public health and welfare, it should prohibit all manufacture of heroin and

its use in medical practice on human beings. (OT 15322)

THE DEBATE CONCERNING RELAXATION OF CONTROLS

Although heroin has been used clinically in the United Kingdom and Belgium for some years there has been little research upon the extent to which heroin might have unique properties in medical practice. What studies have been done differ in their methodology and it is important

to consider such differences when comparing the results. It is important for example to know whether the patient was receiving any drugs in addition to heroin. It is important to note whether the trials have been 'blind' trials (that is where only the person administering

the drug and observing its effects knows what drug is used) or 'double blind' trials (where no person in contact with the drug knows which drug is being used). The use of a placebo (a substance closely resembling

the drug but lacking its properties) may also be used. In addition, it should be noted that in some studies different groups of patients have

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received different drugs while in other studies the same group received different drugs at different times. Effects may vary depending upon whether the drugs are given orally, intravenously or in some other manner.

Important work was carried out by Dr R. G. Twycross during his time as Research Fellow in the Department of Clinical Studies at St

Christopher's Hospice in London. The Commission had the benefit of discussing with witnesses Dr Twycross's articles, 'Clinical experience with diamorphine in advanced malignant disease1 published in International Journal of Clinical Pharmacology, vol. 9, No. 3, 1974, pp.

184--198, and 'The use of narcotic analgesics in terminal illness' published in Journal of Medical Ethics, vol. 1., No. 1, April 1975, pp. 10--17.

Dr Twycross conducted another review of cancer patients at St Christopher's Hospice in London with S. J. Wald, and their findings were reported in the article, 'Long-term use of diamorphine in advanced cancer' published in Advances in Pain Research and Therapy, vol. 1, 1976, pp. 653--661. The authors stated:

About 500 patients with malignant disease are admitted annually to St Christopher's Hospice, and more than 80% of these receive diamorphine. The initial dose is increased until the patient is free of pain throughout the four hours between drug

rounds. The aim is to titrate the level of analgesia against the patient’s pain and to maintain continuous relief by giving the next dose before the effect of the previous one has fully worn off. With the aid of a night sedative, many patients do not require a 2 a.m. dose. A phenothiazine is usually

administered concurrently, commonly prochlorperazine. Other drugs are prescribed when indicated clinically.

For this study patients who had received diamorphine regularly for at least twelve weeks were selected from approximately 3000 patients with cancer admitted between July 1967 and June 1974. A total of 115 patients fitted this criterion, had a mean age of 61 years, and were divided into five groups according to survival after prescription of diamorphine (Table 1)· Diamorphine was administered by mouth in an elixir containing a

fixed 10-mg dose of cocaine hydrochloride (1) or by injection using ampules of freeze-dried diamorphine hydrochloride. Starting doses ranged from 2.5 mg by mouth to 40 mg by

injection every four hours and were similar in all five groups. About two-thirds of the patients were initially prescribed 2.5 mg or 5 mg of diamorphine hydrochloride every four hours. A starting dose in excess of 10 mg four-hourly was confined almost exclusively to those patients who had previously been receiving morphine or diamorphine.

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TABLE 1. Patients grouped according to survival.

Group 1 2 3 4 5 Total

Survival (weeks) 12--13 14--17 18--25 26--41 42+ 12+

Female 13 16 17 13 14 73

Male 10 6 15 6 5 42

Total 23 22 32 19 19 115

Dr Twycross and S.

(OT

J . Wald stated

21691-

that,

-92)

for the five groups

...the initial, continuing, and terminal rates or rises in dose were determined. The initial and final phases were comparable in all five groups, but the rate of rise in the intermediate phase decreased serially from group 1 to group 5. Dose

reductions were common, and the median final dose was less than the median maximum dose. There was no correlation between the maximum dose and survival. Only 9% received diamorphine exclusively by injection. Diamorphine was discontinued either permanently or for a prolonged period in nine patients. One-

third of the patients were able to go home for varying lengths of time.

The data support the hypothesis that, generally, increases in dose are necessitated by increased pain rather than by

tolerance...Diamorphine and possibly other narcotic analgesics appear to be safer in clinical practice than has been generally supposed. The need for further research is emphasized. (OT 21698--99)

Dr Twycross has also made comparative studies of heroin and morphine and of heroin and methadone. In his paper 'Choice of strong analgesic in terminal cancer: diamorphine or morphine?', published in Pain, vol.3, No.2, 1977, p p . 93--104, he stated:

To date, relatively little has been recorded about the effects of narcotic analgesics when administered regularly to patients in persistent pain. Unwarranted generalisations have been made because of a failure by doctors to distinguish between acute

and chronic pain, single and multiple doses, oral and

parenteral administration, addict and non-addict, and human and animal studies. As a result, anxiety and confusion surround their use. (Marks, R . M . & Sachar, E.J., 1 Undertreatment of medical inpatients with narcotic analgesics', Ann. int. Med.,

78 (1973), 173--181.) Moreover, for many years international opinion has favoured the total prohibition of diamorphine (diacetylmorphine, heroin) on the grounds of its addictive potential 'and because its actions are not sufficiently distinct

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from those of morphine to regard it as medically indispensable. (Heroin and the International Conferences of 1925 and 1931, Bull. Narcot., 5 (1953), 55 — 58; and Article 10 of the 1931 Convention, Bull. Narcot., 5 (1953), 59--61). Consequently, all countries except Belgium and the United Kingdom have banned its medicinal use.

Dr Twycross added that:

...diamorphine has been the strong analgesic of choice at St Christopher's Hospice since its inception in 1967 on the grounds that it: (1) causes less nausea and vomiting; (2) often results in a return of appetite when given to patients with anorexia; (3) is less constipating; (4) enhances the mood of the patient whereas morphine not infrequently causes dysphoria; (5) results in a patient who is more alert, active and cooperative.

(OT 21680— 81)

In the British Journal of Clinical Pharmacology, vol. 4, 1977 there was published an article showing the results of a study done by Dr Twycross comparing heroin-with-cocaine with methadone. He concluded that the lower survival rate of patients treated with methadone compared with those treated with the heroin mixture was partly related to the toxic accumulation of methadone. He further concluded:

1. Methadone is a satisfactory substitute for diamorphine in some patients.

2. Diamorphine is better for very ill patients because, when multiple doses are administered, the dose can be adjusted more readily as it does not accumulate in the body to the same

extent as methadone.

3. The data sheet for methadone should be amended to stress the danger of accumulation when repeated doses are given, particularly to elderly or debilitated patients. (Open Exhibit 490)

The Memorial Sloan-Kettering Cancer Center in New York City is currently conducting a 5-year study on the pharmacokinetics and efficacy of various analgesics. The heroin portion of this study is now under way. The 6 October 1978 issue of the Journal of the American Medical Association, vol. 240, No. 15, reported:

In one part of the investigation, the effectiveness of heroin and morphine given intramuscularly will be compared. Each patient will receive both drugs, but at different times and in varying doses. In each of another set of patients, the

effectiveness of heroin administered orally and intramuscularly

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will be compared. These first two sections of the study are expected to take two years.

In a later part of the study, the effectiveness of heroin combined with other analgesic drugs will be observed and compared with that of heroin alone. Psychological tests also are planned to see if there are subtle differences between the effects of heroin and morphine. Both patients with good prognoses and those with advanced cancer will be studied in an

effort to determine whether heroin's mood-altering effects are primarily responsible for pain relief. (OT 22853)

Mr C. E . Mackenzie, Acting Director of the Drugs of Dependence Section, Commonwealth Department of Health, told the Commission that the Sloan-Kettering Center had been granted $US1.9 million for this project, and that in addition the National Cancer Institute in the United States was allocating $US650 000 to pain research.

There have also been some studies of the relative benefits of heroin and other drugs for treating pain in cases of acute myocardial

infarction. One of these was made by Μ. E. Scott and R. Orr, from the Cardiac Department of the Royal Victoria Hospital in Belfast, Northern Ireland, entitled 'Effects of diamorphine, methadone, morphine and pentazocine in patients with suspected acute myocardial infarction'

published in The Lancet, vol. 1, 1969, pp. 1065--1067. This study compared the effects of intravenous diamorphine (heroin) 5 mg; methadone 10 mg; morphine 10 mg, and pentazocine 30 mg on 118 patients with suspected acute myocardial infarction. The study was on a double­ blind, between-patient, basis.

The research undertaken by Scott and Orr was summarised by Mr C. E. Mackenzie:

This study found that diamorphine brought about complete relief of pain in 47% of patients 10 minutes after injection. This was significantly better than either morphine or pentazocine but not significantly better than methadone. At 30 minutes

about 40% of patients had complete relief of pain from all four drugs and at 10 and 30 minutes after injection 90% of patients had some degree of pain relief from all four. The subjective effects of the drugs were otherwise similar.

(0T 20582)

The authors of the study stated:

The incidence of nausea or vomiting after injection of the four drugs did not differ significantly. Pentazocine often produced a rise in systolic blood-pressure, particularly when this was low before administration of the drug. In contrast, the other drugs either did not affect the blood-pressure or caused it to

fall. It was concluded that pentazocine was possibly

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preferable to the narcotic drugs for the relief of the pain of acute myocardial infarction. (OT 22858)

In the paper 'The clinical evaluation of morphine and its

substitutes as analgesics' by L. Lasagna of the Departments of Medicine (Division of Clinical Pharmacology) and of Pharmacology and Experimental Therapeutics, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A., it was concluded:

In summary, heroin seems little better or worse than morphine in its capacity to produce analgesia, respiratory depression, and other side actions, or in addiction potential. To quote from the recent report of the expert Ad Hoc Panel for the White House Conference on Narcotic and Drug Abuse: 'There is a widespread misconception that heroin has effects significantly

different from those of morphine. It does not, and this misconception should be dispelled permanently.' (Open Exhibit 491, p .29)

In addition the Commission had regard to a number of other published and unpublished papers which will be referred to in later volumes of this Report.

The Commission has discovered an interest in Australia among medical practitioners for relaxing the present prohibition against the use of heroin in medical practice. The interest arises from practitioners who had experience of heroin before its banning in Australia in 1953 or because they had experience of its use in England or because they have studied the papers dealing with clinical trials in the use of heroin referred to above. The National Standing Control Committee on Drugs of Dependence in April 1978 considered an approach by Professor D . N. Wade, Professor of Clinical Pharmacology at the University of New South Wales, to conduct clinical trials of the efficacy of heroin in the management of severe pain. The Committee recommended to the subsequent meeting of Commonwealth and State Ministers on Drug Abuse that evaluation of heroin was an important issue that warranted detailed examination. The Meeting of Ministers requested that the issue be referred to the National Health and Medical Research Council for comment. The NSW Branch of the Australian Medical Association published an article 'Medical value of heroin' in its Monthly Bulletin of 27 March 1978. This caused

considerable correspondence which was made available to the Commission. In addition, a number of medical witnesses appeared before the Commission to urge the case that heroin had unique properties for the treatment of severe pain associated with myocardial infarction or coronary occlusion and intractable pain in the terminally ill. The Commission subsequently approached a number of medical practitioners for their views on this subject and upon the value of a controlled clinical trial in determining this issue. No clear consensus among medical practitioners appeared in the material which the Commission gathered but it is probably useful to state shortly a cross-section of the opinions given to the Commission.

Professor Wade told the Commission:

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I really want to make a plea for a calm and dispassionate look at heroin from the therapeutic point of view. I am interested in its clinical use in two circumstances. The first is in the

treatment of the pain associated with acute coronary occlusion or myocardial infarction where heroin may have a unique role and superiority over morphine which is the drug currently used. I believe this might be the case for two reasons-- firstly,

that heroin is less likely to cause vomiting; and secondly, it is less likely to cause a drop in the blood pressure. Both these two properties of the opiates are a great disadvantage in this clinical condition. In fact, they can be disastrous.

With the evidence that is available to me, the good data that I know of and can believe, and based on my own experience (mainly in the United Kingdom, where I have used both drugs) I would recommend heroin as the safest and most appropriate narcotic to use in this situation.

The other circumstance in which heroin may have a place

clinically is in the management of pain, intractable pain, in the terminally ill. I am less sure of my grounds when I talk about its use here but I believe there is a need for a properly controlled clinical trial to be conducted and I suggested that

it should be conducted in this country and should be sponsored by the government. (OT 12757)

Dr S. H. Lovell, a consulting surgeon, also supported the use of heroin in medicine and surgery. He stated that from his own experience:

I am completely convinced that there is no substitute for heroin in the treatment of certain cases of terminal cancer. It is true that the majority of terminal cancer patients can be managed quite adequately by other means, but one only has to

see a patient with sarcoma superimposed on Paget's disease of bone or an inoperable carcinoma of the tail of the pancreas to realize how other drugs fail to provide any relief or comfort. (OT 15339)

Dr Lovell continued:

Large and frequently repeated doses of currently available opiates or other synthetic compounds are associated with undesirable side-effects such as gastro-intestinal disturbance, depression, despondency and confusion. By contrast, heroin,

gives very good pain relief; it is free of these side-effects and it induces a state of relaxed serenity. They are not

'doped', they can co-ordinate and co-operate and as a result their nursing is easier. (OT 23243)

On the question of a controlled clinical trial, Dr Lovell stated:

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I am very much in favour of any study that could lead to a

reasonable, rational and safe usage of heroin in clinical practice. (OT 23243)

Professor R . D. Wright, Deputy Chancellor of the University of Melbourne, which houses the Howard Florey Institute of Experimental Physiology and Medicine, said:

Heroin is a first rate analgesic with mood altering activity which makes it a most useful substance for care of patients with cancerous infiltration of nerves and bone. Despite the laws, I always issued enough heroin for relief of a last

resort.

The unfortunate result of the irresponsibility of medical village specialist ripoff merchants has resulted in legal denial of a valuable therapeutic substance to many patients of

responsible specialists. Therefore I fully support the proposal to test the usefulness of this substance. (OT 15271)

Professor Wright was the Medical Director of the Cancer Institute Board, Peter MacCallum Clinic in Victoria from 1971 to 1975.

Dr M. D. Cridland had experience in prescribing heroin in a few cases in a London cancer hospital between 1959 and 1962. In a letter to the Commission she stated:

Heroin was sometimes used as a preferred alternative to morphine in cases of terminal malignant disease, having fewer gastro-intestinal side-effects. Although my impressions of heroin in this context were favourable, no clinical trials were undertaken at the hospital to compare the two drugs. As

suggested, adequate studies to evaluate the alleged advantages of heroin need to be done. (OT 15278)

Professor J . W. Paterson, Professor of Clinical Pharmacology at the University of Western Australia, told the Commission:

I am interested that evidence has been given to the Commission that heroin may have advantages over other narcotics in some circumstances including the initial management of severe pain associated with myocardial infarction and in the management of severe intractable pain in some terminal illnesses. I

I can only say from my own experience in the United Kingdom, where heroin was available for the management of both types of conditions referred to, that my clinical impression would support the idea that heroin has such advantages. There is no

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doubt that heroin produces a greater euphoriant effect than morphine, and this is well borne out by the addict's preference for this over all other narcotic opiates. In the situation of managing severe myocardial infarction this euphoriant effect

may reduce the risk of cardiac arrhythmia.

I would consider its analgesic effect equivalent to that of morphine, but with less nausea, vomiting and cardiovascular depression than after morphine. (OT 15280)

Professor B. T. Emmerson, Professor of Medicine at the Princess Alexandra Hospital in Brisbane, replied to the Commission's approach in the following terms:

I remember being able to prescribe heroin in Australia and it still seems clear to me that the incidence of adverse side- effects (particularly nausea and vomiting) after its use is

considerably less than that of morphine, whereas its efficacy is very much greater than that of the synthetic analgesics such as pethidine. Accordingly, I would agree that heroin does have advantages over other narcotics in some circumstances and that these circumstances include... the initial management of the severe pain associated with myocardial infarction and the

severe intractable pain in terminal illnesses. To this, I would add those patients, who develop nausea and vomiting after the use of morphine, who may still on occasion need a potent narcotic analgesic.

One must also agree, in view of the unavailability of heroin for medical use for 20 years and the advances in clinical pharmacology which have occurred during this time, that there is a dearth of good quality information on which to base such

statements. Accordingly, a strong case can be made for

carefully controlled studies to be conducted in Australia to evaluate the place of heroin in current therapeutics.

Certainly, the unavailability of heroin for medical purposes does not seem to have prevented the development of heroin addiction in the community, although one cannot conclude that it would not have been greater if heroin had been more readily

available for medical purposes. (OT 15301)

Professor P. Ilbery, Director of the Medical Branch of the National Health and Medical Research Council and Superintendent of the Peter MacCallum Institute in Victoria, stated in a letter to the Commission:

There is no doubt that clinical impressions have favoured diamorphine as being better for pain control and less

constipating, causes less nausea and vomiting and allows the patient -to be more alert while being pain controlled.

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Certainly the patients in Twycross's series on diamorphine were alert, unaddicted and pain-free in the Hospice and even half of those discharged home were alert and mobile on drugs. I

believe that heroin provides greater therapeutic efficiency in some patients with terminal illness associated with distressing systems such as pain or cough. (OT 15303)

On considering the suggestion for a controlled clinical trial, Professor Ilbery noted:

Carefully controlled clinical studies to assess diamorphine might not yield as much information as that already available from St Christopher's Hospice where the requirements of terminal care cancer patients have been carefully examined. Even at a large comprehensive cancer centre like the Peter MacCallum Hospital, there are insufficient numbers of patients

compared with those at the Hospice for such a study. (OT 15304)

Professor L. J . Beilin, Professor of Medicine at the University of Western Australia, expressed the following views in correspondence with the Commission:

The pressure to re-introduce diamorphine into medical practice stems from a belief that the drug has a greater euphoriant effect than morphine and is less liable to produce unpleasant or harmful side-effects for an equivalent degree of pain relief in conditions such as terminal malignancies or acute myocardial infarction. Opposition to its introduction comes from the equally strongly held belief that diamorphine is more addictive than morphine, and consequently would seriously add to the problems of drug addiction in the community.

Neither of these beliefs seems to be based on firm evidence. Taking the clinical situation first, the only satisfactory controlled trial comparing diamorphine and morphine in the relief of pain in patients with terminal malignant disease is that by Twycross from St Christopher's Hospice in London.

The situation in acute myocardial infarction is more clouded in that there have been conflicting studies purporting to show hemodynamic advantages of the use of diamorphine and a suggestion of less vomiting when the drug is used intravenously in an emergency, but other workers have failed to substantiate

this. I have not reviewed the literature recently on this aspect of its use although on the evidence then available I used to use diamorphine rather than morphine for myocardial infarction when in the United Kingdom.

Provided no recent evidence has come to light suggesting that heroin is more addictive than morphine, then I think there is a

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sufficiently good case for a controlled trial of its use for relief of the acute pain of myocardial infarction in comparison with the use of morphine for this purpose. Particular points to look for would be to see whether equal analgesic doses of

the two drugs differed in respect of production of nausea, vomiting and severe circulatory disturbance. The results of Twycross's trial on the benefits of intravenous heroin and lack of benefit of oral heroin in 'terminal' disease seemed pretty

clearcut, and I am not sure that this Study is worth

repeating.

(OT 15307--08)

Dr W. McWhirter, head of the Paediatric Oncology Clinic at the Royal Children's Hospital in Brisbane, said:

Before I came to Australia, I was working in the UK where

heroin was available in hospital, and I had experience with its use, both in patients with terminal malignancy, adult and paediatric, and also it was used as the routine analgesic in obstetrics for primiparous women in labour. My observations were not carried out in any controlled fashion but my

impression was that heroin possessed several advantages over other analgesics. These included a very potent analgesic action, relative freedom from producing nausea and vomiting, and a tendency to produce a degree of euphoria and sedation which was often useful in the terminally ill patient.

I would therefore fully support the idea of carrying out controlled studies in this country into the uses of heroin while appreciating that such use would have to be strictly limited and also that its use would pose some security

problems. I would be more than willing to take part in such a controlled trial, although as I have stated, the number of patients under my care, who would be suitable for such a trial, would be quite small. I would also feel that in the case of

terminally ill patients the use of heroin should not

necessarily be restricted to patients with extreme pain, since its euphoric and sedative properties can make it a viable drug for patients dying in mild discomfort but without a great deal of pain.

(OT 15309)

A Brisbane doctor told the Commission about his use of heroin in his practice in the 1940's. His impressions of heroin although unsupported by factual data, were:

1. In the terminally ill it was the most acceptable drug for the patient because of its best known effects of euphoria and relaxation quite separately from its relief of pain common to any narcotic of this group.

2. In trauma I tended to use morphine which in severe trauma was well tolerated and effective. Only when side effects of , nausea and vomiting occurred would heroin be

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substituted. It was not my impression that heroin was superior to morphine in the relief of pain.

3. In acute heart failure (pulmonary oedema) morphine to me appeared to be the drug of choice and I do not recall

using heroin in this emergency situation.

4. In cases of coronary occlusion one tended to use heroin in preference to morphine for pain relief to avoid any further physical stress from vomiting which might cause further aggravation of the underlying cardiac state. I was not aware of any other pharmacological benefit at that

time from its use.

5. A minor use in the form of heroin linctus was that of a

most effective cough suppressant where no other

contraindication to the use of a respiratory depressant existed. (CT)

The Executive Assistant of the New South Wales Branch of the Australian Medical Association, Dr B . A. Herriott, stated:

This Association would strongly support the establishment of a carefully controlled inquiry to evaluate the use of heroin for defined clinical purposes and that, if the evaluation yields positive results, that existing laws be changed with

appropriate safeguards to permit the use of heroin for these purposes. (OT 21720)

The correspondence which the N.S.W. Branch of the Australian Medical Association received as a result of the publication of the article 'Medical value of heroin' in its Monthly Bulletin of 27 March 1978 was in favour of making heroin available subject to strict controls for limited areas of medical practice.

Senator P. E. Baume, Chairman of the Senate Standing Committee on Social Welfare, also received communications from medical practitioners in reply to his article in the AMA Gazette supporting the re­

introduction of heroin for medical purposes.

The First Assistant Director-General of Health Therapeutics Division, Commonwealth Department of Health, Dr D. de Souza, told the Commission:

My own personal experience of using heroin in severe heart cases, some years ago, when I was in consulting practice, I must say I found it a very effective drug, and it is very easy to show one's own personal biases about a drug, and one has feelings that a drug is good, that it is the best analgesic, that it does not cause as much nausea, and it does not cause as much fall in blood pressure, all this and the other, but when

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you begin to analyse your thoughts you realise that you have not really got any proof of this, and this is why I think it is very important to have a properly controlled clinical trial which gives you the proper answers and not just a set of

opinions from different physicians. (OT 21044)

Dr de Souza continued:

Such a trial would, indeed, be done only with the co-operation and collaboration of the Commonwealth Department of Health, anyway, because, being a clinical trial on a drug which is of such importance and indeed, an imported drug, anyway, there would be total control under the import regulations which, you

know, are the responsibility of the Commonwealth. It would not be possible for anyone to carry out such a trial without the co-operation of the Department, This would involve... I would see it involving the Drug Evaluation Section in the design of

the protocol to try and make sure that we got as many of the answers that we wanted to get. So there would be a lot of

attention paid to the protocol and the design of the

trial...whoever is doing it...and we would hope that a

distinguished clinical pharmacologist, in fact, one or more, would carry it out. (OT 21043)

Dr de Souza stated that there was some substance in the argument that as the Sloan-Kettering Center in New York was conducting trials on heroin there was no need to repeat those studies in Australia. However, there might be other methods, or aspects, that could be examined (OT

21043--44).

A staff physician in oncology at the Royal North Shore Hospital in New South Wales, Dr J . A. Levi, stated:

The unavailability of heroin for use in these circumstances has prevented it from being evaluated as to whether or not it would be an effective addition to our present armamentarium. Clinical impressions from older workers, or those working with

heroin in the United Kingdom, have suggested that it may be of particular benefit in specific situations.

Although these clinical impressions are of obvious importance, I feel that the only way the true role of heroin can be

determined is by properly conducted, controlled, clinical trials with objective criteria for measurement. I would, therefore, most heartily agree that such trials must be considered in Australia so that proper documentation may be

obtained. It is worth pointing out, however, that there are very few centres, if any, in Australia that are presently established to conduct these studies with adequate numbers of patients and proper criteria for evaluation and, ideally, pharmacological back-up to monitor drug levels, etc.

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In view of the current programme of evaluation presently being undertaken by the National Cancer Institute of USA, in relation to heroin and the various studies I understand being carried out in the United Kingdom, I feel that, apart from considering studies of our own in Australia, we should also critically examine the results forthcoming from these centres. It will only be through this mechanism that any worthwhile decisions can be made.

I would, therefore, suggest that two or three selected centres in Australia be considered to undertake such controlled studies with adequate pharmacological back-up and appropriate funding. Their findings in conjunction with those obtained from the overseas centres should enable a fair evaluation of the true place of heroin in the treatment of pain to be determined.

(OT 15314— 15)

The opinions of many other distinguished medical practitioners were received by the Commission but their number makes it too difficult to refer to each in this Report. Enough has been expressed herein to show that there is considerable support for conducting experiments. It might be sufficient to end this short review of the evidence by presenting two opposing points of view.

The Commission received a copy of a report to the Council of the Royal Australasian College of Surgeons from the Therapeutic Substances Advisory Committee of the College. This report was a result of

proposals for a clinical trial submitted to the Committee by Professor D. Wade. The report stated:

The Therapeutic Substances Advisory Committee of the College debated Professor Wade's proposals at some length and his comments on the desirability of having this drug available for the treatment of myocardial infarction and certain cases of terminal cancer. It noted the current price of $40 for a

(doubtless adulterated) dose of heroin on the streets of Western Australia, and the crime that addicts are forced to, to satisfy their addiction. It further noted the drug's reported continued availability in Victoria and in the United Kingdom and Belgium.

In summary, while we believe that clinical studies to evaluate the efficacy and safety of heroin and/or combinations containing heroin in the management of severe intractable pain of terminal illness pose great problems, we accept his first proposal. That is, that carefully controlled clinical studies be conducted in Australia to evaluate the efficacy and safety of heroin in the initial management of severe pain associated with myocardial infarction.

Pending the outcome of these studies, we believe the law should remain in status quo.

(OT 15291)

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The Medicine Advisory Committee of the National Health and Medical Research Council provided evidence to the Commission through the Secretary, Dr G. De Cean:

The consensus of opinion was that while diamorphine probably had significant specific beneficial effects in the treatment of severe pain in a small percentage of terminal sufferers, from a practical viewpoint the marginal advantages did not outweigh

the difficulties involved in collecting sufficient evidence on which to base a decision. (OT 15272)

It is important to stress that support for the legalisation of heroin for clinical purposes without a clinical trial was not nearly as strong as the support for a clinical trial. There were opinions which suggested that a present trial was not necessary and indeed that Australia should await the result of trials from overseas.

Professor M. Eadie, Professor of Clinical Neurology and

Neuropharmacology, Department of Medicine, University of Queensland, said:

1. I have never prescribed heroin.

2. I have practised the specialty of clinical neurology for 18 years, and over this period I have never needed to prescribe more potent narcotics then pethidine or morphine, and have rarely needed to prescribe these.

3 I know the argument is advanced that heroin is a more

efficient cough suppressant than morphine, and relieves pain with less depression of consciousness and depression of mood. On these grounds it is suggested that heroin should be available to treat the cough and pain of

terminal malignancy.

4. It seems to me that the medical profession has got along reasonably adequately without heroin for nearly two decades, and when heroin is believed to act by entering the brain from the blood-stream more quickly than morphine does, but then converting in the brain to morphine before acting to relieve pain, I cannot see any compelling case

for the reintroduction of heroin.

5. While a well designed trial of heroin versus morphine in severe pain might be scientifically interesting, I suspect it would cause more trouble than it is worth. (OT 15292)

Professor M. Tattersall, Director of the Ludwig Institute for Cancer Research, and Professor of Cancer Medicine at the University of Sydney, told the Commission:

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I do not believe that there are many clinical investigators in Australia who have the experience necessary for investigating, in a controlled clinical trial setting, the role of heroin in treating myocardial infarction and intractable pain. Since it appears that these investigations are currently being conducted by competent clinical investigators in other parts of the world, and because the suggested measures for conducting these

trials in Australia would necessitate changes in existing laws and the revision of international agreements, I favour awaiting the results from overseas before embarking on studies in Australia .

(OT 15295)

Suggestions were made to the Commission about institutions where a clinical trial could be conducted. Suggestions included:

* an academic Department of Anaesthetics, such as the Department of Anaesthetics, Flinders Medical Centre

* the Queensland Radium Institute

* the Peter MacCallum Clinic in Melbourne

* the Pain Clinic at Sydney

* the Sacred Heart Hospice for the Dying at Darlinghurst, Sydney.

Finally it must be said that all who supported the legalisation of heroin were conscious of the necessity to institute or maintain strict controls over the distribution of heroin.

The following controls from the patient's point of view were suggested by Dr B. Kynaston from the Queensland Radium Institute:

In the consideration, one has to weigh benefit against risk: the benefit of relief of pain without induction of nausea and with euphoria against the risk of addiction in patients and in personnel who handle it.

This risk may be minimised by careful controls, such as: (1) the exacting selection of patients who are not adequately helped by the array of natural opiates and substitutes which may induce nausea in some patients, (2) the indication for use

then being for the alleviation of pain, and (3) that quantities held in a ward situation, for example, be kept low for

prescribed use only. (It would be envisaged that if one patient is receiving the drug, then some 12 — 18 hours supply be the most released at any time) (OT 15274)

Controls on the distribution of heroin as used in clinical practice were suggested by Dr S . H. Lovell, a consultant surgeon in Sydney, in the following terms:

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Naturally, I am very conscious of the need for very strict control, and I therefore suggest the following method to exercise such control.

1. Heroin should only be available on approval of the

Commonwealth Director of Health in each State.

2. To assist the Director in the assessment of any

application for its supply, the application should be studied by a small sub-committee-- e .g ., in this State by Dr Η. M. Rennie as a specialist physician, and myself as a surgeon. This sub-committee would examine the clinical

details to ensure that no other management, e .g .,

cordotomy, nerve injection or section, etc., was practicable, and that the situation was one in which the exhibition of heroin was correct.

3. Heroin should be supplied only in ampoules carrying a special label and should only be manufactured by one company operating under special licence.

4. It should be packaged in units of ten ampoules with each ampoule marked by a serial number to allow it to be traced and fully documented.

5. Each package should contain a card on which should be

recorded the date and time of the administration of each ampoule and the signature-- not initials---of the person administering the dose. This card, together with any unused ampoules should be returned to the point of

delivery and subsequently to the Director.

6. The delivery of heroin through the postal services or any commercial courier should be prohibited.

7. Where approval has been given, the point of delivery could be a teaching hospital or the nearest base hospital.

8. The practitioner in medical charge of the patient should be responsible for its use in accordance with the grounds of approval by the Director. He should be responsible also for the documentation of its use and for the return

of the record card.

These conditions might appear to be unreasonably severe, but they are an earnest of my belief, and I do not believe that any practitioner who is genuinely concerned for the welfare of his patient and mindful of the overall problem of drugs, would

consider them to be too onerous. (OT 23243--44)

The above review relates to the use of heroin as an analgesic in clinical practice. It has been suggested that heroin also has a place in the treatment and rehabilitation of opiate dependent persons.

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Heroin has been used in this way in the UK since 1968 in programs commonly referred to as 'the British System'. However it appears from the material that this Commission received that there is really no such thing as 'the British System'. It is true that heroin may be prescribed in the treatment and rehabilitation of opiate dependent persons in the United Kingdom. Indeed the abuses apparent in the too free use of heroin in this way led to the appointment of the second Brain Committee which recommended stricter controls. As a result, only licensed physicians at treatment centres are authorised to prescribe heroin for addiction treatment.

The Alcohol and Drug Commission of British Columbia, Canada, in a report entitled 'The British Experience with Narcotic Dependency' said there was a great deal of confusion and misunderstanding about 'the British System'. This report (Open Exhibit 569) exposed a number of misunderstandings about the so-called 'British System'.

The strongest support for 'the British System' in Australia came from Professor D. N. Wade, Director of the Department of Clinical Pharmacology at St Vincent's Hospital in Sydney, and Professor of Clinical Pharmacology at the University of New South Wales. He told the Commission that he had worked within 'the British System' for five years and went on:

I think it's better than our approach. I'm here talking not only of the treatment but of the overall legal attitude towards heroin and narcotics. I think, firstly, it accepts the fact that you can't stop addicts getting narcotics by other ways, and I think we've got to accept this. Oppressive measures may well be necessary, but they're not going to stop addicts getting these drugs.

Secondly, the English system makes the distribution of narcotics much less attractive to criminal elements if the government is supplying narcotics.

The third point I make is that the heroin or other opiate the addict then gets, supplied by the government, is at least pure. We have already heard (and it's a common experience here) that many of the problems the addicts get into here are due to the fact that the street heroin is so impure and is cut with other often unknown constituents and the potency, of course, is not known.

Finally, I think that if the addict were to be in a situation of obtaining his narcotic from the health authorities then it would be much more likely that he would enter some sort of treatment programme or health programme than if he's obtaining

it from a street contact. It reduces the chance of the addict coming in contact with the criminal element, either to obtain his drug or, perhaps just as importantly, it reduces the chance

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of the addict being forced into criminal activity in order to obtain his drug or the money to buy it. Some of the addicts I've looked after here in Sydney— I've had children as young as 14 addicted to heroin, particularly from some of the outer

western suburbs, and I've had young girls as young as 14 who have been forced into prostitution to obtain the money for their supplies of heroin. Of course, it is common that very young children have been involved in breaking into chemist

shops in the past.

I feel very strongly that our approach is totally wrong and that we have a lot to learn from the approach used in the

United Kingdom

(OT 12768--69)

The authors of the British Columbian report on the UK program were less enthusiastic than Professor Wade. They stated:

One of the most often heard arguments in favour of legalized heroin is that it would attract all users into the program. This argument assumes that the heroin user would find free heroin more attractive because there would not be the same uncertainties and anxieties as are associated with an illicit

source. Undoubtedly, a free heroin program would attract users, but a significant proportion would elect to remain outside of it. The registered user would have to give up his

anonymity (many users think they are not known to the

authorities), some of his freedom, control over his dosage and schedule of use, and, perhaps most important of all, his involvement in a sometimes exciting and, in a sense, purposeful lifestyle centered around obtaining heroin. Another factor which has come to light is that pharmaceutical heroin may not be that attractive to addicts. The reason seems to be that

addicts like the buzz produced by caffeine and other

adulterants in the illicit product.

These are real disincentives to some of the individuals in the heroin scene, and it would therefore be an error to assume that all users would view licit heroin as a necessarily more

attractive alternative.

In Great Britain, as already stated, the availability of free heroin has failed to attract even a majority of users into treatment. And, one Canadian observer, Dr Reginald Smart of

the Ontario Addiction Research Foundation, has suggested that heroin may not be any more effective in attracting addicts into treatment than methadone. (Open Exhibit 569, p .6)

Statistics produced by the United Kingdom Home Office indicate that younger drug users were not attracted to the programme: in 1970, 61 per cent of males and 37 per cent of females registered were aged 24 years

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or under; in 1977 these proportions had declined to 1 8 per cent and 26 per cent respectively.

The Canadian Commission of Inquiry into the Non-Medical Use of Drugs recommended an experimental program incorporating heroin maintenance in selected difficult cases (Open Exhibit 22, p .170).

The Final Report of the South Australian Royal Commission into the Non-Medical Use of Drugs pointed out that heroin and morphine have drawbacks compared with methadone when used for maintenance on a systematic basis in the treatment of opiate dependent persons:

A single dose of methadone, taken by mouth, is effective for about 24 hours. Moreover, it can be dispensed in orange juice, making intravenous use very difficult. In contrast, heroin or morphine have a relatively short-lived action, and in practice have to be given intravenously, so that an established addict might require three or four injections per day to avoid

withdrawal symptoms. Thereafter he would either have to attend a clinic several times each day, which is impracticable, or be entrusted with supplies of the drug, creating the risk of diversion to the illicit market.

(Open Exhibit 586, p . 181)

In May 1978 Mr G. Miller, Junior Counsel assisting the Commission, whilst in the United Kingdom investigated the so-called 'British System' of treatment of narcotic dependence. After visiting various establishments, and after discussions with senior officers of the Department of Health and Social Security and of the Home Office, he

furnished the Commission with a detailed report. His conclusion was as follows:

The experience of treatment of narcotic dependence in the United Kingdom suggests that many of the problems faced by those working in the field are peculiar to the United Kingdom itself. There seems a general consensus of opinion that the drug problem in the United Kingdom at the present time is one of multiple drug use (as it seems to be in most parts of the world) but the extent of the problem of drug use in the United Kingdom may well be less alarming than it is in the United States of America and indeed Australia.

The introduction of the drug dependence clinics in London (and of other facilities outside London) in 1968 established a facility for the treatment of the drug dependence, although in many cases the treatment was no more than the maintenance of addicts on injectable heroin or methadone.

The consequences of these programmes of maintenance are now being assessed but it is fair to say that there is no uniform programme in the country and certainly no 'British system' of

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treatment of narcotic dependence. At one of the most

successful treatment clinics (University College Hospital) the success of heroin maintenance could at best be described as equivocal. (OT 15011)

CONCLUSIONS AND RECOMMENDATIONS

Conclusions

The evidence showed that arguments in favour of the relaxation of laws prohibiting the use of heroin fell under two headings:

1. For the use of heroin in general medical practice for the treatment of a limited number of special medical conditions.

2. For the maintenance on a systematic basis of opiate dependent persons in the course of their treatment.

So far as the first of those headings is concerned, there appears to be no clear evidence establishing beyond doubt that heroin has

properties which are so unique that the prohibition ought to be removed. What obviously must be weighed here is the extent to which heroin is unique against the difficulties posed by any system of controlled distribution of the drug, at a time when extraordinarily high prices will be paid by illicit users for that drug. Another factor which must be considered is Australia's international responsibility as a signatory

to the Single Convention on Narcotic Drugs 1961.

It seems quite possible that the overseas studies presently in hand will resolve the differences of opinion among medical authorities as to whether heroin has such unique properties that there should be

relaxation of the prohibition against its use. If these overseas clinical tests prove inconclusive it should be possible to conduct tests directed to the same object in Australia.

On the second heading, maintaining opiate dependent persons on heroin, there has been the British experience from which some lessons can be learned. It seems clear that the dramatic increase in the number of addicted persons in the United Kingdom which led to the second Brain

Committee and the 1967 legislation tightening controls over heroin, which came into effect in 1968, indicated that the strictest controls are necessary when heroin is used for this purpose. There is reason to believe that many persons who attend treatment may not be genuinely

dependent upon heroin and the use of any opiate to maintain them in a course of treatment is really deleterious to them. It does appear, however, that if maintenance by an opiate is to be used, there are significant drawbacks in using heroin or morphine for this purpose

compared with using methadone. These drawbacks were adverted to by the Royal Commission into the Non-Medical Use of Drugs, South Australia, and are cogent reasons against the use of heroin in the maintenance of drug

dependent persons.

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Recommendations

The Commission recommends that:

Clinical studies being undertaken overseas on the use of heroin in medical practice should be monitored by the Commonwealth Department of Health with a view to considering the desirability of conducting clinical studies in Australia.

** No action to relax the present legal controls on the use of heroin in medical practice should be contemplated unless it is clearly established that at least:

- clinical studies have demonstrated that heroin has significant, unique properties as an analgesic which require its use in specified areas of medical practice, and

- strict control procedures can be implemented which will

effectively prevent legal heroin being diverted to uses other than in specified areas of medical practice.

** Heroin should not be used for maintaining drug dependent persons in the course of their treatment.

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Chapter 6 M ethaqualone

Methaqualone is classed as a non-barbiturate hypnotic and sedative. Its sleep-inducing effects are enhanced when it is combined with

diphenhydramine, an antihistamine. A combination of methaqualone and diphenhydramine is marketed under the proprietary name of Mandrax in Australia and other countries. Methaqualone was originally promoted as a safe sedative and hypnotic, superior to the barbiturates and other

sleep-inducing medications; however, it has been reported to have toxic side-effects and, especially in combination with diphenhydramine, to be dependence-producing following prolonged use. Some patients using Mandrax prescribed by a doctor have developed an addiction to this drug. Mandrax is popular with some habitual drug users as a recreational drug and is often taken in conjunction with alcohol or other substances, which potentiate the effects of the methaqualone.

In 1973, following reports of methaqualone abuse, the National Health and Medical Research Council endorsed a recommendation to include this substance and its combinations in Schedule 8 of the Uniform Poisons Schedules along with narcotics and other drugs of addiction. In the

same year methaqualone was placed in the Fourth Schedule of the Customs (Prohibited Imports) Regulations. Methaqualone was removed from the Pharmaceutical Benefits Scheme in 1974, and the Australian Drug Evaluation Committee reaffirmed its recommendation that methaqualone

should be included in Schedule 8 of the Poisons Schedules. It is now thus listed in the A.C.T. and the Northern Territory and in all States except New South Wales. In New South Wales it is listed in Schedule 4 but is classed as an 1 accountable' Prescribed Restricted Substance. The NSW Health Commission has agreed that movements of methaqualone should be monitored by the Commonwealth Department of Health Drugs of

Dependence Monitoring System, as in the case of Schedule 8 drugs. This means that methaqualone and its preparations have been monitored throughout Australia since 1 February 1978.

Figures obtained through the monitoring system show a general decline in consumption of methaqualone and its preparations in Queensland, Tasmania, and the A.C.T., where methaqualone has been monitored for a number of years. In Queensland, for example,

consumption has fallen by over 65% since 1975. For the whole of

Australia consumption figures (stated as grams per 1000 population) are shown below.

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1975 1976 1977 1978

Qld. 84.43 68.72 48.94 30.77

Tas. n.a. 126.95 82.30 46.13

A.C.T. n.a. n.a. 85.17 60.26

N.S.W. n.a. n.a. n.a. 100.07

Vic. n.a. n.a. n.a. 54.01

S.A. n.a. n.a. n.a. 64.15

W. A. n.a. n.a. n.a. 37.85

N.T. n.a. n.a. n.a. 15.76

Australia

n.a. = Figures

n.a. n.a.

not available.

n.a. 65.77

(OT 20563)

A representative of the major importer of methaqualone in Australia confirmed that sales of Mandrax by his company had declined in the past few years to just over 62% (in 1977) of the 1971 figure. He attributed this fall in sales to the exclusion of methaqualone from the

Pharmaceutical Benefits Scheme since 1974 and to the fact that it had not been promoted for more than four years.

Methaqualone became a Schedule 8 drug in South Australia in January 1978 and the prescribing of Mandrax has declined in that State since then, supporting the experience in Queensland and Tasmania that consumption fell after the rescheduling of the drug. Statistics provided by the Commonwealth Department of Health show that quantities of methaqualone imported into Australia, in terms of anhydrous equivalent of the drug in products such as Mandrax, fell from 2973.3 kg in 1976 to 2307.1 kg in 1977 and to 636.8 kg in 1978.

Methaqualone is listed in Schedule IV of the International Convention on Psychotropic Substances, which Australia has not yet ratified. The UN Commission on Narcotic Drugs meeting in February 1979 accepted a resolution to move methaqualone from Schedule IV to Schedule II of the Convention. (Schedule II contains the amphetamines and is subject to more stringent controls.) In effect, therefore, methaqualone is now a Schedule II drug under that Convention.

THE USE AND ABUSE OF METHAQUALONE

The majority of witnesses who gave evidence relating to methaqualone or Mandrax were of the opinion that Mandrax was undesirable for medical use and that other, more suitable drugs, were available. Dr D. G. Wilson, the Queensland Government Medical Officer, for example, said:

The drug has marked euphoric and hallucinogenic properties and is seen more and more to be associated with traffic accidents and impaired driving...

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It has no useful place in medical therapy. (OT 2082)

while Dr T. J. Claffey from the Accident and Emergency Centre of St Vincent's Hospital, Sydney, said that most practising physicians felt that the dangers of this drug totally outweighed its value, and as less harmful substitutes existed, its use was unnecessary (OT 10530).

Dr E . V. Ratcliffe, a psychiatrist at the Lindsay Miller Clinic and the Launceston General Hospital, pointed out:

The combination of methaqualone and diphenhydramine that you speak of is a particularly bad one because it seems to produce a potentiation of the worst properties of both drugs. Mandrax is a combination of those two things. If hypnotics must be used there are many safer ones and much less habituating ones than that.

(OT 4366)

Dr D. G. Wilson told the Commission that Mandrax was in extremely common use by young people and that it frequently led to abuse of more potent drugs (OT 2082). Professor D. N. Wade, Director of the

Department of Clinical Pharmacology at St Vincent's Hospital, Sydney, said that Mandrax was the major cause of drug overdose admissions at the hospital, 26% of such admissions being attributable to Mandrax. He added:

It is a drug which doesn't have a single thing to recommend it pharmacologically, and I tender this evidence really to justify that statement; it has no medical indication at all. (OT 12783--84)

A number of pharmacists also saw no need for Mandrax.

Several expert witnesses thought that Mandrax should be banned since it had little therapeutic value and was mainly abused by people taking it medically. Dr D. G . Wilson said that Mandrax should be declared a prohibited drug and that the best way of eradicating abuse of Mandrax would be to prohibit its manufacture (OT 2082). Dr M. C. Hall,

Principal Research Officer with the Commonwealth Police also thought it would be a good thing if Mandrax were not available (OT 4042).

Witnesses representing the Australian Medical Association, or its State branches, and other bodies and institutions supported prohibition of Mandrax.

A senior South Australian Police officer told the Commission that in South Australia there had been an upsurge in the abuse of methaqualone during the eighteen months preceding January 1978 (when the drug was rescheduled in that State), particularly by the younger set at discotheques and hotels. The usual method of consumption was to swallow a number of Mandrax tablets together with alcohol but there had been

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instances where users injected the drug, and as a result some accidental deaths had occurred. The drug was diverted from three main areas:

* doctors' prescriptions;

* pharmacy breakings; and the

* illicit trade from unknown, interstate sources.

Use of Mandrax was defended by a Sydney general practitioner who believed that it was an excellent sleeping tablet and that a person would be unlikely to die as a result of taking 25 Mandrax tablets but would be very likely to die if he or she took 25 capsules of an

effective barbiturate.

A representative of the manufacturers of Mandrax told the Commission that at the 78th Congress of the Royal Society of Health in 1971 Dr W. Sargant, Physician-in-Charge of the Department of Psychological Medicine at St Thomas' Hospital, London, had stated that Mandrax did not have the same toxicity and dangerous and unpleasant withdrawal symptoms as the barbiturates. However, Dr Sargant's opinion was not supported by Professor D. N. Wade of Sydney (OT 12784).

The witness representing the manufacturers of Mandrax also quoted from an article by Dr L. Clein in the British Medical Journal, No. 3, concluding that the abuse of drugs by a small minority of psychopathic and immature personalities should not lead to a situation where patients who might benefit from useful drugs were deprived of them because doctors became frightened of the drugs falling into the wrong hands. Dr R. J. M. Dunlop, President of the NSW Branch of the Australian Medical Association, did not share the view that abuse of Mandrax was restricted

to persons with psychopathic and immature personalities. He said that even among stable and respected members of the community it had the most undesirable side-effects (OT 12062).

The United Nations Commission on Narcotic Drugs 28th Session in February 1979 drew attention to a continuing rise in most countries in the abuse of non-barbiturate hypnotic drugs, especially methaqualone. There had been an epidemic-like spread of methaqualone abuse mainly among young people, but in certain countries there was a decrease following the introduction of regulatory measures. In this connection the report also stated that the amount of licit consumption per capita of psychoactive substances generally was on the increase. This was clearly related to the increasing illicit use and reinforced arguments for imposing and maintaining strict controls on drugs of this class.

CONCLUSIONS AND RECOMMENDATION

Conclusions

The evidence supports the view that methaqualone, particularly in the form of Mandrax, whilst having some value as a hypnotic and

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sedative, is probably the most abused prescribed drug in Australia. Despite efforts to confine its use, it continues to be readily available on the illegal 'market'. The degree of methaqualone abuse has been

engendered to a large extent by its ready availability and by statements proclaiming its properties as an aphrodisiac, a contention disclaimed by users who gave evidence and not supported by any medical opinion.

Nevertheless, this reputation has contributed to experimentation with the drug followed by increased use in conjunction with other drugs, particularly alcohol, in search of bizarre effects.

In a strictly ordered community where controls could be rigidly enforced, any prescribed drug which has some beneficial effect ordinarily should be maintained for use in the exceptional case. Regrettably, there is no unanimous grouping by the States of this drug

into Schedule 8, but even if New South Wales did come into line with the rest of Australia there would nevertheless remain the present capacity for abuse. The present situation can be regarded as analagous to the amphetamines prior to the successful introduction and enforcement of stringent regulations. The alternatives, therefore, in relation to methaqualone are to adopt the 'amphetamine approach' or else totally prohibit importation.

The vast preponderance of evidence favours the latter course. The Commission's visits overseas reinforced the available evidence that it is a drug of increasing abuse, which all countries visited have either prohibited or attempted to control by stringent measures. In the final

analysis it seemed to the Commission that prohibition against any importation (it being a drug not produced within Australia) is the appropriate course. Whilst this may appear unduly harsh to the

manufacturer of the drug, the welfare of the community as a whole has to be considered. The degree of abuse is so widely spread within Australia as to weigh the balance strongly in favour of prohibition.

Recommendation

The Commission recommends that: * *

** The drug methaqualone, or Mandrax, or any other preparation of which methaqualone constitutes a part, should be absolutely prohibited from importation into Australia, and its use or possession after 30 June 1980 should be absolutely prohibited in any part of the

Commonwealth of Australia.

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Chapter 7 Pentazocine

Pentazocine is a synthetic analgesic with actions and uses similar to those of morphine. It is used for relieving moderate to severe pain. This substance is not controlled under international drug conventions--neither the UN Single Convention on Narcotic Drugs nor the Convention on

Psychotropic Substances-- but in Australia import controls are exercised over pentazocine similar to those applicable to narcotics. Permission from the Director-General of Health is required for importing the drug although an exchange of permits with the exporting country is not necessary and no quotas are set.

The National Health and Medical Research Council (NH & MRC)

recommended in 1972 that pentazocine should be included in Schedule 8 of the NH & MRC Uniform Poisons Schedule, i .e . , in the same category as narcotics, following reports of suspected addiction both in Australia and overseas, particularly in the USA and Canada and, more recently, in Austria, Italy and Spain. Pentazocine has been used as a substitute

for heroin in those countries.

The NH & MRC recommendation was followed in Queensland, Tasmania, Western Australia and the A.C.T., where pentazocine is monitored through the Commonwealth Department of Health Drugs of Dependence Monitoring System, and pentazocine has been given an equivalent classification in

the Northern Territory. Pentazocine is still classed as a Schedule 4 drug, and therefore subject to comparatively less control, in South Australia and Victoria. In New South Wales pentazocine is retained in Schedule 4 but is declared to be an 1 accountable' restricted substance.

Statistics provided by the Commonwealth Department of Health for 1975--78 show a rise in net imports of pentazocine from 57.6 kg in 1975 to 85.2 kg in 1977 and to 214.2 kg in 1978. Stocks appear to be

increasing substantially although consumption (in terms of total base drug) has remained fairly constant.

Dr D. de Souza, first Assistant Director-General, Therapeutics Division, Commonwealth Department of Health, discussing the position of pentazocine in relation to the UN Single Convention, said there was no reason why Australia could not put forward a request to have pentazocine brought under international control. The difficulty, he said, was that pentazocine was not fully monitored in Australia as a Schedule 8 drug,

and accurate figures of the kind needed to support a submission to the World Health Organization on these lines were not available. Although a lot of evidence had been accumulated that pentazocine is a drug of

dependence, it was difficult to make out a strong enough case at the present time (OT 21052).

Mr F. D. Potts, Chief Inspecting Pharmacist in the Tasmanian Department of Health Services, said that pentazocine was treated as a narcotic in Tasmania because it had confirmed itself as a drug of addiction qualifying for equivalent control (OT 1391). Mr R. McCarthy,

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Principal Pharmacologist and Senior Pharmaceutical Inspector in the Department of Public Health in South Australia, where pentazocine is not classed as a narcotic, said that there was control over prescribing pentazocine in South Australia but he felt that it (and also Mandrax)

fell into a category of drugs half-way between ordinary prescription and full narcotic control-- not warranting the same penalties as narcotics but warranting a possession offence (OT 7196). Mr T. J. Malony, Senior Pharmacist at the Royal Adelaide Hospital, did not share Mr McCarthy's point of view, believing that pentazocine should be subject to the same

control as narcotics (OT 8074).

In New South Wales pentazocine is classed as a restricted substance (which approximates to Mr McCarthy's proposal) but this poses particular difficulties. Dr M. S. Y. Dalton, Director of Addiction Services at the Westmead Community Centre for Alcohol and Drug Addicts, told the Commission:

I point out that the addiction rate amongst medical

practitioners and doctors is exceptionally high. We have run into trouble with pentazocine (Fortral). It is not a Schedule 8 drug, and this means that it can be obtained without being checked up upon. It means that doctors who have given up their rights to prescribe opiates can still obtain it. For the last two years I have been fighting to have it put on to the

Schedule 8 list. I know so many of the doctors who were doing very well are now on it. (OT 10684)

Dr Dalton's experience was confirmed by a Sydney general

practitioner, who had surrendered his authority to prescribe narcotics on account of his addiction problems and who told the Commission in a confidential hearing:

Fortral, though now an accountable drug, can still be

prescribed by me. It was the most devastating addiction of all.

Well, I believe that Fortral, like the amphetamines, can produce a psychotic-like state, and certainly in my case during the period I was taking Fortral, quite apart from there being a significant number of amnesic periods, my conduct deteriorated very significantly under that particular drug.

(CT)

Dr de Souza said he believed pentazocine was being abused in Australia and thought that in many instances doctors were not aware that a patient was becoming dependent on the drug. On several occasions where the Department of Health had received applications from doctors

for increased quantities of pentazocine for a patient who claimed to have severe pain-- though not associated with terminal malignant disease-- he had asked the doctor whether he had considered that the

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patient might be addicted to the pentazocine. The doctor was invariably surprised and horrified. Dr de Souza said that doctors, in spite of the fact that the dangers of pentazocine were well documented, seem not to appreciate that their patients might be becoming addicted (OT 21049-­ 50).

Dr de Souza added that he firmly believed that pentazocine should be in Schedule 8, as recommended by the National Health and Medical Research Council. The Commonwealth Department of Health supports this recommendation, considering that for the monitoring of pentazocine to be

really meaningful, and for control to be effective, all States should control the drug under the equivalent of Schedule 8, and wholesalers should be obliged by State Health authorities to report to the

monitoring system.

CONCLUSIONS AND RECOMMENDATION

Conclusions

The evidence before the Commission is overwhelmingly in favour of the view that pentazocine is a drug capable of producing dependence of the opiate type.

Pentazocine is a Schedule 8 drug in all States and Territories with the exception of Victoria, South Australia, and New South Wales where it is in Schedule 4. In addition, New South Wales has declared the drug to be an 1 accountable' restricted substance.

The Commission strongly supports the recommendation of the National Health and Medical Research Council that this drug be uniformly classed as a Schedule 8 substance. The transfer of pentazocine to Schedule 8 would provide for uniform control and would facilitate monitoring of the use of that drug.

RECOMMENDATIONS * * *

The Commission recommends that :

** Pentazocine should be included as a Schedule 8 drug in all States and Territories of the Commonwealth of Australia.

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Chapter 8 Methadone

Methadone is a synthetic narcotic analgesic. Its principal use is in the treatment of severe intractable pain but it may also be used in the treatment of opiate dependent people either for withdrawal or

maintenance. The operation of treatment programs is discussed fully in other chapters of this Report.

INTERNATIONAL CONTROLS

Australia is a party to the Single Convention on Narcotic Drugs 1961. Under this Convention Australia has certain obligations relating to the importation, exportation and manufacture of narcotics, including methadone. Australia must provide annual returns and estimates to the

International Narcotics Control Board (INCB) set up under the Single Convention.

COMMONWEALTH CONTROLS

The Commonwealth Government controls the importation and exportation of methadone. There are also certain requirements to be met in the area of licensing; issuing of permits, quotas, records and statistical returns; control and security of drug movements; and inspections of

stocks and records.

Imports of methadone have increased over recent years. In 1974,27 kg of anhydrous base methadone were imported. By 1978 the quantity imported had doubled. Only minor amounts of methadone are exported, mainly to New Zealand. Methadone tablets, ampoules and syrup are produced in Australia from the base drug, and strict controls are maintained over this operation.

Methadone has been monitored by the Drugs of Dependence Monitoring System since 1971. Consumption of methadone, as measured by this system, has risen steadily from 11 kg in 1971 to 37 kg in 1977.

Australia has become the second highest per capita consumer of methadone after the United States (OT 3852).

The introduction of methadone treatment programs in the early 1970s led to a large increase in consumption and to concern that methadone was being used inappropriately in some treatment centres. With this in mind, the National Health and Medical Research Council (NH&MRC)

considered the role of methadone in drug rehabilitation, and in 1977 drew up the National Policy on Methadone.

The National Policy outlines the objectives of methadone treatment as 1 a combination of reduced mortality, improved physical and psycho­ social well-being, diminished involvement in anti-social behaviour and containment of drug abuse1 (Open Exhibit 140). The National Policy stresses that methadone has only a small place in the treatment of persons addicted to narcotics, and that attempts should be made to

involve patients in a total program with counselling sessions and follow-up care for as long as necessary.

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The NH & MRC recognised that availability and administration of methadone needed to be tightly controlled. The National Policy suggested that methadone used in maintenance programs should be restricted to persons who are chronically addicted. Prescribing of methadone for maintenance is limited to medical practitioners who have

received special authorisation, and the NH & MRC stated that it would be expected that these practitioners would have the support of a clinical team and a 24-hour counselling and emergency service, as well as continuing to participate in training programs for the treatment of drug dependency. The National Policy also stated that these medical practitioners should restrict supplies of methadone for drug dependent persons to their daily consumption needs in the form of syrup.

Despite these guidelines, the Commission received evidence from many sources that treatment establishments do not always adhere to these controls. The Commonwealth Department of Health supports the National Policy on Methadone but sees a need for rigid implementation of the

controls.

The Commonwealth Department of Health also administers the National Health Scheme. Methadone prescribing under the scheme was restricted from 1 April 1977 to 1 disabling pain associated with malignant neoplasia or self limiting disorders of short duration not responding to non­ narcotic analgesics'. Authority for increased maximum quantities and/or repeats of methadone is granted only for the treatment of late-stage malignant neoplasia (OT 3759).

STATE CONTROLS

The State and Territory governments maintain strict controls over Schedule 8 drugs, such as security and storage, labelling and record keeping. State drug treatment centres use methadone in syrup form for the rehabilitation of opiate users. Patients are assessed when presenting for treatment, and methadone is limited to those persons who can be assisted by its use. However, as already mentioned, methadone clinics do not always follow the guidelines laid down in the National Policy on Methadone.

Methadone maintenance programs are conducted by all States and Territories except Tasmania. Tasmania has never had a policy of methadone maintenance. The A.C.T. discontinued its program in 1975 but has recently re-established it.

Private medical practitioners may prescribe methadone for terminal illnesses or for the treatment of drug dependent persons. In the case of the latter, the doctor must obtain authorisation from the State health authority to proceed with such prescribing. Medical

practitioners are prohibited from prescribing methadone without authorisation purely because of addiction, but the Commission heard evidence that not all medical practitioners comply with this or other requirements. Prosecutions have been commenced in Western Australia of doctors who have continued to prescribe methadone without authorisation or for periods in excess of two months.

Another area of State responsibility relates to driving under the influence of methadone. This problem has been considered by several committees of inquiry in recent years, including the Canadian Inquiry

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into the Non-Medical Use of Drugs, the Law Reform Commission, and the South Australian Royal Commission into the Non-Medical Use of Drugs.

The Final Report of the Canadian Commission of Inquiry into the Non­ Medical Use of Drugs stated that there had been 'relatively little attempt to determine the effect of methadone on psychomotor functions involved in driving or the handling of other machinery. At the present

time we are allowing persons on methadone maintenance to drive automobiles, operate other potentially dangerous machinery, and perform other types of complex tasks without adequate assurance that this is a safe or reliable procedure' (Open Exhibit 22, p. 155). This is also the

case in Australia.

Dr D. G. Wilson, Government Medical Officer, Queensland Department of Health, expressed concern on this subject:

■..with the continuing and increasing use of methadone in the therapeutic treatment of heroin-dependent persons, it causes some anxiety in relation to these persons and driving.

Methadone is potentially a dangerous drug in that it produces euphoria, mental sluggishness and hallucinations. As such, it must impair driving skills. Tolerance to methadone effects develops through continued usage, but this does not mean that

driving skills remain unimpaired. (OT 2083)

Dr Wilson echoed the views of many witnesses who appeared before the Commission concerning the effects of drugs on driving skills when he advocated research in this subject. Dr Wilson stated:

There is an urgent need to study the level of driving skills in methadone-dependent persons. I have done some preliminary work to inaugurate such a study. The difficulty is that one cannot use the Lakeside Race track as we did previously for some

alcohol experiments, because I do not know what the results would be with some of these people. I am frightened of people being killed. I am sure they would be, or badly hurt. We are trying to find a simulator or some form with which we could

determine this, but I wouldn't like to put restrictions on these people. I wouldn't like to interfere with other doctors who are treating these people to the best of their ability and in good faith, yet one has got to look at the thing overall,

and I feel that something has got to be done along those lines. It would be pretty hard to suggest that these people should not hold a driving licence during their period of methadone treatment, yet that is a suggestion which has been made to me.

(OT 2084)

The States are also concerned with children born to drug dependent mothers and those on official methadone maintenance programs. Apart from concern for the health of infants suffering withdrawal, there is evidence that the development of children may be adversely affected by

pre-natal addictions, which may involve the child health services and the education authorities.

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CONCLUSIONS AND RECOMMENDATION

Conclusions

On the question of controls, there are minor similarities between methadone and methaqualone. Originally each was claimed to be non- addictive. Both have proved to be addictive and both are the subject of considerable abuse.

However unlike methaqualone where there is almost unanimity from informed sources that it should be banned, methadone has its strong supporters particularly for the relief of pain. At the same time those who strongly support the use of methadone in maintenance programs are in the minority. Many medical practitioners who had originally foavoured

its use in maintenance and indeed had prescribed it widely, having seen the degree of misuse and the effects on patients have had second thoughts.

The Commission also heard considerable evidence concerning the diversion of methadone from maintenance programs, particularly those where the tablet or ampoule form was used rather than the especially formulated syrup. This evidence was given, in the main, by addicts who also frequently stated that the drug was readily available through

certain medical practitioners.

It was also of interest to the Commission that those addicts who had experienced methadone withdrawal were unanimously of the view that this experience was worse than withdrawal from heroin. The Commission is of the opinion that the reason may well be that due to the low potency of the heroin available at street level these people were not really heroin addicts. However with adequate dosage they did become or were made, into methadone addicts.

On balance then the Commission is of the view that methadone has a limited place in treatment and rehabilitation. Much constructive work has been done by those who prepared the National Policy on Methadone. The Commission is of the view that this Policy should be continued as the appropriate guideline and should be strictly enforced.

Recommendation

The Commission recommends that:

** The National Policy on Methadone be continued and be strictly enforced.

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Chapter 9 Cannabis

The Commission noted that in discussions concerning cannabis there was need to consider that cannabis is used in various forms, and that arguments concerning its use often made distinctions between these various forms.

As has already been outlined in Part II of the Report, the plant Cannabis sativa (Indian hemp) produces a number of physiologically ■active substances (cannabinoids), the most common being

tetrahydrocannabinol (THC), cannabidiol (CBD) and cannabinol (CBN). Of these, THC is the substance which most alters mood, and its presence is the most commonly used measure"of the relative potency of the various cannabis forms.

Because cannabis is a vegetable product the potencies of the various forms differ widely due to such factors as climatic conditions, strain, and methods of preparation and extraction.

Marihuana ('grass', 'pot') generally refers to a mixture of the dried leaves and flowering tops of the plant used for smoking.

Marihuana typically contains approximately one per cent of THC. Flowering tops bound around a stick are known as 'Buddha sticks' and their THC content varies somewhere between that of 'pot' and hashish.

Cannabis resin (hashish), the resin from the flowers of the cannabis plant, is usually compressed into blocks. Cannabis resin contains approximately 5 to 10 per cent THC.

Cannabis oil ('hash oil') is a viscous extract of cannabis which can contain THC concentrations of up to 60 per cent.

CANNABIS AND HEALTH

Limitations on Scientific Investigation

Mr A. W. Parsons, Director of the Cannabis Research Foundation, presented evidence to the effect that cannabis had been the subject of considerable scientific probing. He stated:

Dr Lorna Cartwright, senior tutor in Pharmacy, University of Sydney, stated in her address to the 1977 Cannabis Conference that marihuana is one of the most thoroughly investigated drugs in the history of scientific research. Eighty-four years of scientific study has been unable to find any adverse health effects of moderate cannabis use which impel a particular

legislative policy. This is not to say that more research is

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not needed. It is always possible that certain harmful side effects may be discovered, but considering the medical information at hand and the social costs of the present laws, scientific clairvoyance has been used for too long by the anti­ marihuana lobby to justify the present laws pertaining to

cannabis use.

(OT 2461)

The Commission received a contrary view in a report presented by the Commonwealth Department of Health. This report, entitled 1 Cannabis-- A Review of Some Important National Inquiries and Significant Research Reports', questioned the validity of some of the scientific data gathered about cannabis. It said:

Although the current world literature on cannabis includes a considerable number of technical publications, many of these do not meet modern standards of scientific investigation. It was not until 1970 that accepted procedures for the quantitative analyses of marihuana were established and that carefully standardised strains of cannabis became available for research purposes. Much of the contradictory evidence previously

reported may well be a function of widely differing doses of active cannabinoids being studied under different conditions. (Open Exhibit 636, p.7)

The 1970 Interim Report of the Canadian Commission of Inquiry into the Non-Medical Use of Drugs, under the chairmanship of Professor Gerald Le Dain, raised other points which must be considered when evaluating the scientific evidence on cannabis:

Rational discussion of the drug generally referred to as 'marihuana' is frequently impeded by looseness of terminology and failure to identify the substance we are referring to. It is often difficult to compare studies and to generalize from them because of differences in substance, potency, and administration. When one adds to these variables, differences in the psychological and physiological make-up of the subjects, their socio-economic background, their expectation of the drug experience (the 'set') and the circumstances or environment in which the drug is taken (the 'setting'), all of which have an

important bearing on the drug's effect, it is no wonder that there is such confusion and conflict of opinion in the field. Most of the time we simply do not know what we are comparing. (Open Exhibit 21, p .199)

The American Medical Association House of Delegates adopted a statement in December 1977 which outlined some of the shortcomings of early scientific examinations of cannabis. This statement, which was quoted in the above-mentioned Commonwealth Department of Health paper on cannabis, explained:

Much marihuana research has been open to criticism because of methodological flaws. In addition to small sample sizes and short periods of observation, selection of subjects and

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characterization of use have raised serious questions regarding the significance. There is considerable variation in the definition of 'light', 'moderate', and 'heavy' use, so that even when the potency of the drug is uniform across studies it is difficult to compare findings and determine whether results are complementary or conflicting.

(Open Exhibit 636, p .91)

Other limitations on the validity of results of scientific studies on the effects of cannabis brought to the attention of the Commission included the choice of volunteers for human studies-- young male tertiary students in particular-- who are not typical of the entire population, nor even of the cannabis-using population; the difficulty

of determining whether a measurable laboratory finding is of any biological or public health significance; the fact that much of the scientific evidence is based on animal studies and it is very risky to

apply results of these studies to human beings; and, based on the experience with alcohol and nicotine, the need for 20 to 30 years of research before the effects of cannabis on humans are known in any comprehensive way.

There is also the question of the limitations of science itself. While science can prove a drug is harmful, it cannot conclusively prove it is harmless. Harmlessness can only be imputed from lack of evidence of harmfulness.

Metabolism of THC in the Body

Metabolism refers to the way in which THC and other components (metabolites) are absorbed into the body, their life span in, and effect on, cells and tissues, and their final clearance from the body's systems.

Professor Reese T. Jones, Professor of Psychiatry and Director of the Drug Dependence Research Center, University of California, San Francisco, stated in a submission to the Commission, in November 1978:

...the metabolism of cannabis is very complicated. ...there (are) at least 30 metabolites-- that is 30 substances---that cannabis breaks down into after it is introduced into the body. We do not have the foggiest notion as to the activity of any of

these metabolites, other than the THC which is the pure

substance and the so-called 11 hydroxy metabolites. That is the only metabolite that has been studied at all and here are these 30 more. (0T 18115)

The metabolism of THC into the blood stream was also discussed by Dr Gregory Chesher, Reader in Pharmacology at the University of Sydney. In evidence before the South Australian Commission into the Non-Medical Use of Drugs, which was incorporated into the transcript of this Commission, Dr Chesher stated:.

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...THC is very fat soluble, therefore when taken into the body it is very rapidly distributed into fatty tissues and this includes cell membranes. Now, if you look at the blood level of THC following administration of a dose, there is an initial phase that is very shortlived. It only lasts about half an hour and this indicates the short nature of its life and indicates two things. One is the rapid redistribution in the tissues, and two, the very rapid metabolism of THC. THC is indeed very rapidly metabolised. That is too a hydroxy derivative which is in itself very potent, is psychoactive and subsequent metabolites are inactive. That is in the sense of psychotropic activity.

(OT 10471)

While THC is metabolised very rapidly into the fatty tissues, it takes a long time to clear, to be excreted from the body's systems. Professor R. T. Jones explained the fading of THC in the body:

The point has been made that it lingers for a long time, that its so-called half-life, or the rate at which it is cleared from the body, is in the order of a few days rather than a few hours as it is with some drugs-- alcohol, for example...

...What it means is that with repeated dosage you can

accumulate the drug in the body and if what is accumulating is the metabolites, so-called, then in effect the user is dosing himself or herself continually. If you take one dose of a drug each day and it takes two days to eliminate the drug, then gradually you are going to build up a level of the drug in the body. This is probably what is happening with cannabis.

(OT 18114--15)

Professor Jones described experiments he had conducted with volunteers who were given 30 milligram oral doses of THC every four hours around the clock for two weeks. A week after the last

administration of THC, no lingering effects could be measured. Despite the quantities of cannabinoids which were still stored in the body fat, behaviourally and physiologically the volunteer subjects had reverted to their pre-THC, normal state (OT 18118).

Several witnesses mentioned the possibility that the metabolism of THC may be affected by the presence of other drugs or other

cannabinoids. These witnesses said research indicated there are interactions between THC and other substances, but the significance of these interactions in humans has not yet been determined (OT 18122, OT 10504--05).

The rapid absorption of THC into the tissues, and the possibility of other drug interactions, makes it very difficult for law enforcement officers who wish to relate a certain type of behaviour-- for example, driving performance-- to a given level of THC in the blood.

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Effects on Cellular Processes

It has been claimed that THC may have effects on cell metabolism. The Eastland Report, 'Marihuana-- Hashish Epidemic and its Impact on United States Security', 1974, said that 'marihuana, even when used in moderate amounts, causes massive damage to the entire cellular process'

because 'THC reduces DNA and RNA synthesis and the rate at which cells give birth to new cells' (Open Exhibit 636, p . 39). Other researchers have found that cannabinoids can block key events so that the cell can no longer progress through the cell cycle to mitosis (cell division).

If RNA or protein synthesis is blocked, cells will not undergo DNA replication and thus cannot divide. This was claimed as evidence of an essentially genetic effect on the cell itself (OT 17550).

The report presented to the Commission by the Commonwealth

Department of Health stated:

...the results of a number of studies show that cannabis can cause a decrease in DNA and RNA synthesis. However the

relevance of these results to actual human health is not known. Many other drugs have been shown to interfere with DNA and RNA synthesis, e .g ., aspirin, tetracyclines, erythromycin, puromycin, lincomycin, chloramphenicol, tobacco smoke, alcohol.

(Open Exhibit 636, p. 39)

Professor Reese T. Jones concluded that 'there is no convincing evidence at this time that...the alterations in cell metabolism, or DNA, RNA, or protein synthesis changes are of clinical significance' (OT 18086) .

Effects on the Brain and Mental Functioning

Cannabis undoubtedly has an effect on the brain. THC is metabolised mainly in the liver, but Dr Gregory Chesher, Reader in Pharmacology at the University of Sydney, stated that there is evidence that THC is metabolised also in the brain itself (OT 10472). As noted previously in

this Chapter, THC accumulates in the brain and other parts of the body with chronic use. These two factors are of importance in considering THC's effects on the mind.

Witnesses suggested that there is no convincing evidence at present of brain damage or atrophy. Much of the concern on this question stems from a preliminary British report by Campbell, which found evidence of brain atrophy in ten patients. However this study, published in 1976, has been widely criticised because of the experimental design used and

the measurement techniques employed. There have been no true

replications to confirm or discount the original findings.

Some witnesses referred to research carried out by Dr R. Heath, Professor of the Department of Psychiatry and Neurology at Tulane University, New Orleans, who reported that studies he undertook on monkeys forced to inhale THC through a smoking machine revealed brain

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wave changes and cellular changes in the brain which persisted for some months after the cessation of marihuana administration. These studies have been criticised because of the unduly high dosage levels, and in

any case, the behavioural significance of the findings for humans is unknown.

Professor R. T. Jones stated:

Although the evidence for tissue damage or cellular damage of brain structures is still very questionable, there is

absolutely no question as to the presence of functional or neurological effects following the use of cannabis. That is, brain function is unquestionably altered. (OT 18087)

Some of the most frequently mentioned effects of cannabis are panic, depression, anxiety and hallucinations. There is also the 'cannabis psychosis' which in effect is a long term condition with the above elements, particularly hallucination, being apparent.

Professor Jones told the Commission about some early experiments with single doses of very high content THC (up to 10 per cent). The effects were:

...one can reliably produce hallucinations or hallucination- type phenomena, profound perceptual distortions, confusion, disorientation, panic. (OT 18125)

While panic and anxiety undoubtedly occur, some evidence presented to the Commission suggested these reactions occur more frequently with inexperienced users than with regular marihuana smokers (OT 18092). Dr G. B. Chesher cautioned that the panic-anxiety reaction is not necessarily due to the pharmacological nature of cannabis. The expectation of the users and their familiarity with the drug will affect their reactions (OT 10485).

The Commonwealth Department of Health report previously mentioned stated that although prolonged cannabis psychosis has been reported in Eastern literature as occurring under conditions of unusually heavy use, it is often difficult to isolate the causative role of marihuana from that of pre-existing psychopathology or other drug use. Three research studies of heavy chronic users conducted in Jamaica, Greece and Costa Rica failed to detect evidence of cannabis psychosis. However the small numbers in each sample and the comparative rarity of this syndrome may mean that such a consequence was missed (Open exhibit 636).

Professor R. T. Jones stated that persons with schizophrenia show a marked psychosis when using marihuana but that this psychosis disappears when marihuana use is discontinued (OT 18132 — 33).

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Some evidence presented to the Commission suggested memory impairment may result from cannabis use. This evidence pointed to experiments conducted on rats by Dr Kalant of Canada (OT 17562) and on humans by Professor Souief of Egypt which showed that subjects using

cannabis had a pattern of learning deficits and prolonged memory impairment (OT 18129). On the other hand, no convincing evidence was presented to support the contention that marihuana enhances auditory, visual or tactual awareness and sensitivity.

Some reports postulated an 'amotivational syndrome' resulting from the chronic use of cannabis. Although witnesses agreed generally that there is no doubt that apathy, listlessness and reduced motivation occur during the period of intoxication, the persistence of amotivated behaviour is a phenomenon which has not been confirmed experimentally. Experimental models for testing its existence have had serious

limitations. The American Medical Association in a statement made in December 1977 claimed that in assessing the 'amotivational syndrome', as with other marihuana effects:

...it is difficult to delineate the discrete influences of personality, setting, other drugs used concurrently, and the action of marihuana itself. (Open Exhibit 636, p. 90)

Suggestions that cannabis use under normal conditions is associated with aggressive behaviour and crime appear not to be confirmed by experimental results. Several witnesses who appeared before the Commission stated that cannabis use does not lead to aggressive behaviour or criminal activities. However, certain animal studies have

shown that subjects under stress tend to be more aggressive when given cannabis. Similar effects have been observed in humans under stress.

Several witnesses who gave evidence concerning the effect of cannabis on the brain and mental functions referred to 'intoxication'. In his evidence Professor R. T. Jones agreed that the simplest way of describing a state of intoxication would be to say a person had brain poisoning, albeit temporarily. He agreed that both alcohol and cannabis

are, in scientific terms, brain toxicants, and added:

This, I think, would certainly offend the alcohol beverage industry, to use that term for alcohol, but if you were sitting in a laboratory looking at pieces of brain or electrical activity from brain and did not know what was happening, you would assume that something was producing a toxic state in the brain.

(OT 18143)

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Psychomotor Effects

There was no dispute among witnesses that cannabis causes severe impairment of psychomotor functioning. Professor R. T. Jones stated that cannabis has all the potential of other intoxicants, such as alcohol, to lead to accidents, poor decisions and inappropriate behaviour and may impair the ability to judge the environment and make appropriate reactions (OT 18139).

Dr G. Chesher gave details of tests he has conducted on the effects of cannabis on standing steadiness, reaction time, manual dexterity and cognitive skills-- all of which are related to skills necessary to drive a motor vehicle safely. THC was found to affect performance adversely, leading to the conclusion that THC would interfere with the ability to drive safely (OT 10500C). Professor R. T. Jones said:

There are numerous scientific studies indicating drug related alterations in time sense, slowed motor reaction times, impaired motor co-ordination, etc...

...Not surprisingly, the ability to drive an automobile or to fly an airplane appears to be impaired by the use of marihuana at doses commonly used in North America. (OT 18091)

Dr G.Milner,then Director of the Victorian State Alcoholics and Drug Dependent Persons Services Branch of the Department of Health, echoed Professor Jones' comments when he stated:

All these studies indicate that cannabis is, as should have been anticipated, a hazardous drug for the road user when taken alone, but particularly in combination with alcohol. (OT 2608)

The Fifth Report to the United States Congress from the National Institute on Drug Abuse (NIDA) on the topic of Marihuana and Health also addressed the problem of cannabis and driving. The conclusions reached in this report were quoted in the paper submitted to the Commission by the Drugs of Dependence Section of the Commonwealth Department of Health. The paper quoted the NIDA report in the following words:

Present evidence, whether derived from driver test course performance, from actual traffic conditions or from the experimental study of components of the driving task, all

indicate that driving under the influence of marihuana is hazardous. (Open Exhibit 636, p.21)

Evidence was presented to the Commission by Professor R. T. Jones (OT 18091) and in the NIDA reports (Open Exhibit 636) that, in limited surveys, between 60 and 80 per cent of American marihuana users admitted to driving soon after their marihuana use.

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Mr A. W. Parsons, Director of the Cannabis Research Foundation, agreed that marihuana impairs the ability to drive, but stated that the size of the threat which cannabis poses to road safety is a matter of conjecture (OT 2453). Mr J. Billington,founder of the Cannabis Research Foundation, said in evidence that while inexperienced user/drivers may

cause problems for themselves and the rest of the community, the problems are nowhere as great with experienced user/drivers (OT 10839). Professor R. T. Jones (OT 18140--41) and Dr G. B. Chesher (OT 10474) agreed that more experienced users drive with less impairment than persons unfamiliar with the combination of marihuana and motor vehicles.

Many of the cannabis users who gave evidence to the Commission also admitted to being consumers of alcohol, often simultaneously with their cannabis use. Given the known adverse effects of both alcohol and cannabis on driving ability, there is reason for concern that the combination of these drugs may cause serious road hazards.

There is some dispute as to whether the effects of cannabis and alcohol combined are additive or whether there is a multiplicative effect. Dr Gregory Chesher stated:

...it is clear that both alcohol and THC produce a dose-

dependent decrement in the performance of these tasks. The effect of both drugs taken together is one of addition. That is to say that the effect is that that would be expected by the addition of the effects produced by each drug alone.

(OT 10500C)

...there is no evidence at all that there is anything other than a straight additive effect-- in other words one and one is two. (OT 10501)

In evidence to the South Australian Commission into the Non-Medical Use of Drugs, incorporated into the transcript of this Commission, Dr Chesher qualified the above statement:

The most important thing is that the interaction is at least additive. That is, a mild dose of alcohol plus a mild dose of THC produces, at least, an additive effect of the interaction. This means that somebody who has a perhaps below legal limit blood level of alcohol will, nevertheless, still be in a very unfit and dangerous state for driving a motor vehicle.

(OT 10476)

Mr A. W. Parsons, Director of the Cannabis Research Foundation, stated:

It is clear that the effects of the drug and alcohol

intensifies the effect---it is not just adding A plus B, there is another multiplication factor in there.

(OT 2453)

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The Commonwealth Department of Health, in its paper 'Cannabis-- A Review of Some Important National Inquiries and Significant Research Reports' concluded:

The increasing simultaneous use of both alcohol and marihuana by drivers poses a threat that may well exceed either substance alone. A further danger is that some perceptual or other deficit may persist for some time beyond the period of

subjective intoxication. (Open Exhibit 636, p. 2)

The paper also mentioned the dangers of combining alcohol and marihuana when flying. Quoting the Fifth NIDA report, it stated:

The inherently greater complexity of flying suggests that performance is even more likely to be impaired under conditions of marihuana intoxication than is driving. A danger common to both driving and flying is that some perceptual or other deficit may persist for some time beyond the period of

subjective intoxication. Under such circumstances an individual may attempt to fly or drive without realising that his functioning is still impaired, although he no longer feels 'high'.

(Open Exhibit 636, pp.21--22)

The effects of alcohol compared with those of marihuana in relation to driving were also an issue for debate in some evidence received by the Commission. Dr G. B. Chesher stated:

...there is no doubt that, in sufficient dosage, marihuana is going to affect the ability to drive a motor - car.

Qualitatively the effects of marihuana seem to be a little different from those of alcohol and if one can describe the sort of cues, for example alcohol does slow down reaction time, complex reaction time, whereas marihuana quite often has

effects on attention so that visual cues can be entirely missed.

(OT 10480)

Dr G. Milner told the Commission:

In low dosage, cannabis is more dangerous for the driver than low doses of alcohol,...

(OT 2627)

However, Dr G . B. Chesher disagreed. He stated:

...I would stress that at this stage in the research it is not possible to say that THC is any more or less hazardous to driving than is alcohol.

(OT 10501)

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Given the total agreement by witnesses that to drive while

intoxicated with cannabis is dangerous, the problem of how to measure the level of cannabis is of considerable importance. Professor R. T. Jones stated:

...(the metabolism of THC) makes it very difficult for a law enforcement person who wants to relate behaviour, for example driving behaviour or criminal behaviour, to a given level of the drug in the blood because what is going on is that after the first 20 minutes or so most of the drug is not in the blood any more, it is in the tissues.

(OT 18115)

Professor Jones was relatively confident that an adequate analytic technique would be developed for measuring cannabis in the blood, but that a problem exists in relating doses to blood levels and blood levels to behaviour (OT 18117 — 18) .

Other methods such as radioimmunoassay, enzyme-multiplied immunoassay, and breath samples are all being investigated as possible detection techniques for forensic purposes.

Witnesses for the most part agreed that until an easily used

technique is developed to detect cannabis use in drivers, there is no way of controlling the cannabis and driving situation.

Effects on Pulmonary and Cardiovascular Systems

There is general agreement on the pulmonary and cardiovascular effects of THC. However, the biological and health significance of these effects probably will not be fully confirmed for some years.

Professor R . T. Jones said in evidence:

The effects of cannabis on lung function have been of

considerable interest since marihuana is characteristically smoked in cigarette form in the United States and, thus, a concern because of the known adverse effects of cigarette smoking. Although acute smoked doses of cannabis and/or THC

increases the diameter of air passages of the lung and,

therefore, has been thought by some to be useful in the

treatment of asthma, subsequent data indicates that chronic use has different effects producing impairment in lung functioning similar to those found in heavy cigarette smokers even after

only six to eight weeks of smoking a few marihuana cigarettes daily in an experimental situation. (OT 18081)

A recent study by Tashkin et al suggested that customary social use of marihuana may not result in detectable functional respiratory impairment in healthy young males (Open Exhibit 636, p. 48).

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Evidence was received that during the early stages of cannabis intoxication there is an increase in heart rate, a temporary weakening of heart muscle contractions and a decrease in standing (orthostatic) blood pressure.

While these effects may be of little significance to healthy users, there is reason for concern for users with pre-existing cardiovascular disease-- for example, angina, where the ingestion of THC causes pain (OT 18080). Persons with Burger's disease may also be adversely affected by THC (OT 18078--79). Marihuana use also decreases exercise tolerance prior to the onset of chest pain in those with heart disease

(Open Exhibit 636, p. 20).

Effects on Endocrine and Reproductive Systems

Professor R . T. Jones introduced this subject in the following terms:

Certainly the animal data is compelling and the human data is highly suggestive that cannabis has diverse effects on the endocrine system, that is blood hormone levels of a variety of hormones seem to be altered during intoxication. These are probably due to brain effects due to hypothalamus effects of the drug. The one that has received the most publicity has been the changes in testosterone levels. Our laboratories reported decreases in growth of hormone levels in people receiving marihuana. There has been more recent laboratory data suggesting that in females the so-called LH hormone is also depressed.

(OT 18145 — 46)

As with other effects of THC, Professor Jones stressed that:

...the clinical significance of statistically significant but modest changes in testosterone levels is unknown...

The decreases in level of testosterone and growth hormone, should they occur (and there is some dispute among good investigators as to whether they occur), are of unknown biological significance.

(OT 18084/5--86)

Dr G.B. Chesher, informed the Commission of the conclusions of Mendelson et al concerning testosterone:

...most of the changes that are reported fall within the degree of variance that you would ordinarily expect to occur in any healthy young or middle-aged adult.

(OT 10442)

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Evidence indicated that very little is known of the effects of cannabis on the human foetus or offspring. However, animal studies have shown long lasting effects in offspring. Some of the main studies in reproductive effects of THC are the rhesus monkey experiments conducted by Dr Ethel Sassenrath at the Primate Centre of the University of

California Medical School. Dr Sassenrath found a high proportion of miscarriages in pregnant monkeys given THC. Many of the monkeys died in the early stages of infancy and autopsies showed a wide range of

abnormalities in many parts of the body. Surviving infants did not behave normally in response to visual, audial or social stimuli, and also exhibited less than normal caution (OT 17560).

Professor R. T. Jones commented:

Related to the general lack of research information on cannabis effects in females is a relatively small amount of information of the effects of cannabis on the foetus. The pregnant female who is smoking cannabis subjects the foetus to substantial

amounts of cannabis metabolites. Foetal tissue levels and foetal drug metabolism in humans is virtually unknown. Some animal studies indicate possible foetal effects, but great species differences and questions about what are appropriate dose comparisons make firm conclusions impossible.

(OT 18103)

Effects on Immune Mechanism and Chromosomes

The immune system is a series of defence mechanisms the body uses to resist foreign cells and infections. It is a complicated area of inquiry and immunologists are not in agreement on the best method for testing immune competency.

Dr G. B . Chesher told the Commission a study by Nahas et al in 1974 found a marked reduction in the immune response of a group of marihuana smokers when compared with non-smokers. He said subsequent attempts to replicate these results have led to contradictory reports, which may be due partially to the different methods of assessment used (OT 10445-­ 47).

Evidence was given that one American investigator, L. H. Harris, has raised the possibility that cannabis may be an immuno-suppressant capable of hindering the growth of cancer cells. However, Dr G. B . Chesher and Professor R. T. Jones both stressed to the Commission that such findings are only speculative at this stage (OT 10447; OT 18153-­ 54).

Professor R. T. Jones suggested the consensus view of the experts was as follows:

So far there is no evidence that users of cannabis are more susceptible to diseases that are known to be associated with

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serious defects in immune response such as viral infections or cancer. (OT 18084/5— 86)

A similar lack of definitive evidence applies to the effect of TEC on chromosomes. Several retrospective studies of persons who had used cannabis (Stenchever; Herha and Obe; Kumar and Kunwar) indicated increased chromosome breaks in the users. Dr G. B. Chesher told the Commission that there is some doubt about the validity of these studies

(OT 10443) and Professor R. T. Jones said that for the most part

investigators attempting to replicate the findings have been unable to do so (OT 18154). Dr Chesher said prospective studies by Nichols et al and Matsuyama et al where white blood cell cultures were examined both before and after marihuana use had failed to find any increase in chromosomal aberrations (OT 10444).

All the evidence on this topic placed before the Commission indicated there are no convincing data to show that cannabis causes clinically significant chromosome damage.

Tolerance, Dependence and Addiction

Evidence given to the Commission relating to TEC and tolerance, that is, a diminishing response to a repeated constant drug dose, was con­ flicting. Studies by Perez-Reyes et al 1974, Frank et al 1976, and Renault et al 1974, all found no evidence of tolerance to cannabis if moderate dosages were used. The Commission was told that the authors of

the latter two studies concluded that higher doses than those currently used and a more frequent usage were necessary for the development of tolerance (OT 10448— 50).

Other researchers, such as Mendelson et al 1976, Gibbins et al 1976, Benowitz and Reese T. Jones 1975, and Reese T. Jones et al 1976, found evidence of tolerance. In general, higher dosages and more frequent administration of TEC were used in these studies. Professor Reese T. Jones stated:

From our studies and from studies like our own it is well established that almost complete tolerance develops to the cardiovascular effects-- that is, the heart rate changes, the blood pressure changes. A great deal of tolerance-- I cannot put a number on it, but a great deal of tolerance develops, to

the lethargy, the fatigue, the mild confusion, to the high, that sort of intoxication, but that is not complete and I think the interesting and curious thing is that there are great

individual differences and I think that is where the real question lies right now. (OT 18157— 58)

Professor Jones said cannabis almost rivals the opiates in terms of the degree and rapidity with which tolerance develops if the organism is exposed to enough of the drug for a long enough period (OT 18156).

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The issue of cannabis dependence, defined as the appearance of withdrawal symptoms following discontinuation of drug use, is more controversial than the question of tolerance. Professor Jones said there are very few clinical reports of dependence on cannabis, but in

some studies, the researcher did not look for withdrawal symptoms, or mistakenly took them to be influenza. He went on to say:

Under controlled hospital research ward conditions, the cessation of two weeks chronic cannabis intoxication is rapidly followed by irritability, restlessness, decreased appetite, sleep disturbance, sweating, tremor, nausea, vomiting and diarrhoea.

(OT 18096)

Other withdrawal symptoms which Professor Jones found in his studies include hyperactivity, weight loss, and increased salivary flow. These symptoms appear very rapidly after the drug is stopped. Within three or four hours after the last dose, the symptoms become apparent (OT

18160 — 65).

Some evidence was given to the Commission that, in terms of

relieving withdrawal symptoms, there is some cross tolerance between THC and other drugs. Alcohol and morphine have both been used successfully to alleviate the unpleasant symptoms of THC withdrawal.

One of the major issues with tolerance and dependence is what effect they have on drug-seeking behaviour. Is cannabis a drug of addiction? The definition of 'addiction' is not clear, as it is used in a variety of ways, many of which carry implications which may have nothing to do with the drug itself. Professor R. T. Jones defines addiction as

dependence combined with severe, compulsive, drug-seeking behaviour (OT 18167). On this definition he believes that cannabis appears to be non- addictive. He stated to the Commission:

That is what is mainly lacking with the cannabis, the

compulsive drug-seeking behaviour, at least in our culture. That seems to be lacking. (OT 18167)

Professor Jones noted that many other factors have a bearing on ' addiction'-- availability, lifestyle, stress, intelligence and a whole range of socio-economic variables which make it almost impossible to predict the addiction liability of cannabis (OT 18168).

Therapeutic Applications

Cannabis was used therapeutically as far back as the late 19th century. However, Professor R . T . Jones stated, the panic-anxiety reaction which was commonly described in the medical literature of the time led to cannabis being considered unsuitable for medical use (OT

18092).

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Mr A. W. Parsons, Director of the Cannabis Research Foundation, gave the Commission a different interpretation as to why therapeutic use of cannabis was discontinued. He stated that marihuana had been used for a variety of ailments, but due to the difficulty in measuring dosages,

cannabis faded into the background (OT 2480).

Dr G. B . Chesher said the most promising clinical application of cannabinoids to date had been in the treatment of glaucoma. Current treatments are not entirely satisfactory. THC has been found to lower intra-ocular pressure. Clinical evaluation of smoked or orally administered cannabis has had disadvantages because of the psychotropic side effects of the drug. Studies with THC-related derivatives administered as eyedrops have proved successful with rabbits and tests are about to begin on humans (OT 10470).

Professor R. T. Jones stated that the marihuana-induced bronchiole dilation had led to some interest in the treatment of asthma with THC or cannabinoid-like materials (OT 18100). However Dr Chesher indicated that smoking is a poor delivery method for asthmatics, and an aerosol preparation had been trialled with promising results (OT 10404).

Cannabidiol and related cannabis-like drugs have shown some promise of being anti-convulsants and are being investigated as a treatment for epilepsy, according to Professor Jones. He outlined a further area of interest in therapeutic use of cannabis:

The treatment of the nausea and vomiting that occurs in cancer patients receiving cancer chemotherapy seems to be another promising research area. In limited clinical studies, orally administered THC appears to be more effective than traditional anti-emetics.

(OT 18100)

Witnesses indicated that other possible medical applications of cannabis are being examined. Researchers are investigating anti-tumor activity, anti-anxiety and hypnotic effects, and analgesic and anti­ depressant effects. Some investigators have speculated that cannabis may be useful in treating alcohol dependence.

CANNABIS AND SOCIETY

Cannabis in all its forms (e.g ., marihuana, cannabis resin, cannabis oil) is covered by Schedules I and IV of the International Single Convention on Narcotic Drugs 1961. As a party to this Convention, Australia has an obligation to endeavour to prevent the cultivation, production, manufacture and use of cannabis other than for strictly medical or scientific purposes.

Pursuant to this obligation, cannabis has been declared a prohibited import under the Customs (Prohibited Imports) Regulations. In addition, under State and Territory legislation, use of cannabis is prohibited.

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In Australia it is only lawfully available to approved persons for scientific research.

The Cannabis Debate

Notwithstanding its illegal status, cannabis is used by a growing number of Australians. Evidence received by the Commission identified cannabis as undoubtedly the most widely used illegal drug in the community. Its increasing use as a social drug (albeit an illegal one) has been paralleled by sustained law enforcement efforts to suppress its distribution and use. Among drugs involved in police seizures and

criminal prosecutions and convictions, cannabis is pre-eminent.

There is evidence of a mounting demand by some sections of the community for the laws relating to cannabis to be relaxed. The

Commission received submissions from many persons and bodies contending for some measure of relaxation on a variety of grounds. On the other hand, evidence was forthcoming from a number of persons and bodies reflecting the view that the present legal restrictions should be

substantially retained. In a few instances there were calls for a strengthening of the present legal sanctions.

Social commentators have noted the polarisation of debate surrounding the laws relating to cannabis. Such a polarisation was certainly apparent in the submissions received by the Commission. The sharp dichotomy reflected the views of those interested groups at the extremes of the spectrum with a particular motivation to come forward. Such testing of community attitudes as has been done suggests this dichotomy does not truly reflect attitudes of the community at large.

Whatever may be the truth of the matter, with few exceptions the submissions made to the Commission on cannabis were strongly

antagonistic. In the discussion which follows, an attempt has been made to reflect the main arguments advanced for and against the relaxation of laws relating to cannabis.

Much of the evidence received by the Commission on the cannabis question related to the nature, application and consequences of existing laws. It seems appropriate as a starting point, to summarise briefly the main arguments advanced which bear upon existing legislation.

Efficacy of Existing Legislation

Given that it is the expressed intention of the present laws relating to cannabis to prohibit its use, it was strongly argued in a number of submissions that enforcement of the laws had substantially failed to achieve the desired end. Reference was made to estimates of

the large number of cannabis users in Australia and to yearly increases in the number of convictions for illegal cannabis possession as evidence of this failure.

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Frequent reference was made in evidence to the failure of

'prohibition' as a valid approach to drug control. In a paper entitled 'Learning From Mistakes: Six Caveats', Dr R. A. J. Webb of the New South Wales Drug Education Unit articulated the argument as follows:

Prohibition does not work. As the United States learned from 1920 to 1933 it didn’t work with alcohol. As the country has been learning since 1914, it doesn't work with heroin. It isn't working today with marihuana, LSD, or any of the other illicit drugs.

(OT 19374)

It was argued that attempts to stamp out illicit drug use in fact tended to have the opposite effect; they increased both drug use and drug damage. Without proceeding as far as this, the 1977 Report of the Senate Standing Committee on Social Welfare entitled 'Drug Problems in Australia-- an intoxicated society?' did note:

There may be a significant group in the population who use cannabis because it is illegal and who see cannabis use as a rebellion against the laws of society. They are not deterred, but rather are spurred on, by legal prohibition.

(Open Exhibit 379, p. 155)

A number of submissions to the Commission, however, expressed views rather different in character on the matter. For example, Dr C. B. Keogh, National Director of the GROW self-help community health organisaton, in a paper entitled 'Towards a New and Truer Understanding of Alcoholism and Drug Dependence', admitted 'there is overwhelming evidence that the predominantly penal approach is a failure', but went on to say, 'yet the control of availability of harmful drugs remains a necessity' (OT 11383).

Likewise, the Senate Committee on Social Welfare in its above- mentioned report, concluded 'that achievement of the stated and implied objectives of the law relating to cannabis use has been minimal', but found it necessary to add: 'We are unable to say how much worse the situation might have been had present laws not existed' (Open Exhibit 379, p. 157). Elsewhere in its report the Committee observed, 'The law does deter a significant group in the population from the use of cannabis. The size of this group, however, is declining' (Open Exhibit 379, p. 155).

The submission of the Australian Festival of Light, presented by the Rev. F. J. Nile, argued that the law is in fact a deterrent. It

referred to a United States study quoted by Dr Robert Du Pont, former Director of the U.S. National Institute on Drug Abuse (NIDA), in Senate hearings in 1975, in which a sample of 2000 marihuana users cited concern about being arrested as their main reason for discontinuing drug use. Among those who never smoked marihuana, this concern was most often third on the list of reasons for not smoking (OT 10354). The Festival of Light also argued that prohibition of marihuana in the USA

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is a myth, with widespread public use of marihuana in universities receiving no action by police or narcotic squads (OT 10306).

In a submission to the South Australian Royal Commission into the Non-Medical Use of Drugs, which was incorporated into the transcript of this Royal Commission, the late Professor Hardin B . Jones, Professor of Medical Physics and Physiology in the University of California, Berkeley, stated:

Many have pointed out that no country trying to prevent the entry of illicit drugs is likely to be successful in seizing more than 20% of the contraband. I am convinced, however, that each such law enforcement program provides a general deterrent

to smugglers and that without the law enforcement effort the volume of drugs brought across borders would be considerably greater than it is. (OT 7766)

Penalties

A number of witnesses contended that the 'cannabis laws' are a greater threat to the wellbeing of cannabis users than the drug itself. Although it was acknowledged that cannabis users are receiving lighter sentences from the courts as time goes on, it was put to the Commission

that there are other penalties attaching to a conviction, or even a court appearance, for cannabis use which constitute a most serious problem. These penalties were said to include:

* the burden and stigma associated with 'life-time' criminal records;

* alienation from family and peer groups and resultant emotional disorders;

* expulsion from educational institutions;

* disqualification from many job opportunities and promotions;

* loss of employment; and

* exclusion from certain professional bodies.

Professor N. Blewett, Past President of the South Australian Council for Civil Liberties summarised this line of argument succinctly in a paper entitled 'Marihuana: The Most Victimless Crime of All?'. This paper, which was part of a submission by the Council to the South Australian Royal Commission into the Non-Medical Use of Drugs, later

incorporated into the transcript of evidence of this Commission, said:

The law is simply an ass if, in seeking to protect a person from his own actions, it imposes upon him far greater agreed harm than anything likely to result from the prohibited actions.

(OT 8215)

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Mr B. G. Tennant, who described himself as a 'social and law reform campaigner1, said:

On the question of cannabis in particular, one might recall Allen Ginsberg's comment that by outlawing marijuana you make criminals out of some of the most intelligent and sensitive people in the country; for this drug is by no means confined to

the lunatic fringe.

(OT 8506)

Administrative Costs

The Commission did not receive any authoritative estimates of the cost of administering drug laws in Australia. However several witnesses claimed that legal procedures which involve processing charges through the courts, and in some cases long gaol sentences, constitute a large burden on the public purse.

Mr A. W. Parsons, Director of the Cannabis Research Foundation, offered the following comment in a submission tendered on behalf of the Foundation:

The Foundation Advisory Council very loosely estimated that to process one cannabis offender, taking into account police time and wages, costs of the police modus operandi, court, staff and magistrates, costs the taxpayer $1200. This does not include

the cost of remand and jail expenses variously estimated to be between $60 and $120 per prisoner per day. The 1975 bill runs to about $10 million. (OT 2462)

It should be borne in mind when the above-mentioned estimates are considered that the Commission was unable to discover any recent cases where Australian courts had sent users of cannabis to gaol on conviction for being in possession of cannabis for their own use. The implication

in the argument is that young people are being sent to gaol in

significant numbers merely for using cannabis. The fact that nothing like this occurs merely demonstrates that the cannabis debate often generates more heat then light. Under the present laws young persons can be sent to gaol merely for cannabis use. Some polemists proceed on the basis that they are, in fact, being sent to gaol merely for cannabis use.

Black Market and Crime

Numerous submissions to the Commission alleged the existence of a flourishing black market in cannabis which had been created and was fuelled by existing laws. A typical expression of this thesis was presented by the Queensland Council for Civil Liberties. It stated in

its submission:

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In the Council's view drug trafficking has become an attractive business investment because attempts at prohibition have forced up prices and profits. (OT -15360)

Those who took this view tended to stress that the law gives

cannabis users no option but to enter the black market environment to secure the drug; and because of the crass profit motive of those engaged in the trade there are associated dangers arising from adulteration or 'lacing' of the product. Furthermore, it was held that in situations where there was a shortage of cannabis, customers were not infrequently enticed into using the more readily available and more harmful narcotic

drugs.

Certain witnesses claimed that organised crime was also attracted by the profitability of the cannabis trade. Mr B . G. Tennant stated:

The prohibition of something widespread and popular, as cannabis... leads almost inevitably to the involvement of organisations of professional criminals in the black market... (OT 8506)

The Law and its Enforcement

Those witnesses who advocated the relaxation or removal of legal restrictions on the possession and use of cannabis, tended to believe that existing laws relating to cannabis had effects injurious to the public regard for the law and to the standing of law enforcement

authorities.

It was also put to the Commission that the laws were a corrupting influence on law enforcement agencies. Specific instances were cited of the existence of a 'pay-off' system and widespread bribery involving police. Accounts were also given of selling activities by police. It was suggested a substantial proportion of cannabis confiscated by police

and Customs eventually found its way back on to the market. The

Queensland Council for Civil Liberties stated:

At the same time social and moral attitudes about drugs are so ambivalent that some police are open to corruption... as they would not be in cases involving other kinds of criminal

activity of a type universally viewed as abhorrent by society. (OT 15359)

Allegations were made to the Commission of 'planting' and entrapment and other illegal activities undertaken by the police in the pursuit of persons suspected of involvement in drugs. Instances were given of alleged harassment and physical assault of suspects by the police.

It was suggested to the Commission that the current cannabis laws effectively add to the bias and class discrimination claimed to operate in the criminal justice system. In the paper already quoted,

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'Marihuana: The Most Victimless Crime of All?', Professor N. Blewett observed:

The class suggestion here is amply born out by New South Wales statistics. While usage of marihuana there appears to be more widespread among the young of professional/managerial families than amongst the working class young, working class youths are much more likely to fall foul of the law over marihuana. 'The

rich get stoned, the poor get busted'. (OT 8216)

Frequent mention was made in submissions of a deterioration in relationships particularly between young people and the police over the alleged heavy-handed enforcement of the laws relating to cannabis. It was put to the Commission that many young people of good character and behaviour had been soured against police and what they stand for by the

role in which the police had been cast by the existing laws. Mr A. W. Parsons articulated a frequently-stated view when he said:

Those who break the cannabis laws do so in the belief that it is the laws which are wrong, not their conduct. The overall effect of continuing to enforce such unpopular laws tend to weaken respect for the laws in all areas... By breeding contempt and disregard for the present legal system, the current laws are credited by many with increasing our growing crime problem in this country.

(OT 2469)

Certain witnesses drew attention to the fact that deployment of police to apprehend cannabis users denied these resources to the fighting of more serious crimes. Criticism was also voiced regarding the 'disproportionate' time spent by overburdened law courts in hearing cannabis offences and also concerning the 'already overcrowded' penal institutions having to house many people charged with, held in remand on, and convicted on cannabis charges.

A number of submissions received by the Commission substantially rejected the foregoing assessment and criticisms of the consequences of the existing laws. For example, Dr G . Milner, Director of the Victorian State Alcoholics and Drug Dependent Persons Services stated:

When a law is hard to enforce, it is claimed that the whole legal process is brought into disrepute. But laws against theft serve to limit this offence and, when administered within a stable society, do not usually send the schoolboy apple- stealer to jail. No one advocates legalisation of theft to ensure that no apple-stealer is ever punished... The law does reinforce social sanctions and discourages many who would otherwise use illicit drugs.

(OT 2604)

In a statement of dissent from certain of the majority conclusions in the Report of the Senate Standing Committee on Social Welfare, 'Drug

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Problems in Australia-- an intoxicated society?', Senator J. I. Melzer stated:

It is alleged that there is a deterioration in the relationship between young people and the police, and in the respect for law and for law enforcement authorities. I do not believe that

this is as a sole consequence of the legal situation regarding cannabis; nor do I think it accounts for a very great part of that lack of respect for law enforcement agencies. (Open Exhibit 379, p. 189)

Relative Harmfulness of Drugs

One specific criticism of the existing laws which was mentioned by several witnesses is their alleged failure to distinguish adequately between cannabis and more dangerous drugs. In doing this, so it was said, the laws do not promote an awareness in the community of the

difference between cannabis use and, for example, narcotic drug use.

The Cannabis Research Foundation in its submission described its perception of the consequences of lumping all illicit drugs together in this way, in the following terms:

Adolescents are continually warned by many sections of the community of the catastrophic consequences of marihuana use. Once they try cannabis, they soon realise that the government, courts, the media, schools and parents are often grossly wrong

in their assessment... The danger lies, in the circumstances, in the not too unreasonable assumption, on the part of the young cannabis user, that perhaps community attitudes concerning the other illegal drugs are equally ill-founded.

(OT 2464)

A somewhat different, though related, consequence alleged to flow from the existing laws was referred to by Dr R. A. J . Webb of the NSW Central Drug and Alcohol Advisory Service as follows:

What prohibition also achieves is to convert the market from relatively bland, bulky substances to more hazardous

concentrates which are more readily smugglable and

marketable-- from opium smoking to heroin mainlining, from coca leaves to cocaine, from marihuana to hashish. (OT 19374)

Identifying the Victim

A commonly expressed sentiment among witnesses who argued for the relaxation of existing laws with respect to cannabis was that possession and use of the drug harmed no one-- that is, there was no 'victim'. In the absence of an identifiable victim disadvantaged by drug-related behaviour, it was argued, the law should not intervene. The notion of

the drug laws creating 'victimless crimes' was put to the Commission by

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the Cannabis Research Foundation in its submission, in the following words:

The perpetration of a crime against the cannabis laws does not have a victim. The cannabis laws are, therefore, one of the outstanding contradictions of the belief that the criminal law protects people from the harm done by others to their person

and property.

(OT 2462)

A corollary of this line of argument is that legal penalties should attach not to drug possession, use or even trafficking as such, but rather to harm done to others as the result of cannabis use. This principle, it was pointed out, has had long-standing application with drugs such as alcohol. Mr P. R. Rumble, a law graduate in association with the Cannabis Research Foundation, expounded the principle in the

following terms:

If the individual uses any stimulant to excess and damage results from his actions in the 'inebriated1 state, he must bear the consequences. The answer to this problem is not to be found in attempting to outlaw the particular drug.

(OT 10919J)

It is significant that a view along these lines was advanced in its report by the Senate Standing Committee on Social Welfare, 'Drug Problems in Australia-- an intoxicated society?1 (Open Exhibit 379, p. 157) .

In rebuttal of the victimless crime concept, it was argued in certain submissions that there are in fact victims of drug use other than the casualties resulting from actions of drug users in the 'inebriated' state. The Festival of Light, for instance, stated in its submission:

The teenage addict is a victim, as well as his mother and/or wife and family, and our society 'no man is an island'. This is especially true of drugs where almost every user eventually becomes a drug pusher, even if only to his/her own friends.

(OT 10355)

Several submissions argued that taxpayers collectively are the victims of drug misuse in the sense that they bear the cost of the health care and social security services required by drug users.

The Festival of Light argued for a preventive role for the law in the matter of drug use, rather than one which addresses only the damage which may result. In its submission, the Festival of Light stated the law should:

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...serve as a fence at the top of a cliff, rather than a

hospital at the foot of the cliff. The law is based on the

simple proposition that prevention is better than cure. (OT 10356)

In this connection, the Report of the Senate Committee on Social Welfare already quoted, stated:

...legal sanctions, to the extent that they may have limited the incidence of cannabis use combined with driving, may have prevented some road injuries and deaths. (Open Exhibit 379, p. 155)

Some witnesses rejected the notion that the law should properly restrain a person for his own welfare. Some also argued against 'anticipatory' legal strictures which sought to prevent behaviour which 1 might' lead to harm of others. In some submissions, laws directed to these ends were described as 1 paternalistic'.

Cannabis and Alcohol

The Commission received submissions in which the legal use of beverage alcohol was quoted in support, on the one hand, of changing the laws relating to cannabis, and, on the other, of retaining those laws as they presently stand.

Some witnesses strongly urged that it was 1 inconsistent1, 1 illogical', 'discriminatory' and ’hypocritical' for the law to prohibit the possession of cannabis whilst alcohol is readily available. Argument was advanced, for example, that cannabis constitutes a less

serious health hazard than alcohol. Mr A. W. Parsons of the Cannabis Research Foundation stated:

...current medical knowledge... indicates that the health risks associated with cannabis use are insignificant in comparison with the health risks involved in the non-medical use of licit drugs, particularly alcohol...

(OT 2440)

Allegations of legal discrimination tended to be based on argument that the social drug of choice of the young cannabis-- is illegal, and its possession and use are suppressed and penalised, whereas the preferred drug of the older generation-- alcohol---may be obtained and

enjoyed at will. Some witnesses said the present situation represented a double standard whereby society sees alcohol consumption as an expression of 'gracious living', but regards the use of cannabis as indicative of a 'layabout' or 'dropout' mentality, or worse. In his Annual Report for 1975--76, the Commonwealth Director-General of Health

referred to:

...the attitude of many adult moralists who castigate young people for their attitudes to drugs while at the same time

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declining to moderate their own personal over-indulgence in alcohol...

Although they did not necessarily seek to justify the apparent anomaly in the respective positions of, or attitudes towards, alcohol and cannabis, a number of witnesses argued it would be unwise to use the present legal status of alcohol as a justification for removing the

restrictions on cannabis.

It was claimed, for example, that there are significant differences in the nature and use of alcohol and cannabis which must be considered. One such difference was perhaps best articulated in a submission by a marihuana user quoted in the Report of the Senate Standing Committee on Social Welfare, 'Drug Problems in Australia-- an intoxicated society?'.

Cannabis differs from alcohol in one very vital aspect. Alcohol is frequently drunk for the sake of drinking. If one is asked if one wants a drink there is no implicit inference that one will or should get drunk-- however with cannabis 'do you want a smoke' means 'do you want to get stoned'...getting

stoned is rarely incidental to smoking, as getting drunk may be to drinking. (Open Exhibit 379, p. 191)

Another line of argument put before the Commission in rebuttal of the 'alcohol analogy' was that legal drugs such as alcohol and nicotine are already exacting such a high toll in terms of human misery and economic cost that it would be foolish for society to give legal recognition to a further harmful drug. The Festival of Light put this argument in the following words:

Do we wish to add a fourth intoxicant, marihuana, to our other three, (caffeine, nicotine and alcohol)? If marihuana is legalised we will impose this fourth intoxicant on our children, grandchildren and great-grandchildren, for, once a new intoxicant is legitimatized and accepted by the public, it cannot subsequently be arbitrarily proscribed.

(OT 10350)

Dr G. Milner, in an article entitled 'The Case Against "Pot"', which appeared in the 'Australian Family Physician', vol. 6, November 1977, expressed his concern about marihuana and alcohol in terms of multiple drug use, as follows:

The issue is not only marihuana, or marihuana versus alcohol, but marihuana plus alcohol and all the other drugs we continue to use. How many intoxicants can we use-- how much can we consume, and still function? New drugs are being produced all the time, where do we stop?

(OT 2604)

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Several witnesses expressed the view that it was too late for society to have any realistic choice whether cannabis was to be accepted as a social drug-- its already widespread use ruled out the possibility of any such choice now being made. By way of rejoinder, however, it was suggested by some that cannabis had by no means achieved the widespread acceptance that traditional use over hundreds of years had won for alcohol.

Protection of the Young and Weak

A number of submissions urging substantial retention of the existing laws made a special plea on behalf of those who by virtue of immaturity or weakness were said to require particular protection from the alleged harmfulness of cannabis. The particular vulnerability of the young was

stressed by Dr C. Sprague, Leadership Training Co-ordinator of the GROW Movement, as follows:

It is all very well for a mature and formed person who can

handle marihuana by using it at a party once every couple of weeks. He has a formed personality, has a job, has a family and so on. I think that his chances of breaking down with cannabis are less-- much, much, much less-- than those of a 12

to 18 year old child who has an unformed life and character and personality. I think that it is these people, these young people, that we are putting at hazard by this move to

decriminalise marihuana and these are the people that we should be thinking about the most intensely, I think. (OT 11457)

The Rev. F. J. Nile suggested the young have the most to lose from cannabis. The submission he presented on behalf of the Festival of Light quoted certain of the provisions of the United Nations Declaration of the Rights of the Child:

The child shall enjoy special protection, and shall be given opportunities and facilities, by law and by other means...The child shall be protected against all forms of neglect, cruelty, and exploitation.

(OT 10355--56)

1 Progression'

The term 'progression', as commonly employed in discussions on drugs, refers to the theory that the user of a drug will tend to be

drawn inevitably over time in the direction of using more and more potent drugs. It has been suggested, for example, that marihuana users will tend to progress to the stronger forms of cannabis, and thence to the 'hard' narcotic drugs.

A number of submissions representing a wide spectrum of views acknowledged the existence of a form of progression, in the gross and obvious sense that some cannabis users do choose to move to other more potent drugs or to, the use of multiple drugs including drugs of greater

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potency than cannabis. However, comparatively few submissions contended that such progression was related in some intrinsic way to the nature of the drug cannabis (e.g ., its pharmacological properties).

It was suggested by Dr C. Sprague that marihuana was 'almost always the first illicit drug that a person who is to become a heroin addict becomes habituated to' (OT 11325). However, it was contended by Mr A. W. Parsons that 1 the overwhelming majority of cannabis users do not go on to heroin use' (OT 2450).

Mr P. R. Rumble, a Sydney law graduate who appeared before the Commission in association with a submission from the Cannabis Research Foundation, said 'Heavy prior alcohol consumption is a common feature of narcotic drug users generally' (OT 10919E). Another witness affirmed

that, statistically, users of barbiturates were more likely to use hard drugs than users of marihuana, while others postulated more elaborate patterns of drug use development or progression.

In endeavouring to explain the movement from cannabis to heroin, in cases where it does occur, a number of submissions put the view that it is a matter of availability. Mr J. R. Billington, founder of the Cannabis Research Foundation, noted:

...because there are many distributors who are involved in the cannabis issue involved also in the heroin situation, there are times when it's appropriate that the cannabis is either held back or there is a legitimate drought and heroin is substituted through that system.

(OT 10834)

Some submissions, went on to assert that 'droughts' of marihuana leading to hard drug use were caused by its illegal status and the associated law enforcement activity.

Some submissions emphasised the influence of the drug 'sub-culture', in which different drugs are used and in which the marihuana user is likely to be invited to experiment with other available drugs. The Rev. F. J. Nile of the Festival of Light stated:

Once a person uses a drug, he becomes involved in a drug- oriented environment. In such an atmosphere, where many kinds of drugs are available, peer pressure can be very strong. Because his powers of judgment and will are reduced, the marihuana user is highly susceptible to the enticing

possibility of greater pleasure. He may also come to prefer the variety of sensations multiple drug use produces. Many multiple drug users have said in interviews that, after finding they liked marihuana, they set out to try as many other kinds of drugs as possible.

(OT 10335)

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Medical Use

Some witnesses argued that the existing laws had the effect of preventing the use of cannabis for legitimate scientific and medical purposes. On behalf of the Cannabis Research Foundation, Mr A. W. Parsons stated:

We have had personal reports from patients who need cannabis, particularly those suffering from internal cancer, epileptics and patients suffering from glaucoma. We have had approaches from their doctors saying, 'We need cannabis because none of

the other drugs work and this does. We are in a drought

situation. The Health Department will not give us any, nor will the Drug Squad. What can you do for us?' This is

ridiculous when they are handing out amphetamines and such things-- it is ridiculous that we cannot get hold of cannabis for simple therapeutic use. (OT 2480)

The potential medical application of cannabis has been discussed already in this chapter. It has also been noted that the law permits the use of cannabis for legitimate scientific research.

SHOULD LEGISLATION BE CHANGED?

Social Attitudes

Various submissions representing diverse points of view with respect to the proper legal status of cannabis appeared generally to be agreed on the relevance of social attitudes as a legitimate ingredient in the formulation of public policy. However, while those advocating retention of the status quo tended to quote indicators of overall public attitudes to support their arguments, those who advocated relaxation of the present laws quoted what they perceived to be significant changes

occurring in societal views.

Professor N. Blewett, in his article 'Marihuana: The Most Victimless Crime of All?', expressed a standpoint broadly representative of those who argued that there appears to be an emerging public acceptance in Australia of the recreational use of cannabis when he said:

We are probably approaching the condition recently identified in Canada by two members of the research staff of the Le Dain Commission: 'It appears that the last few years have marked the

beginning of the cultural institutionalization of cannabis in Canada. Cannabis is no longer morally aligned with the opiate narcotics and its legal classification with them must be seen as an historical and moral anachronism. Today cannabis is more

frequently equated with the use of alcohol than the use of opiates, and-- in the face of common usage and the absence of popularly expected evidence of serious detrimental effects its de jure legitimation for recreational purposes has become

simply a matter of time.' (OT 8217)

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Professor Blewett acknowledged, however, that the situation described above is still some time away:

There seems little doubt that a majority, if a declining majority, of Australians consider 'smoking pot', as distinct from drinking alcohol or smoking tobacco, the culturally accepted drugs, as wrongful or immoral, and desire that criminal sanctions should be employed against that activity.

(OT 8206)

Several submissions to the Commission referred to the results of public opinion surveys in arguing that the Australian community was not in favour of any relaxation of the legal restrictions on the possession of cannabis. The Commission received the results of several such surveys which were incorporated into evidence as Open Exhibit 680. Some of these are summarised below.

Of 2207 men and women aged 14 and over in all Australian States surveyed by the Roy Morgan Research Centre in 1977, 49 per cent said possession of marihuana should be a criminal offence, 39 per cent said it should not, and 12 per cent were undecided.

Among a number of drug-related questions asked in a survey published by Australian Public Opinion Polls in September 1977, 63 per cent of the people expressed concern at the extent of marihuana usage; 22 per cent were 'a little concerned', and 14 per cent were not at all concerned.

In a survey conducted by the same organisation in April 1978, 72 per cent said they would like to see stricter controls on marihuana. In a similar survey in August 1976, 65 per cent had favoured stricter controls.

Effect on Usage

The Commission noted that the majority of submissions which gave consideration to the incidence of cannabis use following any relaxation of the law took the view that such relaxation would lead to an increase in usage, although some suggested this would be only a temporary phenomenon.

Dr Gerald Milner, in his article 'The Case Against "Pot"',

previously referred to, expressed one view of the matter as follows:

If the law is made more lenient and marihuana use socially approved, epidemiologists predict increased consumption. (OT 2603)

In addressing broadly the same question, Mr F . D. 0. Fielding, President of the Queensland Council For Civil Liberties, stated:

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I think there would probably be an immediate increase, because there would be some experimentation by people who previously had not experimented because it was illegal to do so. I

wouldn't necessarily think there would be a long-term increase. (OT 15354)

Attempts were made in several submissions to draw conclusions from United States experience, particularly in those States (e.g. , California) which have 'decriminalised' marihuana in recent years. In this regard it is perhaps significant that the results of studies in the

State of Oregon were quoted both by those who argued that relaxation would be followed by increased usage and those who took the contrary view. Some evidence given to the Commission suggested that the results

of these studies were somewhat equivocal. A statement made by Mr D. W. Murdoch of the Commonwealth Department of Health to the Senate Standing Committee on Social Welfare, suggested a further reason for caution:

I think we are basing a lot of our thinking on what is

happening in Oregon or what is happening in California. That does not happen in Australia. This is a different society completely and there is not the same usage. (Open Exhibit 379, p. 192)

Effect on Crime and Black Market Activity

A number of advocates of the relaxation of the law relating to cannabis argued that, since the origin of the existing black market in cannabis is the restrictive laws which prohibit its possession and distribution, the relaxation of these laws should have the effect of diminishing or removing the need for black market activity. Argument along this line was advanced by Mr P. R. Rumble, appearing in

association with the Cannabis Research Foundation in the following terms:

By removing the sanctions upon the use of marihuana and

changing our drug policy we would eliminate the black market in drugs and the contact with crime which so many people associate with drugs... (OT 10919L)

Although all witnesses who commented on this aspect agreed that the removal of the black market would be advantageous, not all agreed that this would in fact be an inevitable consequence of the relaxation of the laws. A witness with experience in science education and a member of the former National Drug Advisory Council, Dr N. A. Broadhurst, questioned the extent of black market dealings in cannabis and went on to say:

...to argue that deeriminalisation will eliminate black market dealings must be considered to be suspect to say the least. (OT 6795)

In referring to the matter of organised crime and drugs the Rev. F. J. Nile on behalf of the Festival of Light observed that there was a

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close relationship between marihuana and heroin, and went on to argue that relaxation of the cannabis laws could well exacerbate the heroin problem. Speaking of the situation in the United States he stated:

It appears organized crime has invested large sums to ensure the legalisation of marijuana. They recognise that

legalisation of marijuana would automatically expand their high profit heroin market.

(OT 10363)

Legal Problems

Dr G. Milner stated that there are:

...certainly some arguments in favour of the decriminal!sation of simple cannabis possession and use, but the strength of the cannabis must be carefully defined.

(OT 2608)

Some witnesses held, however, that any attempt to define legally acceptable cannabis in terms of its strength (i . e . , its THC content) would lead to difficult practical problems for the law. Thus, a person having high-content marihuana might incorrectly believe himself to be within the law, while a policeman might apprehend a person in possession of low-content hashish in the mistaken belief that the person was in breach of the law.

It was also suggested to the Commission that the advocacy of relaxation of the law relating to cannabis would give rise to other problems of legal definition and the precise specification of the substances to be affected. For example the Rev. F. J. Nile for the Festival of Light stated:

The decriminalisation of marihuana raises some difficult questions both in drafting the law and in its enforcement. What about the use of these drugs by minors? What about

hashish and the concentrated product, cannabis oil? Is synthetic THC legal, too? Should LSD, psilocybin, and mescaline also be decriminalised, since they are comparable in potency to THC?

(OT 10351)

Submissions seeking relaxation of the law were not fully agreed on the substances which should be subject to more ready availability in the event of a relaxation in the laws. Some witnesses indicated that only marihuana (i.e . , the natural forms of the Indian hemp plant) should be

subject to de-restriction. Others advocated legal relaxation in relation to all forms of cannabis of whatever strength.

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Social Aspects

In surveying the large amount of evidence it received on what could be termed the cannabis debate, the Commission noted that a wide range of social consequences were identified in various submissions as being the logical outcome of the adoption of a policy of relaxation with respect

to cannabis.

Those submissions which argued against relaxation suggested such relaxation would give rise to the following phenomena:

* Many people would quite reasonably assume that the authorities considered cannabis to be safe from a health standpoint.

* Changes in the law would constitute a positive inducement,

particularly to the young, to experiment with, and possibly become habituated to, cannabis in its various forms.

* The law prohibiting the possession of cannabis would come to be regarded as a mere token of veiled displeasure.

* It would be made easier for drug traffickers and pushers to continue the practice of paying fines imposed upon users who buy from them.

* Law enforcement officers would be encouraged to turn a 'blind eye' to offenders against the law.

* There would be a vastly increased risk of death through road and other accidents.

In addition to the above consequences certain submissions foreshadowed the occurrence of other consequences, the precise nature of which was unclear but which would have a damaging effect upon society. The following remarks of Dr N. A. Broadhurst were indicative of this

kind of generalised prediction:

There is still much to be learnt concerning the use of cannabis products by all segments of western society and in the light of experience gained from the studies on alcohol and cigarettes it is reasonable to assume that we can expect a compounding of the

social problems once society condones the use of yet another socially accepted drug. (OT 6796)

On the other hand, those who advocated the amelioration of the law relating to cannabis offered a rather different enumeration of the likely consequences. In the broad, advocates of relaxation contended that the removal of the allegedly harsh legal sanctions against the use of cannabis would be beneficial to the individual, to the standing of the law, to the reputation and effectiveness of the enforcement authorities and to the health of society. Professor N. Blewett of the S .A. Council for Civil Liberties quoted with approval the 1972 First Report of the United States National Commission on Drug Abuse

('Marihuana: A Sigqal of Misunderstanding'). This Report said:

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In view of the magnitude and nature of change which our society has experienced during the past twenty-five years, the thoughtful observer is not likely to attribute any of the major social problems resulting from this change to marihuana use. Similarly, it is unlikely that marihuana will affect the future strength, stability or vitality of our social and political institutions. The fundamental principles and values upon which the society rests are far too enduring to go up in the smoke of a marihuana cigarette.

(OT 8233)

The Road Toll

The Commission found that there was a high degree of unanimity among witnesses and the authors of written submissions on the hazards involved in combining the use of cannabis with the operation of machinery, particularly the motor car. Moreover, it was generally accepted that the community had the right, if not the obligation, to penalise those who endangered the lives of others by, for example, driving in traffic in a state of cannabis intoxication.

The dangers of associating cannabis with driving, combined with the problem of scientific analysis mentioned previously, led the authors of some submissions to the view that existing laws should be retained. Only by doing so, it was argued, could society positively discourage

cannabis use and thereby reduce association between cannabis use and driving.

Generally speaking,those who favoured relaxation of laws relating to cannabis accepted the undesirability of combining cannabis use with driving. But their arguments in the main suggested that retention of existing laws concerning cannabis usage was too simplistic an answer to the problem. For example, Mr A. W. Parsons of the Cannabis Research Foundation stated:

The Foundation strongly discourages the driving of automobiles or operating of other machinery while under the influence of any drug, including cannabis and alcohol, and we recognise the legitimate public interest in prohibiting such conduct. We feel that the driving problem is a question that needs separate and careful consideration. It is a red herring when

considering the work of the present laws. (OT 2457)

A broadly similar view was voiced by Mr F. D. 0. Fielding, President of the Queensland Council for Civil Liberties:

The nature of the penalties for using a motor vehicle while under the influence of cannabis and the procedures for their enforcement should be determined by bringing them within the existing penalties concerning driving under the influence of alcohol or drugs.

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...Where the fact that a person is under the influence of a

drug causes a danger to others, as for example being in charge of a motor vehicle...the penalty should be imposed not for taking the drug but for taking the drug and placing himself in a position in which, through t le influence of the drug, he is a danger to other people.

(OT 15372)

Countries of Traditional Use

Reference has been made elsewhere in this Chapter to advice that considerable caution should be exercised in drawing conclusions regarding drugs from the experiences of other countries. Bearing in mind this qualification, the Commission noted, in a number of

submissions, reference to overseas experience as being of interest, if not of persuasive guidance,to Australian legislation.

Several submissions to the Commission drew attention to the fact that countries which had a long tradition of cannabis use, such as India, Nigeria and Morocco, were signatories to the International Single Convention on Narcotic Drugs 1961 and appeared to be among the more

concerned nations regarding cannabis use.

In evidence given to the Senate Standing Committee on Social Welfare, Mr F . D . Potts, Chief Inspecting Pharmacist, Pharmaceutical Services Section, in the Tasmanian Department of Health Services, said:

...the countries who are strongest in their views, and the people who are strongest in their views, that there should not be any relaxation of cannabis laws, are those with the longest history of its use.

I was quoting from the 1971 report of the United Nations

International Narcotics Control Board. I understand that, at the United Nations level, Egypt, India and countries of that kind, were making strong representations that control should not be relaxed.

(Open Exhibit 379, p. 192)

In noting that countries of traditional cannabis use have tended to reject the legalisation of marihuana, the Rev. F . J . Nile stated on behalf of the Festival of Light:

It is interesting to note, as has one Swedish authority, that 'demand for legalising cannabis has been strongest in those countries which have had the shortest experience and the weakest forms of the drug' (Bejerot, in U.S. Senate Hearings,

1974),.

'In the countries of endemic cannabis intoxication the widespread use of the drug by the working class is associated

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with inefficiency and social stagnation' (Nahas, 1973). These countries try to keep cannabis use from spreading from the sub­ population of chronic users to the general population. (OT 10350)

Some witnesses who gave evidence to the Commission argued that it would not be fair to characterise the apparent opposition of certain countries to the particular cannabis problems within their borders as a denunciation of cannabis use in general. It was suggested, for example, that invariably the serious problems of cannabis use in these countries were associated with cannabis in its stronger forms, with higher THC

content (e.g., hashish and cannabis oil). It was argued that the matter at issue in Australia related to the weaker forms of the drug.

International Implications

In commenting upon the question of whether or not the laws relating to cannabis should be liberalised, the authors of several submissions drew attention to what they believed to be the international

implications of any such action which might be taken by Australia.

One matter of concern expressed to the Commission involved the obligations attaching to Australia's status as a signatory to the Single Convention on Narcotic Drugs 1961. It was argued that any attempt to soften the legal proscription on cannabis would be in breach of the spirit of the Convention.

Dr D. de Souza, First Assistant Director-General of the Commonwealth Department of Health, related to the Commission certain of the proceedings of the 28th Session of the U.N. Commission on Narcotic Drugs, which he had attended as an official member of the Australian delegation. His evidence included the following observations on the potential international implications of any changes which might be

contemplated in Australian laws relating to cannabis:

A number of representatives and observers drew the attention of the Commission to recent information they had received concerning agitation in favour of the 'liberalisation' or 'decriminalisation' of laws relating to cannabis. They expressed the view that cannabis, being a dangerous substance, the world community ought to exercise extreme caution on any such attitude. In this connection they were particularly concerned about the interconnected supply-demand equation;

thus, if the laws in countries in one part of the world were to be 'liberalised' or 'decriminalised', a number of delegations considered this would be followed by an increase in the illicit demand for that drug. At the same time it would stimulate illicit production in other parts, as well as encourage the illicit traffic in cannabis into those countries having enacted such laws.

(OT 21023--24)

Users and Traffickers

Certain of the discussion before the Commission on the existing legal restrictions on cannabis related to the distinction which is drawn

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between those who possess cannabis as users and those who traffic in the drug.

The existing legislation recognises the distinction in terms of the heavier penalties provided for trafficking. The distinction also tends to be carried through as a common social attitude, expressed in the media and public discussion generally.

A number of submissions agreed with the distinction and supported the differential legal penalties. Several persons and organisations argued, however, that the distinction was of doubtful validity, particularly at the street level, where there was said to be

considerable overlap between street dealers and users. Mr P. R. Rumble expressed a view along these lines, as follows:

The legislation of the 1970--71 period is characterised firstly by a distinction being drawn between drug 'users' and

'pushers', heavier penalties being applied to the latter. The aim of the legislation was to attack drug use by hitting at dealers interested in lining their pockets. However, this simple distinction shows an ignorance of the drug scene, for it

fails to take cognisance of the user who must, or chooses to, support his habit bv selling. (OT 10911/12)

Mr B. G. Tennant, the social and law reform campaigner, also

elaborated on some aspects of the same question, as follows:

The distinction between users and traffickers, which some people have felt to be fundamental to serviceable legislation on these matters, is, beyond a certain point, irrational and unjust. There is certainly a difference; there is also a

large overlap, and it is, in practice, sometimes a matter of accident on which charge a person is arraigned. It tends to be assumed that the possession of what the law regards as a

traffickable amount is the same as trafficking. Moreover, the distinction appears to derive its force from the premise that the users are victims of the sellers, which is in most cases manifestly untrue.

(OT 8506--7)

Higher Penalties

For the most part, argument addressed to the Commission on the advantages and disadvantages of changing the laws relating to cannabis had in mind the liberalising or relaxation of those laws. However several submissions gave attention to what were interpreted as calls within some sections of the community for the institution of more

rigorous laws.

Calls for higher penalties almost invariably referred to trafficking in drugs, rather than simple possession and use. The majority of submissions, however, argued that increased penalties even for trafficking were inappropriate.

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Mr F. D. 0. Fielding, President, Queensland Council for Civil Liberties, argued:

The current demands for more draconian legislation and more extensive enforcement will not only fail to attain their objects but will prove more destructive of individual liberty and add greatly to the burden of taxation.

(OT 15364)

Mr P. R. Rumble elaborated on this thesis in the following terms:

The argument for the imposition of higher fines and penalties for marihuana use is also unsupportable. Such changes tend only to increase the amount of crime that will be needed to support illicit drug habits. While there is a market, people who wish to do so will supply that market. An increase in the

risk associated with so supplying (in the form of increased penalties) will only lead to an increase in the profit these people make and the resultant increase in price to the drug user. In the case of a heroin addict, how can he afford to pay more? As a result of his addiction he cannot work, so he turns

to crime or traffick in the drug to support his addiction.

If higher penalties are applicable, the supplier will be less willing to supply lower, less financially attractive drugs such as marihuana which because of its bulk is more easily

detectable. He will prefer to traffick in the harder drugs which are more easily concealed and which result in more profit to him. (OT 10919K)

POLICY OPTIONS

Many of the submissions made to the Commission which commented upon the appropriateness or otherwise of the existing laws dealing with cannabis outlined proposals for changes in these laws.

There was a very wide spectrum of opinion as to the ways in which the laws should be framed so as to best serve the community. However, it became clear that, excluding the question of trafficking, it was possible to see most of the submissions as falling within one of five broad categories. These categories could be characterised as follows:

Category 1: Prohibition/Criminal Penalties Submissions thus categorised argued for the continued total prohibition of cannabis possession and imposition of criminal penalties for breaches of the law. In brief this category

represents those who desire the substantial retention of the existing laws relating to cannabis.

Category II: Prohibition/Pecuniary Penalties ('decriminal!sation1) Submissions classified in this category argued for the continued total prohibition of cannabis possession, etc., but with the imposition of pecuniary penalties for simple cannabis possession.

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Category III: Modified Prohibition

This Category encompasses those submissions which advocated allowing persons to grow and/or possess small defined quantities of marihuana legally for their personal use and perhaps for distribution not involving a profit.

Category IV: Regulation Controls This Category includes those submissions which argued that cannabis possession and use should be subject to such legal restrictions as are needed to ensure purity, control potency and regularise marketing (including age requirements). Proponents of this

approach envisaged the establishment of a government board to strictly regulate cultivation, production, marketing, labelling and taxing of the product. Some submissions envisaged a State monopoly of cultivation, production and marketing.

Category V : Free Availability By and large, this category covers those who took the view that cannabis should be as freely available as tobacco and alcohol.

The above categories are discussed in detail in following pages. They correspond closely to the five major choices which were recently recognised by the South Australian Royal Commission into the Non-Medical Use of Drugs in its publication 1 Cannabis-- A Discussion Paper1 (pp. 8-­

14).

Prohibition/Criminal Penalties

By and large, those who advocated retention of the existing criminal sanctions on the possession of cannabis did so on the ground that continued application of such sanctions was necessary in order to contain what was commonly described as an 'epidemic' of cannabis use. This is not to say, of course, that criminal penalties were seen by

these advocates as the only-- or indeed as the most important---means of curbing greater use of the drug.

Of the submissions received by the Commission supporting the retention of the existing legal sanctions, perhaps the most clear-cut was that made by the Rev. F . J. Nile on behalf of the Australian

Festival of Light. The submission argued for the retention of criminal penalties as an essential ingredient in the community's fight against what are considered to be harmful drugs. For example, it stated:

The law should take a clear and consistent stand, however, against the use of marihuana. To do this it must establish a definitive standard that makes clear that marihuana is a harmful and therefore illegal drug.

(OT 10346)

The submission quoted with approval the firm line taken in the USSR and China:

jC is interesting to note the severe laws in the USSR and CPR (Chinese People's Republic) concerning illegal drugs such as marihuana and heroin. These nations realise that such drugs harm both the individual and society in terms of expensive

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health facilities, weakened economic production norms, and student drop-outs, etc. (OT 10356)

A similar stand was taken by Senators Melzer, Tehan and Walters in their joint dissenting statement in the 1972 Report from the Senate Standing Committee on Social Welfare 'Drug Problems in Australia-- an intoxicated society?1.

We feel that no case can be made for removing a person charged with possession of marihuana for personal use from the general area of the criminal law and the consequences which normally flow from a breach of the criminal law. To reduce the offence

from a crime to a civil offence, or an offence of similar gravity to a parking fine or other minor statutory offence would, we believe, be decriminalising the use of marihuana and would be a major step towards ultimate legalisation.

(Open Exhibit 379, p. 195)

The authors of a number of submissions which advocated retention of the existing laws with regard to cannabis obviously came to that position as the result of much mental travail. For example, it was readily acknowledged by this group that the existing laws could result

in serious damage being done to the reputations and careers of young people convicted of drug offences. On the other hand, there was evidence of a concurrent belief that far more serious damage would be done to a much greater number of young people if the laws were to be relaxed. Dr C. B. Keogh, in a submission on behalf of the GROW

movement, stated:

Any real harm which our society might be doing to persons through disparity in the application of the law should, of course, be removed, and eventually (i.e. as soon as is possible without creating greater evils) must be removed; but it would be unwise and treacherous to tidy up a legal anomaly which causes disadvantage at a surface level to a small number if, in the process, multitudes were to suffer far worse harm through the removal of what is still a meaningful warning and

relatively effective deterrent against the involvements and behaviour which bring on that more notable harm. Indeed, it would be truly criminal to contribute to the removal of such a legal safeguard against larger and worse evils if, in doing so, one was knowingly clearing the way for the freer and more destructive action of many people's own self-defeating immaturity and the cynical forces which systematically exploit their vulnerability for selfish material advantage.

(OT 11332)

In other words, it is one thing to be relatively prevented from a career by a less attractive appearance to others and their unfavourable way of looking at you, when you are still able for, and desirous of, pursuing that career yourself; but, it is an altogether different thing-- an incomparably worse thing-- to have contracted, in the reality of your personal

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life, an internal condition which makes you no longer able for, nor even able to desire, such a career.

There lies the essential and radical difference between the harm, on the one hand, which our society does to individuals by continuing to permit a state of law which punishes a small number of marihuana users simply for possession and use, and

the harm it does, on the other hand, by continuing to permit social, cultural and administrative conditions which lead to widespread marihuana addiction (for there is such a thing) or even serious marihuana dependence.

(OT 11332— 33)

The late Professor Hardin Jones of the University of California, in giving evidence before the South Australian Royal Commission into the Non-Medical Use of Drugs which was incorporated into the transcript of this Commission, commented upon what he described as the 'social

disaster' of harmful drugs and cautioned against a preoccupation with legal anomalies:

...nearly all the sources of public education have been used to bring about a political enlargement of the idea that we can avoid everything by making the laws soft enough so there isn't a legal problem. I don't think that is the nature of our

predicament.

(OT 7782)

Prohibition/Pecuniary Penalties (1Decriminalisation1)

It is of interest that the major line of cleavage in the 'cannabis debate1, as expressed to this Commission, was based not on the issue of prohibition, but rather on the question of penalties. Expressed in other terms, the main battle line was drawn on whether the existing laws

involving criminal penalties should be retained or, alternatively, whether they should be relaxed by substituting exclusively pecuniary penalties. The matter of prohibition, although of deep and profound importance to many people, was clearly not the issue upon which the major protagonists were divided.

The submissions calling for the abolition of criminal penalties for the possession qf cannabis tended to represent two basically different viewpoints. On the one hand there were those who, notwithstanding a belief that the use of cannabis was harmful and should be actively

discouraged, were distressed by the consequences of criminal convictions upon youthful users, and accordingly sought some amelioration of the present laws. On the other hand, a number of proponents of this

approach also expressed a commitment to at least some modification of prohibition in the longer term. In some cases, 'decriminalisation' was explicitly identified as a first step in a series of increasingly liberal policy options open to legislators.

Perhaps the most articulate expression of the more conservative viewpoint is to be found in the Report from the Senate Standing

Committee on Social Welfare, 'Drug Problems in Australia an

intoxicated society?'. In the preamble to its recommendations on cannabis, the Committee stated:

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The law should Indicate disapproval of the use of cannabis. Its use should continue to be illegal, though the penalties require modification. Australian laws can be changed to achieve the benefits of discouragement, at social costs considerably lower than those incurred by criminal sanctions against the possession of cannabis.

(Open Exhibit 379, p. 164)

Subsequently the Committee recommended as follows:

That, for possession of marihuana for personal use, as already defined in most States--

(a) The offence not be defined in law as a crime.

(b) The penalty be solely pecuniary and be enforceable by attachment of property, imprisonment, or such other means as may be determined.

(c) The penalty be a fixed amount.

(d) The penalty be at approximately the same level (that is, $100 to $150) now being imposed by the courts in most States.

(e) Court appearance be required at the option of the

defendant or in the event of non-payment of penalty.

(f) So far as may be consistent with any Criminal

Investigation Bill which may be enacted, police be directed not to fingerprint or photograph defendants.

(g) No record of conviction kept by the courts or the police shall be used in subsequent proceeedings or in relation to any application by the offender for employment.

(h) A conviction should not, of itself, disqualify a person for employment. (Open Exhibit 379, p. 165)

In his submission to the Commission, Dr R. A. J. Webb, Senior Psychiatrist-in-Charge of the NSW Health Commission's Drug Education Unit, postulated an interesting principle of relevance to the Commission's consideration of this matter, as follows:

Physicians have a maxim: nihil nocere. It means that a physician must guard against doing more harm than good. A nihil nocere guideline is needed for drug laws and law

enforcement...Laws and law enforcement cannot solve the drug problem; they should not be allowed to exacerbate

it...Accordingly, future efforts should be directed toward minimising the damage done by drugs. A substantial part of that damage stems not from the chemistry of the drugs but from the ignorant and imprudent ways in which they are used, the

laws punishing their use, society's attitudes toward users and so on. (OT 19374--77)

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Although Dr Webb did not identify himself with the

prohibition/pecuniary penalties approach, the principle of nihil nocere appears to sum up aptly the position of many who expressed the view that the present criminal penalties in relation to cannabis usage worsen the problem rather than contribute to a rational solution of it.

On behalf of the Cannabis Research Foundation, Mr A. W. Parsons put forward 'deeriminalisation' as one of several tenable policy options open to the community:

The options open to you, our legislators and the community are clear. We can toughen or leave the cannabis laws as they are. This course of action will compound, or at least perpetuate, the problems created by the present cannabis laws. We can

'decriminalise' cannabis use. That is, the smoker is subject to a monetary fine with no conviction recorded while the cannabis seller is still subjected to harsh fines and

imprisonment. The effectiveness of such a move depends on the provisions in the new legislation. At best, this legislation would eliminate the problems caused by the stigma attached to bearing a criminal record.

(OT 2470)

Modified Prohibition

This category might with some justification have been titled 'Limited Availability'. The reason is that most of those who argued for this approach identified themselves with the advocates of increased availability rather than those of a prohibitionist persuasion.

Virtually all of the submissions supporting this position were presented in confidential sittings of the Commission by individuals who wished to use, or continue to use, cannabis but who believed that the existing laws forced them to associate with criminals in order to obtain

supplies of the drug.

One South Australian witness stated this view in confidential session:

1. The laws relating to marihuana are in line with a very

dangerous drug or narcotic which I do not consider it is. . .

2. Trafficking, as I know it, is a social thing between

friends but a criminal element comes into it due to the high demand for the product and that it is dealing in an illegal market.

3. Trafficking as we know it keeps the price high and quality ■ low. If it were legal to grow marihuana for your own use, e.g. having two or three plants in one's own back yard, it would meet that need and therefore should be legalised in

that quantity. . (CT)

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Another user of cannabis submitted that people should be allowed to grow up to six plants for their personal use. He stated that this would reduce the incidence of organised crime and be a safeguard against the lacing of marihuana with opiates. Still another witness wanted the laws to be amended to allow persons to grow their own marihuana within a restricted area (one metre square).

Regulation Controls

A number of submissions made to the Commission advocated a

'regulatory' approach to the cultivation, production, marketing, etc., of cannabis.

On behalf of the Cannabis Research Foundation, Mr. A. W. Parsons tendered a submission in which a regulatory proposal was put forward. His submission incorporated the following description of the Foundation's preferred procedure:

The third option open to legislators is to legalise the use of cannabis. Such a move is the only rational way to solve the problems caused by prohibition as well as ensuring that the Government, not the black market, is the recipient of the

considerable revenue that is generated in the cannabis trade. Legalisation could easily be established through a Cannabis Control Board, just as we have a wheat and milk board. The Cannabis Control Board would license growers and retailers

(thereby) facilitating quality control, retail ethics mainten­ ance, and collection of revenue for the Government. (OT 2470)

Associated recommendations made by the Cannabis Research Foundation included:

...the Foundation recommends the following immediate changes in Federal and State Laws:

Possession of marihuana for personal use should no longer be a criminal offence.

Casual distribution of small amounts of marihuana for no remuneration, or insignificant remuneration not involving profit, would no longer be a criminal offence.

A plea of marihuana intoxication shall not be a defence to any criminal act committed under its influence, nor shall proof of such intoxication constitute a negation of specific intent.

It is also recommended that:

Commercial production and distribution of cannabis should be monitored according to the proposed Cannabis Control Board.

Commercial sale of cannabis should not be allowed to minors, nor should licensed retailers be permitted to advertise.

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Non-commercial cultivation of cannabis for personal use should be permissible.

Urgent enactment of legislation be provided for the destruction of the criminal records of persons arrested or convicted of marihuana offences prior to the enactment of legislation repealing criminal penalties for such offences.

Urgent legislative measures be taken to ensure the full restoration of rights and privileges denied or diminished as the result of prior cannabis arrests or convictions.

A discouragement policy be adopted towards the recreational use of all drugs, including alcohol, tobacco and marihuana. This policy should be implemented by a public education campaign aimed at warning users and potential users of the risks

involved with the use of all recreational drugs. Such warnings should reflect honest scientific and medical concern. Similarly, advertising which encourages the recreational use of drugs should be prohibited.

(OT 247S--74)

In the course of commenting upon the Foundation's written

submission, Mr Parsons indicated the proposed approach would not be limited to marihuana only. When asked: 'Would you include hash?', Mr Parsons replied:

Yes, certainly, considering it is being used to the extent that people smoke it until they reach a satisfactory high. (OT 2472)

Mr Parsons suggested that cannabis should be retailed through very few outlets, with no advertising or publicity. As far as permitting cannabis to be sold with other things at, say tobacconists or hotels, was concerned, Mr Parsons said he did not equate cannabis with other

drugs. Retailing through pharmacies was more likely, according to Mr Parsons (OT 2472).

The advocates of a regulatory approach broadly contended that such an approach provided a rational balancing of civil liberties and communal responsibility. Thus the individual would be free within the law to possess and use cannabis if he so desired, with assurances of

continuity of supply, and purity of product. On the other hand, the community would be in a position to determine price, restrict outlets, prohibit sale to minors and tax the product. In addition, enticements to black marketeers and organised crime would be removed.

Free Availability

In the submissions received by the Commission, advocacy of 'free availability' of cannabis tended to be expressed as a broad attitudinal or philosophical desideratum rather than as a detailed model or procedural prescription. That is, free availability was postulated as a

final objective desired by those who believe that legislative enactments

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have no legitimate role in hindering the free use and enjoyment of cannabis by those who desire to do so.

In 'The Distribution Hierarchy of Illegal Drugs in New South Wales', a paper submitted to the Commission as part of a Cannabis Research Foundation submission, authors J. McKenzie and I. Robinson postulated the complete removal of legal restraints as the logical end - state to which the move for liberalisation is tending:

Further, given the reality of widespread marihuana use in the community today and the irreversibility of such phenomena in the absence of a total restructuring of the society in which we find ourselves, the only feasible solution would seem to be in the total removal of legal restraints upon its use and

distribution. To this extent the writers see the current movement towards the decriminalisation of the possession and use of marihuana as a step in the right direction. But whilst ever there remains any legal sanctions upon marihuana, the writers do not envisage any material change in the hierarchical distribution network and the problems which it creates.

(OT 10880)

Several submissions characterised the 'free availability' approach to cannabis as placing this drug on a similar legal footing to that applying to alcohol and tobacco.

CONCLUSIONS AND RECOMMENDATIONS

Conclusions

Cannabis is often compared with drugs such as alcohol, tobacco and analgesics when considering 'dangerous' or 'harmful' drugs. The Commission has often heard cannabis referred to as a 'soft' drug in contrast to the 'hard' drugs like heroin.

The important question however, is not whether cannabis is more or less harmful than these or other drugs, but what is the potential for harm to the user and society when cannabis is used in the form and manner its advocates would wish.

In this Chapter there has been reference to what research work on cannabis has shown. Naturally the Chapter does not pretend to mention all the work that has been done. In spite of the research work done on cannabis, even in more recent times, there are very large gaps in our knowledge. For example:

* Virtually no researchers have studied large numbers of female subjects. Important hormonal and other physiological effects may possibly have been missed by ignoring one half of the human species. *

* We are ignorant of the effect of cannabis smoking on the human

foetus. Thalidomide is a grim reminder of insufficiently

considering the foetal effects of a drug.

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* Practically no studies in experimental situations have been done on adolescents. Most studies concern healthy intelligent males aged 20 years or more.

* People with diseases, mental or physical, have hardly been

considered in experimental studies at all.

Some adverse results of cannabis use have been proved on young, healthy, intelligent, adult males, a group constituting a small section of the whole community. These adverse effects may be much greater in the rest of the community. On the other hand,if adverse results have been demonstrated not to exist in the small segment examined, it is

fallacious to extrapolate the results and claim that it has been established that cannabis use is harmless, even as far as those particular results are concerned.

The reactions to cannabis by people of our culture may be quite different from the reactions by people of another culture. The results of a study of African agricultural workers may prove quite inapplicable to Australian urban communities.

The following evidence of Professor Reese T. Jones should be borne in mind by any person seriously weighing whether cannabis should be made more available on the grounds that it is harmless:

As a physician, I like to think that my scientific data

gathering has some practical significance in terms of

predicting health consequences both to the individual and to the society. I've spent the better part of my professional career studying the effects of drugs, mostly psychoactive drugs, on people. The more I learn, the more I develop a sense of humility when trying to generalise from necessarily limited

laboratory research studies to what happens when a drug is made available without control to millions of potential users.

The lists of drugs where scientists have guessed wrong in the sense of assuming little harm and subsequently finding great harm is almost endless-- cocaine, heroin---which of course was introduced to treat morphine dependence-- not to be non­

dependence producing barbiturates, where if you look at the literature, there is a fifty year debate as to whether

barbiturates produced physical dependence. It was not until 1954, after 50 plus years of clinical use, that the crucial study was done meperidine, which was a synthetic narcotic which many physicians inadvertently became dependent on because

the early research said meperidine did not produce physical dependence. It was because people did not appreciate its metabolism properly...

Minor tranquillisers which were on the market for a number of years before the dependence liability for some patients was recognised; the major tranquillisers, here I am talking about

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the phenotehizines where it wasn't until some people were treated for 15 years that the so-called tardive dyskinesia became apparent as a side effect. This is a strange motor abnormality that was not predicted from animal studies and didn't turn up for 15 years of fairly high dose use, and just as an aside to the Commission, may be a consequence, at least in animals, of long term methadone maintenance that you wouldn't expect to see until someone had been on methadone for 10 or 15 years at high doses. There is a whole host of where, in the history of drugs, we thought we understood, but where we have made serious mistakes. One could also cite the history of amphetamines that were around for many, many years before the post World War II amphetamine psychoses crisis hit Japan and then worked its way around the world. LSD was a drug that was researched for years before it became an illicit drug out in the street and caused all the social problems it did, and when we began studying LSD in the early 1960's , there were almost two thousand scientific publications on LSD and it hadn't posed any serious problems. It wasn't until Timothy Leary in our country posed all these problems, and then finally the drugs most of you are quite familiar with, tobacco and alcohol, where it took many, many years of experience to fully recognise the long-term consequences. One could go on and on. Thus, if I seem overly conservative when trying to draw conclusions from the cannabis research literature regarding potential benefits and potential harms of uncontrolled cannabis use, that conservatism stems from past errors of judgment made by knowledgeable but all too human fellow scientists in the past.

As the availability of a drug increases, the potential for harmful effects increases.

Asked to expand on this last remark, Professor Jones added:

It is something we could spend a couple of days on; that in general, the more available a drug is, the more people use it and, more importantly, the more people use it as higher doses. There are other factors that shape these things, too;

advertising, whatever the fad is at that time but, you know, I think a truism almost is, 'The more available something is, the more people are apt to try it.' (0T 18106 — 07)

Clearly, cannabis is not a harmless drug. For one thing, any substance which intoxicates the user has a capacity for harm. It may be harmful to the user while he is intoxicated. It is potentially harmful to the community if the user is engaged in activities which can not safely be performed by an intoxicated person. There is no evidence that cannabis users are any more likely than alcohol users voluntarily to desist from activities of this kind when intoxicated.

There is a logical case for treating cannabis in a manner similar to alcohol and prohibiting the driving of motor cars, the operation of

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industrial machinery and the engagement in other like activities by persons intoxicated by the drug. There is,however, an equally logical case for legalising all intoxicating drugs and treating them in like manner. If one believes that statute law should not interfere with what

a person does so long as he does not harm others, then there is no

reason why heroin and other narcotic drugs should not be subject to a prohibition against their use only when the user is engaged in

activities which jeopardise safety to life and limb.

It must be accepted that to remove the prohibitions against cannabis use in accepted situations will lead inevitably to arguments that other drugs should be accorded like status. The removal of prohibitions against cannabis would of course cause Australia difficulties in

international affairs for it would be departing from the intention and spirit of the Single Convention on Narcotic Drugs. This, however, is a secondary matter in the sense that Australia must first decide what is the correct domestic Australian policy and shape its international course accordingly.

The Royal Commission into the Non-Medical Use of Drugs in South Australia in its Final Report, April 1979 said:

Cannabis is a mood-altering drug. Its effects are related to the dose taken. It is not a narcotic or an opiate, but its

pharmacology resembles alcohol in that it is essentially a depressant of the higher centres of the brain. In some

respects it also resembles the hallucinogens. It has a low toxicity: that is, the lethal dose is so high that death from overdose is extremely unlikely. It appears to have very few acute side effects, being rather specific in its action on the higher centres of the brain. However, its effects on

psychomotor skills are such that use of the drug may adversely affect driving skills, although there is no clear evidence in Australia that cannabis use has caused road accidents. Because in this country it is usually smoked there is a possibility

that it may adversely affect the lungs of regular users. As for its long-term effects, brain damage or poor mental

functioning has not been shown conclusively to occur in man as a result of cannabis use, but the results of experimental research with animals suggest that this is a definite long-term possibility. In any event that would be a reasonable

hypothesis, because of the nature of the drug and its mode of action, although the precise risk has yet to be established. Experimental research indicates some possibility of other effects, at least in animals, on the reproductive and

immunological systems, but there has been no suggestion yet of any human clinical disorder of these systems caused by

excessive cannabis use. (Open Exhibit 586, p. 307)

The South Australian Commission went on to consider what changes in patterns of use of cannabis would occur even if the present law remained unaltered. It had earlier considered the possibility of adopting a regulatory mode of control for cannabis (making it available legally but

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under controls) or a policy of partial prohibition (relaxation of penalties for private use) as options to the continuation of the present prohibition policy. The Commission added:

...we repeat the view expressed in our discussion paper that the introduction of a regulatory model of control for cannabis is likely to lead to a significant increase in the use of the drug beyond that which would occur if total prohibition were retained. If the increase were confined to experimental use, with no harmful consequences, this might not be a matter for

concern. However, the increase is likely to include a higher rate of intensive or otherwise irresponsible use. While this may be offset to some extent by a decline in the intensive use

of other drugs, especially alcohol (as users move to cannabis), we think the risk is unacceptable. Our reason for thinking that all forms of use will increase is that a system which involves the government in licensing the production and sale of cannabis would be seen as an abrupt change of policy signalling official approval of cannabis use, thereby removing one of the important barriers to use. Moreover, a regulatory system, even if hedged with restrictions on advertising, inevitably involves commercial forces stimulating demand, an element that is largely (but not entirely) absent from the existing system of controls. Consequently a regulatory system carries with it an unacceptable risk of a significant increase in use of a kind that may be harmful to the user, or have harmful consequences

for other members of the community. (Open Exhibit 586, p. 309)

This Commission agrees with this estimate and it believes that relaxation of the prohibition on cannabis to the extent of making its use unlawful only when special activities are performed will result in a significant increase in its use.

There are a lot of persons in the community who generally obey laws without having to reach a conclusion that the law is good rather than bad. There are a lot of persons who obey laws even though they do not accept that the law is a good law. These people would correctly

interpret a relaxation of the prohibition against cannabis as an approval of its use, except under special circumstances. On the other hand, among people in the community who are not disposed to obey a law unless positively satisfied that it is a good law, there will remain a number who are never to be satisfied until all restrictions and prohibitions on the use of drugs are removed.

The critics of the cost of police action against cannabis use generally will still be entitled to complain of the cost of police action in enforcing the remaining prohibitions against use in the special circumstances described above. It should be pointed out that at the present moment there is no practical way for police to measure cannabis intoxication, as alcohol intoxication can be measured by the breathalyser. Probably a considerable period of time will elapse before

such apparatus is available. Apparatus to measure cannabis intoxication will probably be inadequate to measure the intoxication of persons who

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have been using cannabis with alcohol or cannabis in combination with some other drug. The Commission is satisfied that a substantial number of cannabis users do in fact use drugs other than cannabis.

Accordingly, this Commission rejects the submissions in favour of a regulatory model of control for cannabis, such as that of the Cannabis Research Foundation, that there be set up a Cannabis Control Board to supervise the production and distribution of cannabis.

Another suggestion was that users of cannabis be permitted to grow, for their own consumption, a specified number of plants. This

suggestion found favour with the South Australian Royal Commission which described it as a model of partial prohibition and recommended its adoption. This conclusion and recommendation of that Commission appears most clearly in the draft Act which formed part of its report. The

complete prohibition of cannabis oil (1 which is generally very much stronger than other forms of cannabis’) was to be maintained. On the other hand there was to be relaxation towards leaf cannabis and cannabis resin. It should be noted that prohibitions against these forms of

cannabis as a partially prohibited substance were retained everywhere in the Act except for Section 20 which is as follows:

20.(1) Notwithstanding any other provision of this Part--

(a) it is not an offence for a person to cultivate plants of the genus Cannabis for his personal use, or the personal use of any other member of his household over the age of eighteen years who is not producing cannabis for his personal use;

(b) it is not an offence for a person to extract cannabis resin from plants of the genus Cannabis for his personal use or the personal use of any other member of his

household over the age of eighteen who is not producing cannabis resin for his personal use;

(c) it is not an offence for a person to have cannabis or

cannabis resin in his possession for his personal use or the personal use of any other member of his household over the age of eighteen;

(d) subject to subsection (2) of this section, it is not an offence for a person to supply cannabis or cannabis resin gratuitously to a person over the age of eighteen years for his own personal use.

(2) A person shall not, in any public place, supply

cannabis or cannabis resin to a person over the age of eighteen years for his own personal use. Penalty: Two hundred dollars.

(3) A person shall not smoke or otherwise use any

substance consisting of, or including, cannabis or cannabis resin, in, a public place.

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Penalty: Two hundred dollars.

(4) The supply of cannabis or cannabis resin shall not be regarded as gratuitous for the purpose of this section if the supplier acts for or in the expectation of monetary

consideration or a material advantage of any kind whatsoever. (Open Exhibit 586, p. 389)

Many difficulties would arise as a consequence of adopting the approach of the South Australian Commission. The criminal law will not be greatly removed from the scene because the exception in favour of personal use is rather narrow. It will therefore be necessary for policing of cannabis use to continue, not only in relation to the prohibited oil, but also in relation to cannabis leaf and resin. There would be considerable problems arising in deciding whether the

cultivator was cultivating plants for his personal use or the personal use of any other member of his household over the age of eighteen years who was not producing cannabis for his personal use. What is the limit of personal use? Will people desirous of making money and not averse to cannabis use, but who do not use cannabis themselves, take advantage of a provision such as this to produce cannabis for secret sale to other persons? Even if there is an effort to maintain by government a policy of discouraging cannabis use, it is difficult to see how this can be effected when youth and immature people see their neighbours growing and using cannabis. This Commission does not believe that the policy of partial prohibition will significantly reduce the black market in

cannabis products or the amount of public money presently spent on police activity. Analyses of cannabis seized by law enforcement agencies convinced the Commission that it is possible in Australia, by carefully manicuring the plants to produce cannabis as potent as the highly regarded Asian varieties. At the present moment, analyses of seized cannabis suggest that cannabis used in Australia generally has a THC content of between one and two per cent. If careful cultivation is lawfully permitted, this THC content figure would likely increase four or five fold. The South Australian Commission, this Commission believes, did not conclude that the economic costs of police detecting and prosecuting offenders would be greatly changed by the adoption of partial prohibition rather than total prohibition. This Commission believes that the South Australian Commission was more influenced by what it referred to as the social costs, that is to say, arbitrary or selective enforcement and the impact of convictions upon offenders.

Arbitrary or selective enforcement is something that can happen in almost any area of law enforcement. It occurs because police do not act objectively and honestly but are motivated by bias or other improper motives. This must be seen as a continuing problem of law enforcement particularly in drug law enforcement where opposing social attitudes can

easily produce prejudice. It is a problem,however,which is not solved by removing the prohibition against the use of drugs but by continual vigilance in the administration of police forces and by proper education of police engaged in drug law enforcement.

The impact of convictions upon offenders must be considered in the light of each offender. A mature person who, knowing the consequences of a conviction, deliberately breaks the law cannot legitimately

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complain if a conviction is recorded against him. It is immaterial that he believes the law to be a bad law. The immature young experimenter is in a different position. If he is charged and convicted of a minor breach of the law, the community recognises in the future, if it sees

his criminal record, that the offence was minor. The range of penalty is so great for drug offences that a conviction for a drug offence could be considered more serious than it really was. For example few people would consider the conviction of one 17 year old for under-age drinking

serious, but many people might regard another's conviction for being in possession of cannabis as quite serious. Each youthful experimenter is probably equally guilty. Neither experimenter probably saw the effects that a conviction might have on him in later life. The youthful

experimenter is a particular problem for the criminal law, and in the drug criminal law more than in other areas.

The Commission has concluded that there is good reason to provide that a person under the age of twenty-one years who is convicted of an offence under the drug laws may apply to the court which convicted him, at any time following expiration of twelve months after the conviction,

for an order expunging the conviction. On such an application,the court could direct the application to be adjourned to a later date or it could accede to the application and direct that the conviction be expunged either immediately or at a fixed time in the future. If an order is made directing the conviction to be expunged, then it must follow that

for all matters of record the conviction was never made. The formerly convicted person can now honestly state that he has never been

convicted, and any fingerprints, photographs or criminal record sheets must be destroyed. The basis upon which the court would act is that it is satisfied that the incident-free life led by the applicant since his

conviction proves that he fell within the experimenter class and deserves to have his conviction expunged.

This recommendation appears in Part XIV where Drugs of Dependence Acts are considered. It is there also recommended that such Acts contain a provision permitting courts conditionally to discharge an offender against whom the court finds the charge proved if the court

concludes that it is in the public interest that the offender be conditionally discharged rather than convicted. The honouring by the offender of the conditions upon which he has been conditionally discharged for the period named in the conditions will entitle him to an absolute discharge without conviction. This recommendation really gives a statutory basis for a diversionary scheme.

The two recommendations relating to expunging convictions and conditional discharges apply to all illegal drug abuse. If legislation is enacted as recommended, the Commission is of the opinion that the good sense of the courts can be relied upon to ensure that it operates

for the benefit of youthful experimenters, including those who experiment with cannabis. The Commission has not only considered the recommendations of the South Australian Royal Commission into the Non­ Medical Use of Drugs but also the major recommendations of the Senate

Standing Control Committee on Social Welfare in its 1977 Report and the recommendations of the Tasmanian Committee of Inquiry into Victimless Crime. After a full consideration of the evidence, of submissions and

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recommendations of other tribunals, even those in North America, the Commission has reached the firm opinion that total prohibition on cannabis use ought to remain. The enactment of the legislation referred to above for conditional discharges and expunging convictions would fortify that firm opinion.

The Commission was pressed with the argument that as cannabis is not a narcotic drug but a psychotropic drug it is incorrectly included in the Single Convention on Narcotic Drugs. It was said that Australia should initiate moves to have it removed from that Convention and included in the Convention on Psychotropic Substances. A careful reading of the two Conventions would support a view that the appropriate Schedule for cannabis in the Convention on Psychotropic Substances is more onerous than the Schedule where it presently appears in the Single Convention on Narcotic Drugs. The Commission sees little legal

significance in this undoubtedly incorrect, pharmacological classification and feels that it must be internationally accepted that there has been an incorrect classification. The same is true of cocaine. The Commission is unable to conclude that there is any practical benefit in initiating moves for a reclassification. Until at

least as many countries have ratified the Convention on Psychotropic Substance's as have ratified the Single Convention on Narcotic Drugs, such an initiative could not sensibly be taken.

There is one final observation which the Commission feels it should make. Much of the debate in relation to drug abuse, especially the abuse of cannabis, is conducted in a vocabulary which purports to divide drugs into 1 hard1 drugs and 1 soft1 drugs. The Commission is of the opinion that this is a misleading classification. It understands that the term 1 hard1 drugs is supposed to encompass more dangerous drugs than those encompassed in the term 'soft' drugs. The danger of a drug will depend on the potency of the substance being used, the regularity with which it is used, and the physical and mental health of the person using

it. The danger also depends on whether the drug is used alone or in combination with other drugs. The Commission has seen and heard sufficient evidence to be satisfied that the great Australian problem is of poly-drug or multi-drug abuse. In view of abuse of this kind it is mischievous for people to argue as though the population is divided into

segments, each of which uses only one class of drug.

The Commission could summarise its important conclusions on cannabis as follows: *

* that cannabis is a drug with a capacity to cause harm;

* that cannabis will always remain an intoxicating drug;

* that time may show that the harmful effect on the user and on the community are greater or less than present research has established; and

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* that, within a 10 year period, the proposed National and State Drug Information Centres will have advanced our knowledge on all aspects of the problem of drug abuse including cannabis use.

Since the 1960's the Western World has been treated to a highly polarised argument on cannabis. The leaders in the debate often have done far more reading than research. Arguments on both sides have been dressed up in many guises to advocate the point of view rather than to

assist the perplexed community, standing on the middle ground,to reach a rational conclusion.

After nearly 20 years of acrimonious division, the time has come in Australia to put aside polemics and to enter upon a period of balanced consideration of the issues of cannabis. This consideration must take place in the context of a consideration of the whole area of drug abuse

in Australia. In the Commission's view, the operation of the national strategy which is recommended for this period of time, will place the Australian community and its policy makers in a position to review objectively whether present prohibitions against cannabis should be maintained. This moratorium will ensure that a relaxation of the prohibitions against cannabis is taken for good reason. A decision to

relax the prohibitions at the moment will, in the Commission's view, be an unwise reaction to emotive and possibly misguided pressure.

The fact that Australians must bear in mind is that a decision now to remove the prohibition against cannabis can never, from the practical point of view, be reversed.

Recommendations

The Commission recommends that:

** No relaxation of the present Australian prohibition on cannabis be made for ten years from the commencement of the operation of the Drug Information Centres recommended in Part XIV.

Vw'r At the expiration of the ten years the legal prohibition against cannabis be reviewed by the Commonwealth and State Governments acting in concert.

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Part XIII

Improving S om e E xistin g C ontrols

P a r t XIII Improving Som e Existing Controls

Chapter 1 . Drug Detector Dogs

Chapter 2 . Ultrasound Techniques

Chapter 3 . Forensic Laboratories

Chapter 4 . Forged Prescriptions

Chapter 5 . Financial Controls

Cha pter 6 . Drugs in the Post

Chapter 7 . Interception of Communications

Chapter 8 . Task Forces

This Part, the Commission must confess, is a reposi­ tory for some topics which are important enough for separate treatment but which do not fit neatly into any other Part.

The initiative of the Department of Business and Con­ sumer Affairs with drug detector dogs has been mentioned in Part VI. Other government departments in Australia (Police, Defence and Prison Services) have an interest in training dogs for different purposes. The Commission was struck by the present fragmented Australian approach to the whole subject of training dogs as aids to government departments. It explored whether the subject could be approached on a national, uniform and rational basis. Chapter 1 of this Part is the result.

'Ultrasound Techniques’, Chapter 2, is the result of the Commission's investigations directed to solving a pro­ blem that the Bureau of Customs has in detecting the

smuggling of drugs by couriers who secrete the drugs in internal body cavities.

'Forensic Laboratories', Chapter 3, follows from the Commission's consideration of scientific laboratories in Part VII as an essential aid to law enforcement. The

importance of forensic services, not only in drugs but in the administration of the law generally, has caused the Commission to examine whether a national approach to

forensic laboratories is not long overdue.

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Chapter 4, 'Forged Prescriptions', considers what steps can be taken to reduce the diversion of controlled drugs on to the illicit market by forging prescriptions.

Chapters 5, 6, 7 and 8 consider other topics which

the Commission sees as initiatives made desirable by evidence dealt with elsewhere in this Report.

Chapter 5 endeavours to show how the controls on money movements which presently exist can be co-ordinated to interdict the movement of money in the illegal drug trade. The acquisition of money is the object of traffickers, and their operations are possible only because they have, and are able to use, large amounts of money.

Chapters 6 and 7 consider how organised drug traffickers can be denied the assistance of public systems of communi­ cation in furthering their illegal activities.

Chapter 8 explores how the resources of different government agencies may be committed jointly in offensives against drug trafficking targets.

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Chapter 1 Drug D etector D ogs

Trained dogs have long been an established part of the law enforcement bodies and armed forces of many countries, either as guardians or detectors of people or property.

While the breeds of dogs used, the methods of their training and the work entrusted to them have almost limitless variation, evidence received by the Commission and its own enquiries showed that the main responsibilities of such dogs could be categorised generally as:

* general police work, including crowd control and assisting in the pursuit and apprehension of criminals, and in some cases involving an 1 attack' role;

* searching for people such as criminal suspects and escapees or lost persons, either in the open or in buildings;

* searching for property either legitimately lost or concealed with criminal intent, such as a weapon or proceeds of a crime; and

* detecting particular substances, such as drugs or explosives.

EXTENT OF USE

Overseas Use

The extent of the use of dogs for any or all of these tasks varies from country to country, but some indication of their popularity was given by Australian witnesses who mentioned the British Army has more than 1200 dogs and that British armed forces have more than 800 dogs in service in Northern Ireland.

A rapid increase in the use of dogs trained to detect drugs has paralleled the emergence of drug abuse as a problem of international dimensions. An international survey of the drug law enforcement agencies of 79 countries in late 1975 showed that while dogs were used

for drug detection in only 13 of these countries in 1971, this number had grown to 35 by 1975. By 1978 the number exceeded 40.

Countries using drug detector dogs in 1975 included the Federal Republic of Germany, where Police and Customs had more than 400 dogs trained in drug detection,and the USA, where the United States Customs Service had more than 100 drug detector dogs in service and planned to

increase this number to 500.

Ten of the 35 countries using drug detector dogs in 1975 were doing so only to detect cannabis and its derivatives. In most of the other countries dogs were trained to detect opium and heroin as well. In some countries, such as the USA and Sweden, some dogs had been trained to

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detect all three of the above-mentioned drugs and other drugs as well, such as strong-smelling pharmaceutical products and cocaine.

In thirteen of the 35 countries, drug detector dogs were multi­ purpose dogs-- that is, dogs trained for both general police or security work as well as drug detection. However in some of these countries, different law enforcement bodies had either or both multi-purpose dogs and dogs trained specifically for drug detection work.

Australian Use

Australia is one of those countries where the use of dogs for drug detection has been a relatively recent development. This development, however, has dramatically accelerated at both Commonwealth and State level in the last few years, especially during the course of this Commission in 1978 and 1979.

Although the Bureau of Customs made attempts between 1968 and 1974 to introduce dogs into its anti-smuggling operations, these were unsuccessful and in 1975 there was still no regular use in Australia of dogs trained specifically to detect drugs. By mid-1979, however, the Bureau of Customs, the Royal Australian Air Force and several State police forces were using drug detector dogs, and dogs from one or more of these bodies were operating in every State except Western Australia. Evidence was given in final Commission hearings of plans to extend

training and operational programs in 1980.

The Commonwealth body most heavily involved in the training and use of dogs for drug detection is the Bureau of Customs. While the RAAF uses far more dogs, the majority are for general guard duties. The Australian Army also uses dogs extensively, but detection training is

limited to detecting explosives. The Royal Australian Navy has some dogs trained by the RAAF, but these also are for general guard duties.

Although officers of the Australian Federal Police indicated in evidence their general support for the use of dogs in drug detection, they said that the force had no such dogs in operation nor any immediate plans to introduce them.

The present Bureau of Customs dog detector program began as a three- year development program in 1976. After a study of requirements undertaken by an Australian Army dog expert in 1975, training courses for Customs Preventive Officers and dogs were undertaken in 1976 and

1977, first at the Army's Mine Detector Dog Wing near Sydney and later independently on Customs property at Sydney Airport in a compound described in evidence as 'makeshift'.

By late 1977, 15 dog/handler teams were operating in Sydney and plans were made to deploy one of the teams to Melbourne.

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Following early successes detailed later in this Chapter, several teams were introduced into Melbourne. During 1978 the Department of Business and Consumer Affairs authorised Mr I. A. Foster, a Chief Preventive Officer of the Bureau of Customs, to attend an international

dog trainer/administrator program at the United States Customs Service's Narcotic Detector Dog Training Centre at Front Royal, Virginia, and to report on selection and training techniques used at the centre. In

another initiative in 1978, Mr W. Fife, the Minister for Business and Consumer Affairs, offered on behalf of the Bureau of Customs dog training facilities to all Australian State police forces.

By August 1979 the Bureau of Customs had 14 dog/handler teams stationed full-time in Sydney and five stationed full-time in Melbourne. By way of implementing recommendations made by Mr Foster on his return from the USA and other suggestions brought to its attention during the

course of the Commission, the Department of Business and Consumer Affairs had decided to begin training courses in Canberra which it hoped would lead to the deployment of the following number of dog/handler

teams in each State (OT 23699):

Sydney 16 Brisbane 2 Perth 2 Darwin

Melbourne 10 Adelaide 2 Hobart 1

In its 4 September 1979 submission to the Commission, the Department said a total of 16 dogs and two officers each from Queensland, South Australia, Western Australia and Victoria would begin a training program in Canberra on 17 September and, depending on the failure rate of the

dogs undertaking the course, the officers would return to their home States to establish units there and, in the case of Victoria, to bolster the existing unit in Melbourne.

Flight Lieutenant R. W. G. Dove, Officer-in-Charge of the RAAF Police Dog Training Centre at Toowoomba, outlined the RAAF dog training programs when he gave evidence to the Commission in March 1979. He said that while the RAAF's main use of dogs was for security work, the RAAF

had introduced its first detector dog course in 1978 and eight

handler/dog drug detection teams were deployed at RAAF establishments throughout Australia. Two teams were stationed in Sydney, one in Melbourne, one in Canberra, one in Darwin and one each at bases at Richmond and Williamtown, New South Wales, and Edinburgh, South Australia. Detection training up to mid-1979 had been only for

cannabis.

Four State police forces-- those of Victoria, South Australia, Queensland and Tasmania-- were operating in 1979 at least one dog trained in drug detection, although some were trained only to detect cannabis and not heroin.

In Victoria, Sergeant P. J. Deimos, Acting Officer-in-Charge of the Victoria Police Dog Squad,told the Commission in May 1979 that the squad had begun operations in its present form on 1 February 1976 with four

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dogs trained in general police work (but not drug detection). This number had increased steadily since then and if all dogs in training in 1979 were successful, the squad would have 23 operational dogs by the end of the year. Three dogs had already been trained in drug detection as well as general police work and another three dogs were undergoing drug detection training (OT 22228).

In South Australia, a senior officer of the State Police explained in confidential hearings in June 1978 that police at the time had in service 12 dogs which had been trained in general police work. These dogs had been trained to detect cannabis but not heroin, although it was hoped dogs would be trained to detect heroin and put in service in the near future. This officer also indicated that South Australian Police dogs had been used at times by the Bureau of Customs, with some success.

Further confidential evidence in May 1979 indicated that the South Australian Police had accepted the above-mentioned Bureau of Customs offer to train a dog and handler to detect heroin. This team would be attached to the South Australian Police Drug Squad later in 1979, and would be in addition to ί lie Bureau of Customs plan mentioned above of having two Customs handlers and their dogs stationed in South Australia.

In Queensland, confidential evidence was given that apart from the State Police Dog Squad for general-purpose police work, a german shepherd trained in drug detection by a constable attached to the State Police Drug Squad had begun operations in November 1978.

In Tasmania, police officers said a dog and handler of the Tasmanian State Police trained by the Bureau of Customs in 1978 had been operating since early 1979.

In New South Wales, the State Police Department carried out a survey in 1978 investigating the possible re-introduction of dogs. Two general-purpose dogs trained in Victoria were introduced in 1979. Evidence from the Department of Business and Consumer Affairs in 1979 suggested that the NSW Police had informally indicated interest in the Bureau of Customs offer to train dogs and handlers in drug detection and that it could seek to have a handler included in a 1980 Bureau of

Customs course.

In Western Australia, evidence was given that the West Australian Police conducted a survey in 1978 to evaluate costs involved in maintaining and operating a drug detector dog squad.

In the Northern Territory, evidence was given that RAAF dogs had been used in drug detection work. An officer of the Narcotics Bureau said that while the Northern Territory Police had no drug detector dogs, the Bureau of Customs expected to have its own dog unit operating in Darwin before 1980 (OT 21519). Other evidence given in Sydney indicated

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that dogs normally attached to the Sydney Customs unit had been operating in Darwin in 1979.

Examples quoted later in this Chapter show that drug detector dogs have been successfully used in Australia in the following situations:

- at international airports, to check passengers' personal baggage including hand luggage, and unaccompanied baggage (that is, passengers' personal baggage arriving as freight often when their total baggage exceeds airline personal baggage limits); - at waterfront areas, to check passengers' baggage and to search

ships;

- at freight storage areas, either at airports or at sea ports; - in checks of letters and parcels sent through the mail; - in searches of premises conducted independently or jointly by Narcotics Bureau agents and State Police officers.

Although evidence was given of instances where various law enforcement bodies and the RAAF have on occasions used each others' dog teams, State Police dog teams have, because of the nature of their operations, been involved mainly in searches of premises, while Bureau of Customs dog units have concentrated essentially on those areas where offences against the Customs Act are committed-- that is, at the point of importation.

Evidence during the course of the Commission showed that the Bureau of Customs has progressively widened its area of operations as more dog/handler teams were trained. In confidential evidence in 1977 a senior Bureau of Customs officer said that during its first year of operations the Customs drug detector dog unit in Sydney had focused mainly on Sydney Kingsford Smith International Airport among passengers' baggage and in freight sheds. Some work had been undertaken, but to a

lesser extent, in Sydney wharf areas and, where called upon, in premises searches initiated by the Narcotics Bureau or on interstate assignment for specific investigations.

While teams were used to a limited extent among overseas mails at the Redfern Mail Exchange in Sydney in the early stages of the Customs drug detector program, this had been expanded into a full-time operation by 1978 and teams had also been employed in similar work in the Parcels Post Office in Melbourne early in 1978.

Similar developments in the use of dogs were taking place in other capital cities in 1978 and 1979.

Except in the case of premises searches the Bureau of Customs has for the most part used dogs in what a senior officer referred to in confidential sessions in 1977 as 'sterile' situations: that is, areas such as baggage and freight areas divorced from those areas frequented by the public such as baggage collection halls at airports or at wharves.

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Senior officers explained that this was done for two reasons--firstly, to allow dogs to operate in areas with the least possible distraction and secondly, to avoid direct contact with the public. Indications were also given in early confidential sessions that delays in the introduction of dogs to mail exchanges had been due at least partly to trade union reaction.

Examination of personal baggage at airports has been carried out in restricted areas such as baggage bays and those areas housing conveyor belts while baggage is enroute from the aircraft to the hall where passengers collect it. Several senior Customs officers during the course of the Commission expressed considerable reservations about introducing drug detector dogs to areas where they would be in close proximity to the public. They were particularly concerned about public

reaction if a dog frightened or appeared to threaten anyone, especially an elderly person or a child.

Some witnesses suggested no airport in the world yet used dogs in such situations. The Commission noted, however, that in Singapore, dogs are used in close proximity to the public at both the international airport and at border checkpoints on the Causeway between Singapore and Malaysia, despite the religious sensitivity of many of the people of

this area regarding close contact with dogs. At the Causeway border checkpoints, dogs and their handlers patrol in a narrow area enclosed by a wire fence between lines of people passing through Customs and

Immigration checkpoints. At the airport, dogs check baggage from aircraft in areas separated from the public by wire fences but in full view of the public. The Commission noted that in the case of the

airport, passengers in general appeared to raise no objections.

The Commission also noted that at the First International Narcotics Detector Dog Conference in Singapore in November 1977, a Canadian representative said a report on the use of dogs at border crossings, wharves and rail terminals had indicated passenger reaction was one of general acceptance.

During Commission hearings in 1978 and 1979 senior Customs officers made reference to the fact that the Department of Business and Consumer Affairs was considering new initiatives concerning the use of dogs. In confidential hearings in August 1979, a Departmental witness gave evidence that the use of dogs at passenger terminals on the Sydney water front had been extended and that the Department had made proposals to the Commonwealth Government concerning introduction of dogs into public areas at airports. The witness said that as part of these proposals a special desk with glass surrounds had been placed in the concourse at Sydney International Airport which passengers used to move from their aircraft to the baggage collection hall. A dog and its handler would be behind the desk at the earliest possible point after disembarkation and passengers selected at random would have their hand luggage (the luggage actually carried from the plane) placed in close proximity to the dog.

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The Commission noted that the Minister for Business and Consumer Affairs announced on 6 September 1979 that among other initiatives to strengthen drug smuggling detection, he was considering use of dogs in airport concourse areas.

The Commission has recently been informed of the implementation of this method, with appropriate safeguards, at Kingsford Smith Airport, Sydney and at Tullamarine Airport, Melbourne. Its extension to other international airports can be expected. Monitoring of the effectiveness of this method is continuing.

The use of drug detector dogs in this situation points to the

possibility of their increased use in other situations.

SELECTION AND TRAINING

Breeds Used

The breeds of dogs used in drug detection vary considerably

throughout the world, although german shepherds and labradors are the most common. Of the 35 countries which the above-mentioned

international survey indicated were using drug detector dogs in 1975, eight countries were using german shepherds exclusively, eight were using labradors exclusively, nine were using both and the remainder were using various breeds, including dobermans, boxers and bloodhounds. Law

enforcement bodies in several countries were considering replacing labradors with german shepherds. On the other hand, Nigerian

authorities were replacing german shepherds with labradors because it was felt labradors were better suited to the climate and more easily controlled when working among people.

The countries which used various breeds included the Federal Republic of Germany, which used cocker spaniels and Scottish terriers as well as labradors and german shepherds,and the United States and Sweden, which indicated simply that larger dogs were preferred.

Australia is one of the countries where german shepherds exclusively are used for drug detection work. Evidence received early in the Commission told how early Bureau of Customs trial programs using labradors had not been a success.

The Department of Business and Consumer Affairs submission to the Commission of 4 September 1979 which outlined the Bureau of Customs plans to implement its nation-wide drug detector dog program said german shepherds would be the main breed of dog used, but that other breeds would be experimented with subject to the priority of maintaining

effective operational units for all areas (OT 23699).

Three Australian witnesses concerned with the training and handling of dogs referred to,the question of which breeds were most suitable for

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drug detection. Sergeant P. J. Deimos of the Victoria State Police Dog Squad pointed out that in general police work the german shepherd was the dog most commonly used. Its mobility was an advantage and, in general terms, its work had been proved almost beyond doubt. He thought, however, that in specialist drug detector work, the labrador might be easier to train because it was more of a natural retriever.

Mr T. R. Luxton, chairman of the Kamarn Breeders Foundation Ltd, a non-profit organisation interested in controlled breeding of german shepherd dogs which the Bureau of Customs uses as its prime source of dogs, said that if ability to discriminate scent was the sole

requirement, the best breeds to select would be the hound breeds, such as the bloodhound (OT 22285A). However, these dogs did not have the stamina law enforcement work required. The german shepherd had been the most popular dog because although not necessarily the best dog in terms

of detection ability, it was above average in this respect and had many other advantages. Mr Luxton believed that while using a mixture of breeds could prove effective, multiple techniques of training would be required and costs would increase.

Mr I. A. Foster, the Chief Preventive Officer administering the training of Bureau of Customs drug detector dogs, recommended to the Department of Business and Consumer Affairs after his 1978 visit to the United States Customs Service's Front Royal training centre that breed or sex of the dog was not important in drug detection work. He pointed out that U.S. Customs Service dog trainers believed the attitude and potential of individual dogs should be the deciding factor in selection

(Open Exhibit 669, p .3).

Other evidence suggested smaller dogs would be preferable if the dogs' only responsibility was to detect drugs. Smaller dogs obviously would be able to gain access to hiding places inaccessible to bigger dogs.

Age and Time Needed for Training

The 1975 international law enforcement survey also showed that ages of selection of a dog for training, the length of time for individual training sessions, and the total duration of training also varied considerably from country to country. In most cases the variations were caused at least partly by such factors as the work required of the dog being trained-- whether specialist detection work or general-purpose work as well-- how much, if any, training the dog had had in obedience before recruitment, and how intense any 'post graduate' training would be after the dog became operational.

The survey showed that although the average age of selection was generally between 10 and 15 months, training sometimes began as early as six months, as in Egypt and Sri Lanka, and as late as three years, as in the USA and Switzerland.

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Total training periods varied from a combination of 12 months basic training and seven months specialist detection/retrieval training in the case of the Austrian Federal Police to nine weeks in Luxembourg. Other evidence indicated that the U.S. Customs Service in 1978 generally expected to train an adult dog in general obedience and to detect

cannabis tops (marihuana) and cannabis resin (hashish) in 10 weeks and to detect heroin and cocaine after another two weeks.

Evidence detailed later in this Chapter showed that ages of dog selection and total training time for dogs used in drug detection vary as widely in Australia as in overseas countries and depend largely on whether the dog is being trained only for drug detection or for other work as well.

Selection

The Commission noted that although considerable differences in opinion were expressed both by Australian witnesses and in information received from international sources concerning the best breed of dog for drug detection work and the optimum age at which such dogs should commence training, there was unanimity that irrespective of these factors, selection of suitable dogs was extremely difficult and that the failure rate of even the most successful method was extremely high.

Witnesses suggested that while few people would dispute the olfactory acuity of dogs, serious study of this ability had been a comparatively recent development. Although some evidence presented to the Commission suggested research was becoming increasingly widespread since the first serious studies undertaken in the United States in the

1940s, most information received by the Commission indicated that much research needed to be done, particularly in relation to the application of dogs to drug detection work. Evidence indicated that while areas of disagreement existed among international authorities, there seemed general agreement that:

* The ability of dogs to detect and discriminate one scent among many others is even more sophisticated than commonly realised. While a dog's olfactory acuity exposes it to an extremely wide range of scents, it has the ability to discriminate one scent from many and the intelligence to react to that scent if trained to do so.

* Despite this ability, intensive and continuous training is required firstly to achieve an acceptable degree of efficiency and secondly to maintain it.

* Considerable research still needs to be carried out on the olfactory processes of dogs to enable them to be used to maximum advantage in drug detection work. While it is commonly agreed there are factors which limit a dog's detecting ability, not enough is known about

these factors-- what they are and how they effect dogs.

Some Australian evidence suggested that even the most successful selection system now being used for drug detection dogs would have a

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failure rate of at least 80 per cent, even after preliminary aptitude assessment (9T 20798). In his report to the Commonwealth Department of Business and Consumer Affairs after his visit to the U.S. Custom Service's Narcotic Detector Dog Training Centre at Front Royal, Virginia in 1978, Mr I. A. Foster quoted literature from the Centre which emphasised that animal selection and continual assessment of dogs during training were highly critical. His report pointed out:

About one out of every 43 healthy and temperamentally sound animals meets the basic requirements. Of these, one of three is able to complete training. (Open Exhibit 669, p.22)

A background paper explaining the Front Royal Training Centre's policy of selecting dogs gave details of two attempts made in the mid- 1970s to launch breeding programs because of difficulties in obtaining sufficient suitable dogs for training in 1975. Both programs, one using golden retrievers and the other german shepherds, were subsequently abandoned.

Mr T.R. Luxton of the Kamarn Breeders Foundation Ltd said that while he thought Kamarn german shepherd dogs which were carefully selected and lived in carefully selected home environments as puppies would have a higher than average acceptance rate, he thought the selection rates of dogs for drug detection work in Australia generally was less than four in 100 (OT 22286). He quoted a State police officer with dog training experience as estimating 200 dogs had to be assessed before five were selected for training. (Mr Luxton also said that five of six Kamarn dogs nominated by his Foundation specifically for police work had been accepted for police training.) Mr Luxton also expressed pessimism about the potential of breeding programs aimed at trying to 'breed-in' the qualities sought for general law enforcement work and specialist detection work.

In explaining Victoria State Police Dog Squad training methods, Sergeant P. J. Deimos stressed that only a certain type of dog already trained in general police work was considered for drug detector training. 'He must possess a good degree of nose ability, with a high degree of nose obedience', Sergeant Deimos said (OT 22229).

In his recommendations to the Department of Business and Consumer Affairs concerning the Customs drug detector dog program, Mr Foster stressed the need to reduce wastage in dog selection. He recommended a set of selection criteria based on the system used by the U.S. Customs Service. These criteria emphasised general characteristics which other authoritative witnesses also stressed-- excellent physical condition and stamina, a temperament which could cope with any situation and a very strong desire to retrieve.

Mr Foster's report quoted the following comments from the U.S. Customs Service on the various qualities sought in a drug detector dog (Open Exhibit 669, p.22).

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* Obedience-- 'Strict obedience is not desirable as it will

subsequently make the animal dependent on the handler when trained. For this reason the commands of "sit", "stay", are taught with limited emphasis. Only the command used for recall is strictly enforced ' .

* Temperament-- 1 The trait is one of independence and is reflected in the animal that is restless and would sooner investigate his surroundings that be at his master's side. Such a dog is not

usually outwardly aggressive toward people. He has a bold outgoing temperament and unhesitatingly charges into strange surroundings, convinced the space he occupies belongs to h i m ' .

* Retrieval-- 'He must show a strong, frantic desire to retrieve... a dog that has been a forced retrieve animal is a poor candidate... a possessive attitude toward a retrieving object is particularly desirous'.

Several witnesses commented strongly on the need for equally careful selection and training of dog handlers. Most pointed out that dog and handler operated as a team and that sub-optimal performance either in training or in operational situations could as easily be the fault of the handler as of the dog. Evidence was given that U.S. Customs Service drug detector dog handlers have at least one year's previous experience

in handling of working dogs. The evidence indicated that while

enthusiasm was a prime prerequisite for dog handling, the U.S. Customs Service experience showed that considerable and in some cases

incorrectable damage could be caused in the early stages of training by a sincere but inexperienced handler.

A summary of U.S. Customs Service dog training methods presented in evidence emphasised the need to make rigorous and unbiased evaluation of each dog (and handler) during training, especially before the final training stages specifically involving detection of heroin and cocaine.

'To advance a marginal dog by giving it the benefit of the doubt usually only serves to compound the problem*, the summary says.

EFFECTIVENESS

Evidence generally agreed that a dog's operational efficiency could be affected by any of the following factors:

- the type of drug for which the dog is searching and the amount

involved; - the length of time the drug has been hidden (especially important with respect to freight containers); - the nature of the area to be searched; - the number of distractions present in the search area; - the temperature and other climatic conditions which can inhibit a

dog's willingness or ability to work; - the quality of training the animal has received; - the attitude and physical wellbeing of both the dog and its handler; - the need in some circumstances for handlers to carry out certain

procedures sub&equent to an alert by their dogs (e.g., in the case

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of an alert of drugs concealed on a person where a dog might attempt to retrieve the drugs).

Most witnesses agreed that the first three of the above

considerations were the most important since they were outside of the control of law enforcement bodies and the initiative was with the would- be drug trafficker.

Several witnesses also drew attention to the fact that special consideration must be given to dogs involved in specialised work such as drug detection in order to avoid boredom. These witnesses argued that although a dog needed to be trained and exercised up to one day a week throughout its working life in the full range of tasks expected of it, constant repetition of the same work situation would soon lead a dog to a state of frustration and lack of interest. When referring to the need to ensure that the use of drug detector dogs by the Australian Bureau of Customs was closely co-ordinated, Mr Foster said he hoped to

see a program within the Bureau which would promote an awareness among all operational staff of the potentialities of dogs so as to widen the dogs' areas of activities. 'You cannot send a dog down into a baggage area where he stays for four days a week', he said. 'He gets bored. He gets fed up with it' (OT 20805).

Some other witnesses also pointed to the loss of operational man­ hours for handlers either because of the need for continuing training or because dogs became either temporarily or permanently incapacitated.

However, despite these operational inhibitions and the difficulties in selection and training mentioned earlier, evidence from virtually every source unreservedly endorsed the use of dogs as an effective tool for law enforcement bodies.

While very strongly divergent opinions were obvious both in Australia and internationally about the best methods of realising the potential of dogs as drug detectors, evidence unanimously supported the sentiments expressed by Mr R. N. Battard of the United States

Customs Service who told the First International Narcotic Detector Dog Conference in Singapore in December 1977:

All of the requirements and associated costs considered, we have found that the (U.S.) narcotic detector dog program is our most cost-effective enforcement effort. (Confidential Exhibit)

Mr Battard said that in the previous financial year, U.S. Customs Service detector dog teams had been responsible for some 9000 seizures of drugs with an estimated total street value of more than $US 100 million.

Mr Battard's conference speech and other evidence received by the Commission quoted instances where remarkable results had been obtained,

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even in circumstances considered to be most adverse. Australian witnesses said that although heroin in its pure form was a difficult drug for a dog to detect, particularly in small quantities, U.S. Customs Service dogs had detected it in a bottle of eau de Cologne and in a tin

of paint.

Evidence concerning the establishment of the U.S. Customs Service detector dog program in 1970 showed that although dogs originally were trained only to detect cannabis tops and cannabis resin-- considered the easiest of the widely-trafficked illegal drugs to detect-- trials

carried out soon after the first training programs to test dogs' ability to detect heroin and cocaine proved so successful that training programs were extended to include detection of these drugs as well.

Other evidence included details of early U.S. Customs Service trials where dogs had detected cannabis tops and resin even in instances where a dog had alerted his handler to the presence of cannabis tops more than nine metres from the package in which it was concealed and in another

instance where cannabis resin had been so well concealed in a car door trained Customs officers could find no evidence the door had been tampered with. Evidence was given that the U.S. Customs Service now regarded a dog as a failure unless it was 100 per cent successful in

detecting cannabis tops and resin. A spectacular case of the success of an individual dog quoted to the Commission was that of Chopper, a U.S. Customs Service detector dog credited with detections of drugs with a total street value of more than $US70 million.

Evidence concerning the proved and potential effectiveness of drug detector dogs in Australia reflected much of the optimism shown in the USA and other countries. In his 6 September 1979 announcement

concerning consideration to extend the use of dogs in international airport terminals, Mr W. Fife, the Minister for Business and Consumer Affairs, said he believed Australian results compared favourably with those attained by overseas law enforcement agencies.

Although decisions on some ways to implement a nation-wide Customs drug detector program were not taken until 1979, evidence in Commission hearings in 1977 and 1978 indicated senior Customs officers at that time were becoming increasingly convinced of the potential of dogs since the

experimental program had begun in Sydney in 1976.

In his evidence of 18 April 1978 outlining the functions of the Special Services Section of the NSW Customs Collectorate, Chief Inspector of the Section, Mr R. P. McMahon, spoke at some length of the Bureau's hopes for the Sydney detector dog unit. Mr McMahon, who in

later evidence remarked on the enthusiasm of the unit, said that naturally there had been development problems, but results were sufficient to lead the Bureau of Customs to believe the unit would be a very viable part of Bureau operations. He said:

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Although still in its infancy, the success rate of positive finds by the unit has been high. As at 31 March 1978 the dogs had achieved 32 successful finds of drugs secreted in baggage, cargo and mail. Eventually it is expected use of detector dogs will achieve manpower savings in cargo and mail screening areas.

(OT 9555A)

Results of the Commission's own analysis of data on drug seizures recorded by the Narcotics Bureau indicated that not all seizures attributed to the dogs could be classified as being seizures due solely to the initiative of drug detector dogs, and that some seizures would have involved the dogs in a confirmatory role. However, although the dogs might be considered to have initiated only 10 seizures during 1977 and 1978, these seizures in most instances were of significant quantities of drugs. They totalled 9.89 kg of heroin, 92.2 kg of cannabis tops, 15.9 g of cannabis resin and 11.4 kg of cannabis oil. Almost all of the seizures were at Sydney Airport, the main operational area of the dogs at that time.

Later statistics provided by Mr G. E . Sheen, NSW Collector of Customs, listed 19 drug seizures involving detector dogs in the first six months of 1979. They included detections in personal luggage at Sydney Airport and aboard ships, in letters and parcels at the Sydney Mail Exchange, in premises searched by Narcotics Bureau officers, and in one instance in a linen cupboard in Darwin in premises searched by the Northern Territory Police Drug Squad. Drugs seized in the period were virtually all cannabis and its derivatives, although in one premises

search conducted by Narcotics Bureau officers a dog detected traces of heroin. Drug amounts seized included 90 kg of cannabis resin, 13.7 kg of cannabis tops, 700 g of cannabis oil, and 37 lysergic acid (LSD) tablets found in a parcel.

Places or items of concealment included:

- in a suitcase packed in a wooden box containing incense sticks and wet straw (90 kg of cannabis resin); - in a parcel under cakes of liquorice (cannabis resin); - behind the backing of a painting (cannabis resin); - in a cassette recorder imported as personal luggage (cannabis oil).

In one instance where a dog alerted its handler to a webbing bag amongst airline baggage, no drugs were found in the bag but a body search of the bag's owner led to the seizure of some cannabis tops.

Individual State police officers also quoted impressive results.

Sergeant P. J. Deimos of the Victoria State Police Dog Squad submitted figures to the Commission showing that apart from general police dog work, the squad had been involved in 424 searches between 1 February 1976 and 30 April 1979 in which drug offences had been

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suspected. These searches had resulted in 161 drug seizures and the arrest of 268 people.

He said that there were only two instances known of where the dogs had failed to detect drugs. Both cases involved small amounts of heroin (OT 22235). He said his only reservation about the ability of dogs to detect drugs was their ability to detect heroin. But he agreed

such failures were likely to involve small amounts.

In Queensland, confidential evidence was given that the german shepherd attached to the State Police Drug Squad had been involved in five drug seizures in its first eight months of operations, including cannabis tops, cannabis oil and heroin with a total estimated street value of $14 500. The constable concerned with training the dog felt

that while the training had been to the best of his knowledge, it was possible it could be improved upon. He said:

...I feel that the success that we have had is a credit to the dog's ability and one wonders how good the dog could be if given a really professional comprehensive program.

From information obtained, it appears that in America one dog in 400 is suitable for narcotics detection. Here in Queensland the one dog...(was) used. One wonders what success we could have if we had the proper facilities and the number of dogs.

(CT)

Confidential evidence given in Adelaide in June 1978 and May 1979 indicated that law enforcement officers in South Australia could see considerable potential for the use of dogs in that State trained in detecting heroin. 1 Considering the problems we have locating heroin--

they can be small quantities and so easy to conceal--dogs seem to be the only effective way at this stage, apart from direct information' , one witness said.

Comments from both Commonwealth and State law enforcement officers involved in training and operating drug detector dogs emphasised that in many situations the benefits of using a dog extended beyond a simple measurement of whether the dog had initiated a successful search. Their

deterrent value and particularly their value in terms of time-saving were seen by some officers as the principal advantages.

On the aspect of deterrence, a well known criminal and convicted drug smuggler in confidential evidence, when asked about the attitude of persons in the drug scene to the 'sniffing' dogs, said:

This, I understand, is quite a deterrent or has a deterrent effect on any would-be importer-- quite a deterrent effect. (CT)

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Sergeant P. J. Deimos of the Victoria State Police Dog Squad described the main advantages in these words:

A dog can complete a narcotic search far quicker than a human. A well-trained dog can search a normal three-bedroom house including yards and outbuildings in approximately 40 minutes, and I believe without a dog it would take between 16 and 20 man hours to complete the same search with the same degree of efficiency.

A dog can either locate narcotics or declare a building clear with an absolute minimum of disturbance to the property. (OT 22231--32)

Several Commonwealth and State law enforcement officers quoted examples of the deterrent effect on would-be drug smugglers and traffickers, particularly when a suspect was confronted with the possibility of a search by dogs of either personal possessions or premises. A State police officer in confidential evidence told of an offender revealing details of drug caches in other parts of a city after being informed police officers were considering having dogs search premises of associates whom the offender had visited. 'Obviously (he was) not wanting to embarrass other people and other friends', the police officer added.

Customs officers also referred to dogs being able to check vast numbers of baggage or freight items in a relatively short time. Some officers also drew attention to the successes of dogs used in mail exchanges where legislation difficulties arose over the opening of first class mail by law enforcement officers. A confidential witness in Sydney in 1979 said that in terms of numbers of seizures, this had developed into the dogs' most successful activity.

Customs officers also referred to using dogs in searches of cargo containers, an area of particular concern to the Commission and the Bureau of Customs. New initiatives outlined in confidential evidence in March 1979 mentioned having dogs present at examinations of selected containers to enhance the possibility of drug detection.

Witnesses in confidential sessions also referred to efforts in Canada and the USA to develop devices to expel air either from baggage or containers without damaging them but at the same time enhancing a dog's chances of detecting scent created within the baggage or container by the presence of drugs.

DOG TRAINING IN AUSTRALIA

Australian dog training establishments brought to the attention of the Commission included those of the RAAF, the Army, the Victoria State Police,and the Bureau of Customs.

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The RAAF Police Dog Training Centre, the biggest of these

establishments, is based at the RAAF's No. 7 Stores Depot at Toowoomba, Queensland. Its primary role since it was opened in 1969 has been to train dogs and personnel for police work. Training of dogs for all three armed services has taken place there. It has a training compound

situated on 2 ha (5 acres) of land within the total depot area of 55 ha. Its Commanding Officer, Flight Lieutenant R. W. G. Dove, has a staff of seven, including two trainers and five personnel in supporting roles. Although facilities at the centre include kennels for 56 dogs, staff capacity limits the centre's training capacity to 14 handlers and 14 dogs at one time.

Flight Lieutenant Dove told the Commission that training for the most part was what would be required for police work. Considerable time was spent on basic obedience before training progressed into guard work including catching a person and holding or guarding the person on

command. He regarded developing a capability for tracking as

fundamentally part of basic police dog training. Although not all police dogs were good trackers most dogs were basically proficient, Flight Lieutenant Dove said. He said the two areas requiring specialist

training were those of drugs and explosives detection. Since the introduction of drug detector dogs into the RAAF in June 1978 , dogs assessed at an early stage of their training at Toowoomba as unsuitable for general police work are further assessed for potential usefulness in drug detection work. Training in drug detection in 1979 was limited to cannabis, he added.

Captain A. D . Mitford-Burgess, Commanding Officer of the Australian Army's Military Dog Section, explained that while the Australian Army was carrying out a pilot scheme in police-type dog training at Oakey near the RAAF dog training centre at Toowoomba, its primary interest was

a program to breed and train dogs in explosives detection. This program was based on what was known as the psychogenetic theory in which dogs were being bred over 10 generations to develop special characteristics. The program, which Captain Mitford-Burgess believed was unique, was in

its third generation after eight years and results so far had been as good if not slightly better than in the case of other dogs used in similar work.

The program is being carried out at the Australian Army School of Military Engineering at Casula, near Sydney. Captain Mitford-Burgess explained that he and a staff of 13 were training and raising an average of 20 dogs, not all of which were housed at the training centre. He

said that besides kennels for 16 dogs the establishment consisted of a Commanding Officer's office, an administration office and toilet facilities. Other administrative support facilities were part of the School of Military Engineering. The training centre had no veterinary examination rooms as at the RAAF1s Toowoomba Centre, although use could be made of nearby civilian facilities. Dog training areas included the nearby Holdsworthy Army Range and various areas such as warehouses and

garages by arrangement with civilian and military organisations and the NSW State Police Department.

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Captain Mitford-Burgess pointed out that although the training school's function was not to supply other organisations with dogs, law enforcement bodies such as State police forces could call on the Army dogs in the event of a situation involving explosives such as a

terrorist bomb. The school had also trained Customs dogs and handlers between 1971 and 1976 and some personnel of other countries such as Malaysia and Singapore.

The Victoria State Police Dog Squad's training centre is situated at Westmeadows, near Melbourne's Tullamarine Airport. The training compound, encompassing about 1 ha (2.5 acres), includes a classroom, an office block, veterinary surgery, storeroom and kennels. Land at the adjacent Police Stud Farm and near Tullaramine Airport is used for training purposes.

When he gave evidence in May 1979 Sergeant P. J. Deimos said seven dogs were in part-time or full-time training at the centre. Dogs trained were all german shepherds recruited at ages of about seven months or between 13 and 24 months. All dogs were trained in general police work and some with a high degree of detection ability were

trained in drug detection. Younger dogs and their handlers generally received 23 weeks training spread over 12 months. After a preliminary period in which handlers were taught the basics of dog care the handlers kept the dogs at home for four months during which time they attended

the training centre two days a month for basic obedience training. Training in tracking was then introduced over a period and then a final training phase of 15 weeks was conducted.

Training for older dogs combined six weeks of preliminary training and familiarisation and the final 15-week training course, Sergeant Deimos said. Further training in drug detection for those dogs selected averaged between four and six weeks.

As mentioned earlier in this Chapter, the Bureau of Customs dog training programs were originally centred in Sydney, firstly at the Army training establishment at Casula and in 1976 on Customs property near Sydney Airport.

Following decisions to centralise and expand Customs dog training and operations, the Department of Business and Consumer Affairs Ln 1979 decided to use facilities in Canberra. In its submission to the Commission of 4 September 1979 the Department said:

Central training arrangements are being established in Canberra on an interim basis and without prejudice to further decisions on permanent training facilities. (OT 23699)

Mr M. A. Besley, the Department's Secretary, explained that the Bureau of Customs intended to use the Department of Capital Territory's

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dog pound to house dogs and use Manuka Oval for field training. He added:

. . .we have made an in-principle decision to try and establish a central training system somwhere. The question of where it will be and what type of course... will depend in part on our assessment of this trial run in Canberra this month.

(OT 23702)

Mr Besley also explained that Customs dog training programs, which involved only drug detection, were using only german shepherds at present, although other breeds could be introduced later. The main source of dogs at present was the Kamarn Breeders Foundation, which gave

the Bureau of Customs carefully selected adult dogs. The Bureau's latest training programs were expected to take four weeks.

In addition to the evidence already referred to, Commonwealth and State law enforcement officers acknowledged that much development work still needed to be done to realise the full potential of dogs in

detection work. Most witnesses acknowledged that in Australia, as in most other countries of the world, the rapid increase in, and demand for, drug detector dogs and the paucity of exact knowledge of how dogs

used their powers of scent detection had combined to create a situation where several bodies with varying degrees of experience and expertise were attempting to achieve similar goals but by a wide range of

differing methods and a considerable amount of experimentation.

Although evidence included many examples of both Commonwealth and State bodies co-operating in either the training or operation of dogs for drug detection work, several witnesses agreed with the proposition expressed in Commission hearings that: 'We have a lot of people doing a

little bit each on dogs in Australia' (OT 21075).

One law enforcement officer described the position concerning training of drug detector dogs in Australia in these words:

...we are only babies at it. (OT 22233B)

In one of the Commission's earliest hearings in December 1977 a senior Department of Business and Consumer Affairs officer who in confidential evidence spoke of the promising results already obtained in the Bureau of Customs drug detector program also said:

Development is necessarily empirical, and there is already a questioning of training techniques adopted, of whether the german shepherd breed-- or any one breed is the optimum for the work, and of whether current operational use of teams is to best advantage.

(CT)

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In Commission hearings in September 1979 Mr M. A. Besley said when explaining the improvised Customs training arrangements made in Canberra:

...having done that we will stand back and say 'Now, how did it go? Is Canberra the place? Is this the right kind of course?1 and so on.

(OT 23703)

As well as the evidence about plans to centralise Customs dog training, several of the previously-mentioned witnesses discussed with the Commission ways of co-ordinating and developing Australian dog training expertise and facilities. Much of this discussion centred on the question of the feasibility and possible benefits of a centralised training establishment to cater for the requirements of all Commonwealth and State law enforcement bodies and the armed services.

The Commission also noted that in the 1975 international drug law enforcement agency survey, 22 of the 35 countries then training drug detector dogs did so at national dog training centres. These countries included the USA, Britain, Canada, Sweden and New Zealand.

Some Australian witnesses expressed reservation about training dogs away from the climatic environment in which they ultimately would operate. Others drew’ attention to the need to be conscious that friction could occur between strongly motivated people with sometimes widely divergent concepts of the best way to train dogs.

In the main, however, witnesses endorsed the principle of a centralised training establishment.

When asked for his personal opinion about such an establishment, Flight Lieutenant Dove said:

I think it is a sound concept. I can appreciate the economies of scale there, and it would certainly dispose of the

duplication of services or facilities that now exist in some areas.

It would provide the continuity, I would think, of expertise, and would localise it. There would certainly be economies of scale on the dog training side of things on continuation training, on canine diet research programs, and evaluation of other breeds for particular types of work, and so forth.

(OT 21076)

Flight Lieutenant Dove went on to stress that those involved in the specialised field of drug detection training should carry out a survey of international methods used in other countries such as the USA, the Federal Republic of Germany, Sweden and Britain. In order to continue

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monitoring of overseas training developments, lecturers or head trainers from any centralised Australian establishment specialising in various types of dog training could regularly visit different countries where dog training was being developed. This would be in much the same

fashion as a university or other education institutions functioned and developed.

When asked whether he personally could

centralising and co-ordinating dog training in Mitford-Burgess said:

see advantages in Australia, Captain

I would perceive that if an organisation like that was

established, the working dog in Australia, certainly for the police forces and the services, would improve dramatically. (OT 21061)

Captain Mitford-Burgess said that although present Australian dog training techniques, sometimes aimed at producing the same type of dog, were drawn from different parts of the world, he would estimate that about half of the training courses contained similar basic subjects such

as canine psychology and handling techniques and to some extent at least obedience. These basic subjects were taught before specialised training in various areas such as detection and various types of police work began.

Captain Mitford-Burgess said of dog training in Australia that it seemed to him there was a lack of cross-flow information. He and Major G. Hulse of the Army had arranged a small Informal meeting in 1978 which dog trainers and administrators from the RAAF, the Army, Customs

and the NSW State Police had attended. The meeting had decided it would be beneficial to hold a national conference to discuss ideas and problems of dog training. It was hoped the conference would take place late in 1979.

These witnesses and Mr I . A. Foster of the Bureau of Customs also discussed at length the advantages of pooling resources to recruit dogs, since dogs which might not be suitable for one type of work might prove ideal for another. A dog not suitable for some types of police work because it would not attack a person might have excellent detection

ability.

The witnesses also stressed the advantage of careful and continuing monitoring and assessment of dogs not only in training but also throughout their operational life. Mr Foster pointed out that the U.S. Customs Service's Front Royal dog training centre kept a full history of

dogs from the day they graduated from the centre as well as during the course of training (OT 20805).

Mr Foster said although costs for any central complex might be high, he could see the prospect of economies of scale in centralising such facilities as veterinary, feeding, and general maintenance arrangements.

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Overheads would be reduced because of better contractual arrangements for feed and equipment (OT 20805).

CONCLUSIONS AND RECOMMENDATIONS

Conclusions

From its earliest hearings the Commission was given examples of the considerable potential drug detector dogs have demonstrated both in Australia and overseas as a weapon against drug traffickers.

The subject was much canvassed in evidence in Australia. Whilst overseas the Commission took every opportunity to obtain the views of law enforcement authorities about the efficiency of dogs used for detection of drugs and other substances likely to be concealed with criminal intent. Although it was not within the Terms of Reference of this Commission, some experts suggested there was a role to be played by dogs in detecting smuggled wildlife-- a matter of obvious and real concern to Australian authorities.

The Commission saw a wide variety of training techniques and breeds of dogs used in drug detection work in several countries as well as, of course, Australia. Although the Commission did not have the opportunity of visiting Europe to observe recent advances there, it was particularly impressed by the efficiency of the United States Customs Service's training establishment at Front Royal, Virginia.

The Commission concluded that drug detector dogs have a permanent place as an important aid to drug .law enforcement efforts. Their ability to detect drugs is beyond doubt. They also have an important deterrent effect.

There was virtually unanimous support by witnesses for the use of dogs in overall law enforcement work and, particularly, drug detection work. No evidence seriously challenged the sentiments expressed in the comments of Mr R. N. Battard of the United States Customs Service to

the First International Narcotic Detector Dog Conference in Singapore in December 1977: 'We found that the narcotic detector dog program is our most cost-effective enforcement effort'.

The expanded use of drug detector dogs in Australia should be treated as a matter of considerable urgency.

The effectiveness of particular breeds of dogs in drug detection work can vary according to climate and the type of work involved, including the environment in which a dog is operating. For example, the Commission does not believe that early abortive attempts by the Bureau of Customs to use labradors as drug detector dogs, should permanently rule out the use of labradors within Australia. Advances in training

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techniques and methods of using such dogs might well lead to the conclusion that the failure in previous attempts was not the fault of the dogs. The Commission was impressed by the steps being taken in Kuala Lumpur, Malaysia, to expand the use of this breed for drug detection. On the other hand, there were those in Thailand and in Singapore who felt that further experimentation should take place to see whether the long-haired german shepherd dog was as effective as other breeds under conditions of high temperatures.

Whether authorities should attempt to breed dogs especially for drug detection or limit their choice of dog to one particular breed, or use the United States Customs Service approach of recruiting adult dogs of individual characteristics rather than specific age or breed, must depend on continual evaluation of the systems in operation. Australian authorities have achieved excellent results, particularly in Sydney and Melbourne and to a limited extent in Brisbane, with the exclusive use of

german shepherd dogs. Whilst people such as Mr T. R. Luxton of Kamarn Breeders Foundation Limited are so generously prepared to breed and provide these dogs for police and particularly drug detection work, the present system should probably continue. No doubt the Bureau of Customs

use of german shepherd dogs can be reviewed as dog use is expanded into parts of Australia where summer temperatures could have considerable bearing on the effectiveness of some breeds of dogs. Northern ports

such as Darwin, Cairns and Broome are examples of this.

The Commission noted that dogs have really 'come into their own' as a suitable adjunct to drug law enforcement only since about 1975. Because of this, all aspects of their use and training should be constantly reviewed in the light of developments both in Australia and

in other parts of the world.

On the other hand, the Commission would deprecate any attempt to retard the implementation of increased drug detector dog use by investigations or debate as to whether the methods used in, for example, Britain or the Federal Republic of Germany are better than the United States Customs Service's method or whether one breed of dog is better

than others.

Some arguments suggested that the heavy expenditure of time, effort and money brought about by the high rejection rate of dogs recruited under the U.S. Customs Service's recruitment system could be avoided by specialist breeding programs. However the lack of measurable success of at least some of the attempts to breed dogs specifically for drug detection shows that firm conclusions about such methods could be premature. Obviously, one must be flexible in approach and make provision for possible experimentation and change in the light of future

developments.

Although witnesses unanimously conceded that drug detector dogs in Australia, as elsewhere, have demonstrated they are much more efficient and faster drug searchers than men in nearly all circumstances, the Commission was impressed with the need to maximise research and

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development of training if the full potential of dogs was to be

realised.

In this connection, the Commission was very much impressed with the concept of a centralised training establishment within Australia to train dogs for all types of use to which they are presently put or may be put by the three armed services, and by police and Customs

author:ties.

The concept received considerable support. Such an establishment could collect and/or breed dogs for all purposes. After an initial basic course the aptitude of a particular dog for a particular type of duty could be assessed. At present in many instances, a dog unsuitable for drug detection work is returned 'whence it came' after considerable expenditure and no assessment made of its potential usefulness in such activities as guard work, explosives detection or anti-terrorism duties.

After separation of the dogs into appropriate categories, intensive training in the selected avenue could continue. At the same time research would also proceed.

Such a central training establishment would have many advantages from the point of view of personnel administration, procurement of dogs, and consolidation and development of necessary support services. The advantages of avoiding duplication of effort and expense are obvious.

During its hearings and inspections, the Commission explored many aspects involving the feasibility of a centralised training

establishment. It became obvious -that the location of such an establishment needs to be carefully selected bearing in mind the need for a considerable area of land in reasonable proximity to the various types of establishment needed for training the dogs to cope with circumstances they will later meet.

The use of drug detector dogs is a relatively recent innovation available to those engaged in endeavours to detect the presence of drugs. In the course of the evidence received by the Commission its proponents claimed much for it. On the other hand,it was clear to the Commission that an extensive drug detector dog program was likely to prove expensive to set up and maintain. There seemed to the Commission,

and there still seems, dangers that decisions might be taken which would miss opportunities to provide common resources to all involved in the use of dogs in law enforcement type functions as well as effecting

considerable economies. The Commission received considerable evidence and assessed it carefully before coming down, as it does, strongly in favour of the use of drug detector dogs.

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Recommendations

The Commission recommends that:

** A national training establishment for all dogs used in law

enforcement, anti-terrorism work, prison services, and by the armed services should be set up by the Commonwealth. The

establishment should serve the needs of both Commonwealth and State agencies.

** The national training establishment should have a single administration to conduct:

- a dog selection program;

- a basic training course for dogs and handlers;

- courses for specialist training in such fields as detection of drugs and explosives.

** Careful consideration should be given to the suitable location of such an establishment bearing in mind:

- the number, types, breeds, and ages of dogs that may be

involved;

- the variations in the type of training and facilities necessary for the dogs and handlers.

** The national training establishment should be subject to policy control by a committee on which all interested departments, both Commonwealth and State, have representation.

** One Commonwealth department should be given the responsibility of administering the national training establishment subject to the directions of the policy committee and should be given adequate resources to do so.

** The Bureau of Customs should be given the task of planning the specialist training for drug detector dogs within the national training establishment.

** The instructional staff for the national training establishment should be drawn from Commonwealth and State agencies with an interest in the establishment.

** Commonwealth and State agencies should ensure so far as practicable that officers returning after secondment to the national training establishment are given a responsibility for assisting agency efforts in continuing on-the-job training for graduate dogs.

** Specialised courses should be conducted as a part of the overall central training establishment's program.

** The national training establishment should maintain records of the careers of its graduate dogs with a view to re-training them if necessary and to continual improvement of its training programs.

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** All law enforcement bodies, Commonwealth or State, should be encouraged to look to the local Collector of the Bureau of Customs to provide drug detector dogs and handlers to be used in searching for drugs, and the Bureau of Customs should accept the responsibility of providing this service.

** The proposed National Criminal Drug Intelligence Centre should be responsible for monitoring the overall effectiveness of dogs in drug detection and reporting at regular intervals to the proposed policy committee and thence to the national training establishment.

** In the context of the foregoing Recommendations there should be:

- urgent intensification and expansion of the use of drug

detector dogs in drug law enforcement;

- efforts made promptly to establish whether such dogs have a greater part to play in the detection of drugs imported in cargo and particularly in cargo containers.

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C h a p t e r 2 U ltrasound Techniques

Ultrasonic Examination for Internal Drug Concealment

The Commission heard evidence from many witnesses about the importation of drugs concealed within body cavities such as the vagina, rectum and stomach. Heroin with its low volume, high value ratio was particularly favoured. Cannabis resin oil and, in at least one instance, cannabis

buddha sticks, have also been detected so concealed.

Substantiated instances of such means of importation have been extracted from the evidence. They amount to 25 instances in the first 10 months of 1979, 10 in 1978, and 5 in 1977.

In order to establish that a person is carrying drugs concealed in a body cavity an intrusive body search may be necessary particularly in the absence of an appropriate admission.

The carrying out of such a search represents a gross intrusion into personal privacy. Such considerations are reflected in the attitude of the Bureau of Customs to the use of the power given to it under Section 196 of the Customs Act of 1901 in carrying out intrusive body searches. The Commission was informed in confidence by a senior Customs officer in

Sydney that current Department policy demanded that officers be virtually 100 per cent certain that items were concealed internally before committing themselves to an intrusive search. The same witness

agreed that there had not been an internal body search which had proved negative for 'a number of years’ and that this was a reflection of such policy.

Considerations of the need to carry out intrusive internal searches because of recourse to the use of body cavities to conceal drugs, coupled with the serious invasion of individual, privacy which such a search causes, led the Commission to the consideration of the adaption

of ultrasonic medical diagnostic techniques for drug detection purposes. The Commission was mindful of the fact that recourse to x-rays for this purpose could be harmful to some individuals.

This use of ultrasound was first brought to the Commission's attention in a submission from Hawker de Havilland (Australia) Pty Ltd which was presented to the Commission in Sydney in April 1978 by the company's Technical Director, Mr S. S. Schaetzel. That submission

contained the following paragraph:

Evidence so far given to the Royal Commission intimates that one of the principal methods of drug entry into Australia is via female couriers who conceal the merchandise inside the body orifices.

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Two methods appear suitable to detect a reasonable proportion of transgressions:

a. Computer profile of the person (age group, occupation, background, more than one trip to the area) followed by:

b. Ultrasonic body scan-- this method, unlike a compulsory x-ray examination, should not be resisted on medical grounds-- and a threat of same may provide an admission without an actual examination.

(OT 9614 — 15)

Mr Schaetzel explained that Hawker de Havi1land had been providing ultrasonic equipment to the medical profession for the last eight years for use in determining the position of a foetus in the mother's womb, and that the same principle could be adapted to detect foreign matter, such as a container of drugs, within the body by using a simple scan across the abdomen (OT 9615).

The Commission was interested by the prospect of harnessing this technology to overcome what appeared to be an intractable problem and sought the expert assistance of Mr G. Kossoff, Director of the

Ultrasonics Institute of the Commonwealth Department of Health, and Dr W. J . Garrett, Director of the Department of Diagnostic Ultrasound at the Royal Hospital for Women, Paddington, Sydney. Both men have

international reputations in the field arid were generous in their assistance to the Commission.

ULTRASOUND AND ITS PROPERTIES

Ultrasound is sound waves above the audible frequency; any sound wave above 15 000 cycles per second is ultrasound (OT 12323).

Ultrasound is used as a diagnostic tool in medicine, and in that application frequencies of several million cycles per second are used. At these very high frequencies ultrasonic waves acquire properties different from audible sound waves, and, in particular, do not travel through air although they do travel through liquids and solids (OT 20967).

In principle, ultrasound is similar to sonar devices used to locate submarines or fish or to indicate the depth and contours of the seabed. Low intensity sound pulses are bounced off tissue layers in the body, the echoes are recorded, and they build into a composite picture which is displayed on a television-type monitor.

The ultrasound technique in medicine is used to examine all soft tissue organs that do not contain air, or from which air has been excluded by means of introduced fluid. Investigations are currently undertaken of the following organs by ultrasound: the brain, the eye, the thyroid, the breast, the heart, the upper abdomen, the liver, the

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kidneys, the pancreas, and the uterus. In addition, ultrasound is used extensively to examine the foetus, even in the earliest stages of pregnancy (OT 12323). However, ultrasound is not very useful for examining bones and x-rays are still the main method of conducting these examinations. Unlike x-rays though, there is no evidence to suggest

that ultrasound has any deleterious effects at the present dosage levels (OT 20975).

MEDICAL ULTRASOUND IN AUSTRALIA

Dr Garrett and Mr Kossoff instituted a research program in

ultrasound in 1959 at a time when there were only two organisations in the world engaged in this work. Mr Kossoff said that when the

Ultrasonics Institute was conceived it had a philosophical approach fundamentally different from its overseas counterparts. Whereas the overseas approach was for physicians to undertake the work and call upon technical specialists for advice, the approach adopted by the Institute was for technical specialists to undertake the research with physicians as consultants. This had an immediate payoff: the Institute attained

fundamental advances and, the Commission was told, has been leading the world in this field for the last 15 years (OT 12323).

Ultrasound has burst into major prominence in the last four to five years. According to Dr Garrett, Mr Kossoff was responsible for revolutionising the subject when he introduced grey scale echography in 1969 (OT 20978).

From the Commission's point of view the situation was most

gratifying. The Commission was able to call upon expertise of

international repute and to receive advice on this novel application of ultrasound in advance of known developments overseas.

Dr Garrett, as a world authority and pioneer in the diagnostic applications of ultrasound in medicine, is, predictably, extremely busy. The Commission was most grateful to him for his assistance in its work. Dr Garrett generously devoted much time to assisting the Commission in understanding and dealing with the application of ultrasonic examination

to internal drug concealment. The following is a summary of his evidence.

THE EQUIPMENT FOR ULTRASONIC EXAMINATIONS FOR DRUGS

In August 1979, Dr Garrett told the Commission that the finest quality ultrasonic pictures in the world were currently being obtained by a machine called the U.I. Octoson (OT 23432). This machine was designed by the Ultrasonics Institute under Mr Kossoff and was built by

a private firm under a licensing arrangment with the Commonwealth Government. It suffers from the disadvantages in its use for detecting drugs internally concealed in that it is expensive, currently selling for approximately $90 000, and the transducers and the patient are in

fixed positions relative to each other so that the view of the vagina and/or the rectum is obstructed by the pubic bone. (OT 20969, 23425,

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23432). It is a much larger and more detailed machine than is necessary for drug detection. A portable 1 real time' examination machine is more suitable. Such machines produce a movie type display and are very good when there is a need for a quick and simple search. The resolution, although sufficient to indicate that a foreign body is present, will not necessarily be sufficient to identify it, but may provide the

justification to detain the suspect or to make further examinations of a more direct nature (OT 20974).

Dr Garrett pointed out that, unlike hospital patients who can be properly prepared for examinations, suspected drug carriers would not in all probability be so co-operative.

Dr Garrett believed that a portable real time ultrasonic machine fitted with a sector scanner was 195 per cent of the answer' when considering ultrasonic examination of suspects for internally concealed drugs (OT 20965).

On 14 August 1979, Dr Garrett conducted the Royal Commissioner and his staff on an inspection of various ultrasonic diagnostic machines in operation at the Department of Diagnostic Ultrasound at the Royal Hospital for Women, Paddington, Sydney. The Commission viewed the large static ultrasonic scanner U . I. Octoson in operation as well as the mobile real time ultrasonic sector scanners, the Emisonic 4290 and the Kretz Technik Combison.

Various estimates have been made in evidence to the Commission of the cost of ultrasonic machines appropriate to the task of detecting drugs concealed internally; these estimates vary from $3000 to $5000 in the case of equipment which Mr Schaetzel believed Hawker de Havilland could supply (OT 9615) to $90 000, the price of a U. I. Octoson.

Perhaps the most reliable estimate was supplied by Dr Garrett who was able to draw on his specialised and detailed knowledge of what is required. Dr Garrett's price estimate was in the range $15 000 to $24 000, which includes 30 per cent duty not applicable to a Commonwealth Government purchase. It was based upon his opinion that a portable real time ultrasonic machine is the appropriate machine.

THE EFFECTIVENESS OF ULTRASOUND IN DRUG DETECTION

Two advantages of ultrasound are its capacity for measuring the size of an object to the nearest millimetre and its capacity for

differentiating between a liquid and a solid (OT 20974).

Tests conducted by Dr Garrett on consenting persons, together with his many years of clinical experience, led him to certain conclusions about the capacity of ultrasound to detect caches of drugs concealed within internal body cavities. However, in giving his findings, Dr Garrett insisted on differentiating between the stomach on the one hand, and the vagina and rectum on the other. He said that the problems faced

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in relation to concealment within the stomach were dissimilar from those of examining the contents of the vagina and the rectum.

Dr Garrett made the following observations about ultrasonic examinations:

I would say that the presence of a plastic container containing a powder similar to heroin can be detected in the vagina. I have demonstrated that. I would think that I have every reason

to believe that the same would apply to the rectum. (OT 20973)

A package containing oil or liquid of any kind would be seen in either the vagina or the rectum. A package containing a powder with air in the interstices between the powder would be more difficult to detect in the rectum but not too difficult in the vagina.

(OT 23430)

I am acting on theoretical grounds rather than experience at this point but I feel that the sort of report you could get for an examination of the rectum in either male or female was that the rectum contained an object, object unspecified which could

include normal faeces, or that the rectum appeared empty or that the examination was unsatisfactory. More likely the examination would divide the suspicious from the nonsuspicious without giving an absolute diagnosis.

(OT 23430)

I have every reason to believe that in the case of a female, we could demonstrate the uterus, vagina, and any distortions of anatomy of the vagina produced by foreign bodies. I also believe, although I have yet to have practical proof of it, that we could detect in females foreign bodies in the rectum on most occasions, but there could be some unreliability in that examination. In the case of males, the bladder and prostate can be well seen and the rectum is immediately behind the prostate. The lower border of the prostate is approximately two to three centimetres above the anus, so we know that the penetration of the picture goes down to within two centimetres of the anus so we would certainly have the foreign body in the

field. If it were a liquid containing foreign body such as a capsule of oil, we would see it. ...I should imagine with 90- odd percent reliability, if it was a container containing a powder, there may be some difficulty in differentiating its exact nature. However, if it was sufficiently large to distort the anatomy, that fact should be able to be reported.

(OT 23432--33)

Subsequent to his last appearance before the Commission in August 1979, Dr Garrett continued to experiment with the application of ultrasound techniques in the detection of internal drug smuggling. In a letter to the Commission in October 1979 he was able to report on, and produce photographic evidence of, the ultrasound detection of, firstly,

a foreign body containing 17ml of liquid in a latex rubber capsule which

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had been inserted high in the rectum, and secondly, a foreign body containing 40gm of dry lactose powder also in a latex rubber capsule. The liquid filled capsule simulated a foreign body containing cannabis oil, while the capsule filled with dry lactose powder simulated a foreign body containing heroin. Both were clearly visible in the photographs and easily identified.

Although in Dr Garrett's judgment there might be some difficulty, with present technology, in distinguishing in the rectum between packages containing a powder such as heroin, and faeces, his clinical experience was that not more than one in twenty to one in fifty persons has a full rectum upon examination. Air travel and heroin addiction undoubtedly increase the incidence of constipation; the mere discovery of objects in the bowel might of itself be sufficient justification to

require the suspect person to undergo a direct medical examination, or to be held for a period until those objects are passed and examined.

Furthermore, with the development of computer analysis of ultrasonic echograms it might be possible in the next few years to use this

technique to elucidate the nature of a foreign body and differentiate containers of powder from faeces (OT 23434).

Dr Garrett was more reserved about the ability of ultrasound to reveal packages of drugs concealed within the stomach because it is an air containing organ adjacent to many loops of the bowel (OT 20977). Persons concealing drugs by this method take a very considerable risk as the stomach contains strong acids which can break down the container and may result in death. Furthermore, a container sufficiently strong to

resist corrosion might, of itself, physically damage the host so as to endanger his or her life and might return an echo strong enough to be detected by ultrasound.

Dr Garrett told the Commission that his assistant, Dr P. Warren, was probably the world authority on ultrasonic examination of the stomach, having published, as at March 1979, the entirety of papers on the subject. With Dr Garrett he has developed a method whereby ultrasonic examination of the stomach can be achieved. The patient is given a litre of methyl cellulose solution to swallow which fills the stomach and forces the air to the top making ultrasonic examination possible from the side. It would be theoretically possible to detect a foreign body in the stomach by this method, but, as Dr Garrett pointed out to the Commission:

...one has to live in a real world, and to be practical, I

quite frankly think that with an unco-operative patient such difficulties would be placed in your way that this would be difficult. (OT 20977)

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PERFORMANCE OF AN ULTRASONIC EXAMINATION TO DETECT DRUGS

The Commission heard evidence on what was involved in an ultrasonic examination from a subject's point of view. Certain requirements for an ultrasonic examination of the stomach have already been discussed above and will not be repeated here.

The procedure would be similar to that currently used at a public hospital. The suspect would be offered a changing cubicle and a gown made of an easily-launderable material which would open down the front and would then be asked to lie down on an examination couch. A small area of the abdomen only would be exposed, perhaps 15 centimetres x 12.5

centimetres; this would give a sufficient window to enable examination of the vagina and/or the rectum.

A contact medium is necessary to exclude the presence of air between the skin and the transducer, so oil would be spread on the exposed area. This is usually peanut oil, but a water soluble oil can be used, thus avoiding any possibility of staining the suspect's clothing (OT 20976-­

77). The examination itself would take only a few minutes. Ultrasound, even with a contact transducer, causes no discomfort so that the suspect would feel no pain or physical distress (OT 23433).

THE SAFETY OF ULTRASOUND

The Commission is aware that in May 1978 the Commissioner of the United States Food and Drug Administration (FDA), Mr D. Kennedy, cautioned the medical profession about the use of ultrasonic devices while giving evidence to a United States Congressional Committee.

Subsequently, the FDA's Director of the Bureau of Medical Devices and Diagnostic Products emphasised that 'knowledgeable people' had observed no detrimental effect in humans from the use of ultrasound and explained

that the rationale of the warning was that people should not be exposed unnecessarily to something about which everything is not known.

Witnesses appearing before the Commission were unanimous that at current dosage levels ultrasound causes no deleterious effects on human tissue.

The Commission put this report to Mr Kossoff for comment and he replied:

I think it just a cautionary note to suggest that we should not just expose people to something just because it is available. (OT 12327)

The following questioning of Dr Garrett on the safety of this method is important.

(Question)No possibility of harm-- there is no build up of echoes?-- (Answer)No. The question of the safety of ultrasound

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is constantly under review by the World Health Organization, the American Institute of Ultrasound in Medicine, and there have been no deleterious effects shown whatever, including on the earliest of pregnancies.

(OT 20975)

CONCLUSIONS AND RECOMMENDATIONS

Conclusions

The Commission is of the view that ultrasonic examination for internal drug concealment should be available in Australia. In order to properly carry out such examinations legislative provisions should be introduced. Suitable arrangements should be made for examinations to be conducted at appropriate establishments by persons properly qualified to conduct such an examination.

Recommendations

The Commission recommends that:

** Ultrasonic examination for internal drug concealment should be utilised.

** The Bureau of Customs should make arrangements for the use of facilities for ultrasound examination of any person whom an officer of Customs or police, on personal observation or information received by him, has reasonable cause to suspect is carrying within his body cavities any drugs the importation of which is prohibited.

** Such facilities should be available in an appropriate hospital in each city having an international airport.

** The Customs Act be amended in the following respects:

- Section 196A should be amended to the effect that when an

officer of Customs or police has, as a result of his personal observation or information received by him, reasonable cause to suspect that a person is carrying within his body cavities any goods subject to the control of Customs or any prohibited imports he may require the person to undergo a preliminary ultrasound examination by a prescribed device operated by an authorised medical practitioner.

- The person required to undergo such an examination shall be obliged to accompany the officer and undergo the examination to the satisfaction of such officer of Customs or police in circumstances affording the greatest practicable privacy.

- Refusal to undergo a preliminary ultrasound examination should be deemed 'reasonable cause to suspect1 within the terms of Section 196B, so as to found an order for a search of the body cavities by an authorised medical practitioner.

- The authorised medical practitioner carrying out the ultrasound examination shall certify the results of the examination and

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hand a copy to the person examined and to the officer of

Customs or police who required the examination. The

certificate shall be admissible and prima facie evidence of the results of the examination.

Section 196B of the Customs Act should be amended to provide that a person who is ordered by a magistrate to submit to an examination by an authorised medical practitioner of his body cavities be detained for a period not exceeding three days to

permit this to be done. At the expiration of that period if an examination continues to be justified, the person may be brought back before the magistrate who may make a further order requiring an examination or may impose a penalty or both.

There should be provision protecting all those who exercise powers under Sections 196A and 196B from any liability for the reasonable exercise of those powers. Such provisions should

provide appropriate authorities with power to keep a person in custody, to restrain and to search, using no more force than is reasonably required.

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C h a p t e r 3 Forensic Laboratories

The Report of the Commonwealth Attorney-General's Committee of Enquiry into the need for a National Forensic Institute, dated April 1974, stated:

The number of scientists in Australia involved in any one aspect of forensic science is relatively small and the constant demands of case work prevent them from carrying out anything but the minimum of research. As a result, the introduction of many new methods is delayed because of a lack of opportunity to

evaluate them.

Since the basic needs of most government forensic service laboratories are similar, the Committee believes that their need for applied research and information would best be met by the Australian Government establishing a national forensic science research institute. In other countries, national

forensic science research organisations have been established and their operations have demonstrated that, in Australia, such an institute could provide a useful and efficient service. (Open Exhibit 526, p. XI)

In Part VII, Chapter 5 it was shown that the present fragmented nature of forensic science in Australia was impeding its full

development into an invaluable law enforcement tool, as well as restricting the application of forensic science expertise in other areas. This Commission considers that only by welding the scattered elements into one co-ordinated service can forensic science be developed and utilised to its full potential. Ideally, there should exist in each of the capital cities a forensic laboratory provided jointly by the State in which it is located and by the Commonwealth Government to serve the needs of law enforcement agencies operating in the State or even, if the laboratory has developed special techniques or skills, agencies outside that State. The forensic laboratory would be established by

special Act of Parliament as a corporation, and this would ensure a high degree of independence and enhance its scientific integrity.

A forensic science laboratory in Sydney, for example, would undertake all forensic work for the New South Wales State enforcement agencies and for Federal law enforcement agencies in the course of their operations in that State. The laboratory’s services would not be

restricted to the various State and Federal law enforcement agencies but would be available to all agencies requiring scientific assistance. Indeed, it is reasonable to believe that there would be many cases in which the laboratory's assistance would be sought for civil litigation,

e .g ., the forgery of a will. The laboratory envisaged here would ideally perform all the drug analysis work required in New South Wales. At the present moment the Federal expertise in drug analysis does not reside in a forensic department at all but in the Department of Science. The State expertise in drug analysis in New South Wales, for example,

resides in the Health Commission's Division of Analytical Laboratories.

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AUSTRALIAN ATTITUDES

The Commission wrote the following letter to the various bodies in Australia with an interest in forensic science:

An important matter which this Commission is considering is the support which drug law enforcement agencies can obtain from expert forensic science laboratories. It is desirable, however, in the interest of avoiding duplication and

fragmentation, to consider forensic science concerning drugs in the wider context of forensic science generally.

The Australian approach to forensic science has never been concerted, and no national policy has ever emerged. In 1975 a conference of police ministers agreed to the recommendation by

the 1974 Commonwealth Attorney-General1s Committee that an Australian forensic science research institute be established. This recommendation does not seem ever to have been taken

further. The forensic science work for law enforcement agencies in Australia, including drug analysis work, is generally performed by laboratories which are responsible for serving the requirements of bodies other than law enforcement agencies. Consequentially, the laboratories cannot always give the desired level of priority to law enforcement work and the analysts involved do not have the opportunity to develop a high expertise in forensic science nor a detailed understanding of the significance of particular aspects of their work to the enforcement agencies.

One suggestion that has been made to the Commission is that there should be created in each State capital a forensic science laboratory funded from Federal and State sources which would do the forensic science work for law enforcement agencies, State or Federal, operating in that State. Forensic

scientists would be especially trained and recognised as experts in this specialised discipline, and the interchange of information between the laboratories would ensure that national expertise was developed. The laboratories could establish a National institute which might, in time, develop into a National forensic science research institute.

It has been suggested that if the substance of the above suggestion were to be implemented, the specific advantages that would occur to drug law enforcement might include:

(a) The development of a common approach to analysis and improving technology.

(b) The attainment of reliable national statistical

information, which is presently lacking.

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(c) The distribution of intelligence upon drugs among

different law enforcement agencies.

(d) The provision of a speedier service to law enforcement agencies.

(e) The making practicable of recommendations of a number of witnesses that no one should be convicted, even on a plea of guilty, of a drug offence, unless the drug has been analysed.

I should be pleased if you would kindly give your considered opinion as to the desirability of establishing forensic laboratories along the lines contained in the suggestion made

to the Commission. Any alternative view, or possible measures by which the suggestion could be improved would be appreciated.

The Commission understands that drug analysis work for your Force is presently performed by the Government Analyst Laboratory associated with the Department of Health Services. (The preceding sentence varied, of course, with the addressee.)

It does not know the present arrangement for forensic science generally, but it would be useful if you could describe those arrangements so that the Commission has the benefit of an explanation of how forensic science generally and drug analysis

in particular is dealt with in respect of your State.

Information relating to the current cost of forensic science facilities provided by your organisation would also be valuable if it is available. (CT)

In reply, the Commissioner, Commonwealth Police, had this to say :

It is important, in my opinion, for drug analyses to be simply considered as one physical evidence area within the broader framework of forensic science. Certainly from personal observation, it appears to me that the Department of Science analysts performing drug analyses do not fit satisfactorily within the routine analytical framework of other Department of

Science activities as the special legal requirements associated with drug analyses related to prosecutions laid under the Customs Act mean that they are not necessarily routine. This contrasts with other chemical analyses undertaken by AGAL

(Australian Government Analytical Laboratories) analysts. At present, the requirements of any customer Department or agency requiring a drug analysis by AGAL staff must fit within the priorities set by the Department of Science. Delays in drug

analyses can result due to resource limitations. I

I believe that such analyses are better undertaken within a broader-based forensic science laboratory which is dedicated to law enforcement support rather than within a minor section of an organisation which is designed to meet other objectives.

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Whilst other drug analyses are currently undertaken at no cost to this Force, the time taken, due to the priorities set by the organisaton undertaking the analysis, is often longer than we would desire, but we have no control over this factor,

particularly as the work is done free of charge.

This Force, to meet its own forensic science requirements, needs a dedicated laboratory. Drug analyses, however, would form only a small part of the analyses undertaken, unless the Australian Narcotics Bureau were to become attached to the Commonwealth Police. ■

In that case, the main requirements for drug analyses would still arise from operations in the capital cities and for that reason the necessary laboratory resources for drug analyses would have to be geographically located in those cities. Through a centralised information and chemical intelligence

system the analytical laboratories could provide an

intelligence service, based on results of analyses, to all appropriate law enforcement agencies both within Australia and overseas. In the United Kingdom this function is undertaken by the Drug Intelligence Unit (DIU) at the Home Office Central Research Establishment, mentioned previously, and in the United

States by the Drug Enforcement Administration. The CRE's DIU is currently undertaking a number of intelligence research projects on behalf of Interpol. Commonwealth Police operate the Interpol National Central Bureau for Australia.

I concur with the view that forensic science in Australia is in a fragmented condition, with varying levels of expertise and experience available in those undertaking this work. Consequently, Australian law enforcement operations are being severely hampered.

If the situation is to be improved on a national basis, there will have to be an upgrading of service facilities in all States, new service facilities established in the Australian Capital Territory, the control of drug analyses for the Australian Narcotics Bureau vested in an organisation dedicated

to law enforcement support (i.e. not the Department of Science) and the establishment of a central facility for scientific research and the provision of common services to the

operational laboratories.

Any piecemeal attempts will lead to further fragmentation and a corresponding fall in effectiveness of the already limited forensic science service facilities in Australia. I

I urge the Commission to give careful consideration to these arguments which have been developed over the past eight years. (CT)

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In response to a second letter from the Commission seeking further advice as to the forensic science resources utilised by the Commonwealth Police, the following reply was received:

As far as routine forensic science service requirements for the Commonwealth Police are concerned, the agencies utilised are dependent on the nature of the physical evidence requiring examination.

It should be emphasised that for maximum effectiveness of physical evidence usage, a trained forensic scientist should be involved from the outset in careful examination of the materials from the scene. The correct sequence of examinations

can then be undertaken, with the best possible chance of effective results being obtained. These can then aid the investigator in choosing the most profitable course for his enquiries. The trained forensic scientist is also aware of what appropriate methods are available for the scientific

examination of the physical evidence in question.

The importance of utilising professional personnel in the conduct of case work, as well as research work, in the forensic science domain should not be underestimated. (CT)

The reply received from the Narcotics Bureau explained the current situation in the following terms:

Drug analyses for this Department are carried out by the Australian Government Analytical Laboratories, a section within the Department of Science. AGAL laboratories exist in all capital cities with the exception of Canberra, Darwin and

Brisbane. In the case of Sydney and Melbourne specialist forensic units have been developed within the laboratory organisation to provide support for the Narcotics Bureau in its operations.

Drug analyses for Queensland and the A.C.T. are carried out in Sydney whilst in the Northern Territory the Narcotics Bureau and Police share the services of an AGAL chemist located in the Forensic Laboratory within Police Headquarters. This latter

arrangement is currently being reviewed as a result of self government.

Some limited forensic work (other than drug analysis) is also carried out for the Narcotics Bureau by AGAL laboratories usually by one of the specialist units in Sydney or Melbourne. Other general forensic work is also performed by State or Commonwealth Police specialist units, e .g . , fingerprints; handwriting; ballistics, etc.

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On the question of the establishment of a joint Federal/State Laboratory in each State capital city, the Bureau commented:

Although the need for such a laboratory in each capital city is doubtful the establishment of such a facility in appropriate regional locations would provide drug enforcement with a far more efficient service, and in particular in those areas outlined in (a) to (d) of your paragraph 4. In respect of (e)

I would advise that in all instances that a person is

prosecuted under the Customs Act for a drug offence the drugs are analysed before the matter is brought before the Court regardless of the plea.

In his report to the Minister for Administrative Services on the Organisation of Police Resources, Sir Robert Mark recommended that Forensic Science Laboratories become the responsibility of a Police Advisory Committee. Appendix B of the report addresses itself to this particular aspect of police servicing. This Department agrees with his comments.

(CT)

The Health Commission of New South Wales responded:

It should be emphasised that, in l"his State, forensic science work is generally performed in laboratories which are separate from those providing a clinical service. Laboratories at the Health Commission's Division of Forensic Medicine at Glebe are

involved wholly with coronial and police work, although the Forensic Biology Laboratory will soon become involved in paternity testing under the Children (Equality of Status) Act, 1976. Laboratories at the Health Commission's Division of Analytical Laboratories at Lidcombe are primarily involved in

drug and alcohol analyses for coronial and police purposes, and analysis of food, water and other environmental samples for public health purposes. A report on the organisation of clinical pharmacology and toxicology services in New South Wales, a copy of which is enclosed, emphasises the separation between clinical and forensic work in New South Wales.

While the Health Commission supports the concept of an Australian Forensic Science Research Institute, it must be realised that this would not remove the need for service laboratories in each State.

(CT)

The report referred to above was prepared by the New South Wales Government Analyst, Mr L. G. Clark, who advised that:

While it is desirable that various facilities and services should be upgraded, one of the main advantages would be in rationalising existing services and improving liaison. The

States already have considerable facilities for drug analyses.

(CT)

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Commenting on the need for a National Research Institute, Mr Clark stated:

The needs of the State laboratories and the Commonwealth laboratories are substantially different. The States have fairly high case loads. At present, our laboratory can just handle its case load without significant delays but an increase

in work could cause this situation to deteriorate.

Much information on analytical methods is received from the DBA in America and from other sources but there is always the need to validate established methods to make them work well in each laboratory and to analyse standard samples to ensure that results are accurate. A National Research Institute could better co-ordinate this work, some of which is presently

carried out on a co-operative basis between the States and Commonwealth.

The Commonwealth narcotics laboratories have a different set of problems to the State laboratories. The former are concerned with establishing the country of origin of illicit drugs and work is also carried out on the substances used to dilute the

drugs and on materials associated with the drugs such as their containers. We have been advised that considerable research needs to be carried out on these topics.

Most of the liaison initiated by the Commonwealth was brought about by the enthusiasm of Dr Ivars Dainis, previously in charge of the Illicit Drugs laboratory of the Commonwealth situated in the Customs House at Circular Quay. Dr Dainis has

been temporarily transferred to other work in Western

Australia.

It would be much preferable if this co-ordinating role was taken over by a national institute such as the proposed

National Forensic Research Institute.

Dr M. C. Hall of the Commonwealth Police, Canberra, at present provides a valuable service of disseminating information obtained from the Central Research Institute in England, to the State forensic laboratories. This was a service which was

proposed for the National Forensic Institute and one which it should take over when it is formed. Included in the

information presently circulated by this means are analytical methods for illicit drugs.

The creation of a National Forensic Science Research Institute would be justified on the basis of the contributions it could make in the field of illicit drugs. While this could well be the initial justification in favour of its creation, its

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activities should not be confined to this. Among its initial functions, the following would be important:

distribution, validation and preparation of standard drug substances, a task presently undertaken in part by the Curator of Standards;

the collation of scientific data, particularly from overseas and its distribution within Australia-- presently undertaken by Dr Malcolm Hall of the Commonwealth Police;

the provision of an information service including on-line computer search facilities for mass-spectral and other scientific data;

funding, by way of grants, for research within the

existing State and Commonwealth laboratories engaged in drug analysis. Such research could include overseas training and experience. (CT)

The New South Wales Police replied:

The establishment of a National Forensic Science Research Institute has been a recurring item on agendas of the

Conferences of Commissioners of Police since 1971...On each occasion Conference has re-affirmed its support for the formation of a National Research Unit.

One area in which progress has been made towards the

establishment of such an Institute has been the development of the Australian National Information Service for the Forensic Sciences, which is operated by the Commonwealth Police Force. Through this service, all Police Forces in Australia have access to the United Kingdom Home Office Central Research Establishment at Aldermaston, England.

This department's scientific investigation Section, which is part of the Scientific and Technical Services Branch, exists primarily for the purpose of attending scenes of crime and various serious occurrences; to record the scenes and collect physical evidence; to ensure expert examination of this

evidence either within or outside the department; and ultimately to present this evidence to the courts within the criminal jurisdiction. The section operates under a system of decentralised offices and staff located in Sydney and at four

suburban and thirteen country centres throughout the State. All centres are actually crime scene units. The Sydney section is divided into the following units:

Crime Scene Photographic

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Ballistics Document Examination

In this State, Police provide the following

technical/scientific services:

Scene of crime examination Photography and photomicrography Drafting (including terrestrial photogrammetry) Matching and comparisons of physical exhibits Toolmarks, shoe and tyre imprint comparisons

Appraisal of improvised explosive devices (including x-ray examination) Firearms and ballistics examinations Examinations of questioned documents,

handwriting, typewriting, etc. Fingerprints Breath alcohol

In leading overseas Police Forces, e .g. the London Metropolitan Police Force, any or all of these services are often handled by academically qualified staff.

All other examinations of a technical or scientific nature are referred to outside laboratories. These may be in government or semi-government departments, hospitals, universities or private industry. No charge is made by any of the institutions

concerned for the examinations requested by this department.

The Health Commission of New South Wales provides the bulk of the forensic science services. Briefly, the laboratories and sciences concerned are:

The Division of Analytical Laboratories

Toxicology Blood/alcohol Flammable materials and accelerants Glass, paint, etc. Hairs and fibres (natural and synthetic)

Trace elements Explosives residue Drugs

The Division of Forensic Medicine

Forensic biology Pathology (autopsies) Histopathology Serology

Microbiology Virology

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Human and animal hairs Anatomy Radiology

Regular, but less frequent, services are also provided by the undermentioned laboratories:

University of New South Wales University of Sydney Macquarie University Department of Agriculture CSIRO Department of Labour and Industry Forestry Commission of New South Wales Mines Department Bureau of Meteorology The Australian Museum Hospitals Commission of New South Wales Australian Atomic Energy Commission Australian Consolidated Industries James Miller and Co. Pty. Ltd.

It is agreed there is a great deal of fragmentation in the forensic science services in this State. However, the wide range of expensive scientific equipment available to forensic scientists through the several laboratories could not be economically duplicated in a single forensic science laboratory nor could the highly developed expertise of scientists in so many specialised fields, which this department exploits, be expected. In considering the economics of this matter it is advised that the London Metropolitan Police Forensic Science Laboratory at Lambeth employs over 200 forensic scientists.

One area in which improvement could possibly be made is in the presentation of scientific evidence before courts by the expert witnesses. Experienced forensic scientists generally present

the right type of evidence in understandable form, and this is useful to the courts. With others of less training and

experience the value of their evidence is often diminished. The introduction of forensic science laboratories, as suggested, could perhaps help eliminate this deficiency by ensuring better liaison amongst the scientists.

From the foregoing, it is considered that there could be advantages in the establishment of a forensic science service laboratory in Sydney and in each of the Capital Cities, with

the ultimate aim of a National Forensic Science Institute. However, some doubt must exist as to the feasibility of such a project both from an economic and practical viewpoint. (CT)

The Victorian Police Department, which handles all Forensic Science work in the State, replied:

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The Director of the Police Forensic Science Laboratory, Mr L. Turner, has furnished the following comments:

1. Police drug seizures in this State are analysed by this laboratory.

2. This laboratory has 78 members, 33 of these being members of the Police Force and 45 being Public Servants. There is one Police member with a B . Applied Sci., while 29 of the Public Servants hold Science Degrees, including 1 Ph .D ., and 3 M.Sc. Degrees.

3. The laboratory is compri&ed of the following sections:

Photograph Document Examination Field Investigation

Breathalyser Maintenance Biology/Serology Applied Chemistry Fire Investigation Drug Blood Alcohol Methods and Training Computer

4. The laboratory has a mandate to do research and currently two Public Service members are working towards M.Sc. Degrees and one towards a Ph.D. Degree.

5. Staff selection has been such that many of the staff have wide scientific experience in other laboratories, viz:

University Research Departments CSIRO Private Analytical Laboratories Coroners Laboratory Customs Laboratory

6. Local Courts accept our scientists as experts in their various fields. (CT)

The arrangements for forensic analysis in Queensland were described in the following response from the State Department of Health:

Forensic work in Queensland is presently carried out by the Laboratory of Microbiology and Pathology, the Government Chemical Laboratory and the Police Laboratory. The Government Botanist is also used.

Staff of the Government Chemical Laboratory are engaged on Forensic Toxicology and Clinical Drug work analysing drugs from

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the Police, from the Drug Dependence Unit, from Hospitals and Pathologists, from the Government Medical Officers in connection with traffic charges, and biological specimens in connection with coronial enquiries.

Queensland State Cabinet is now giving consideration to the setting up of an Institute of Forensic Science for Queensland and has given approval for the establishment of an

interdepartmental committee to consider all aspects of the proposal.

Preliminary discussions have been held by the Commissioner of Police, the Principal Government Medical Officer and the Directors of the Government Chemical Laboratory and the Laboratory of Microbiology and Pathology and some of the

resulting conclusions the committee may consider are that:

(a) The establishment of a central Institute of Forensic Science is most desirable;

(b) The Institute should function separately from the Police Department and should in general be staffed and directed by civilians;

(c) The services of the Institute would be available for police investigations as well as to prosecutors and defendants in criminal matters and could be made available to parties in civil matters on a basis to be determined;

(d) The major subsections of the Institute would be: Forensic Biology Toxicology (including narcotics and alcohol) Botany General Chemistry (including contact trace work) Ballistics (including explosives and toolmarks) Documents (including handwriting) Photography Administration;

(e) Scene-of-crime investigations would remain primarily the responsibility of the Police Department with the assistance of Institute personnel in appropriate cases and in the training of scene-of-crime officers.

(CT)

Mr C. S. Crisp, Director of Chemistry, Chemistry Division, South Australian Department of Services and Supply replied:

Initially all specimens are collected, seized or otherwise handled by police officers, either members of the Drug Squad, scene-of-crime officers of the Technical Services Division, or other officers under the direction of the Coroner. The relevant specimens are then handed to the experts in the

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appropriate laboratories. For the main categories these are as follows:

1. Chemistry Division, Department of Services and Supply (formerly Chemistry Department) : Post-mortem toxicology, blood alcohols, illicit drugs, explosives and arson residues, contact evidence such as fibres and paint chips,

etc.

2. Australian Mineral Development Laboratories: Earth, sands, glass chips, paint chips, fractured metals etc.

3. Forensic Biology Section: Institute of Medical and Veterinary Science. Blood and seminal stains, hair and saliva.

A. Police Technical Services Laboratory: Ballistics, tyre, tool and footmarks. Botanical specimens (mainly cannabis) are examined by a botanist recently retired from the Botanical Gardens who works in the laboratory two days a week.

The Australian Government Analytical Laboratories in this State also carry out analyses of suspected illicit drugs to determine if they may have been imported into the country. The analyses of illicit drugs referred to under 1. above, are done in the Toxicology Laboratory of this Division, as are the other

categories of work except explosives and arson residues, which are done in the Gas and Explosives Laboratory. The situation is not as stated in the latter part of the second paragraph in page 1 of your letter in that the analysts are employed almost

entirely on forensic work and do indeed develop an expertise in these areas.

I do not consider the proposal to create in each State Capital a forensic science laboratory funded from Federal and State sources to be necessary or in fact likely to be viable.

Forensic scientists from the various States already have strong links developed through regular conferences in a number of areas in this discipline and information on new techniques and methods of analysis are exchanged at these specialist meetings

and at the various meetings and symposia conducted by the Australian Forensic Science Society.

The formation of a National forensic science research institute has been discussed from time to time, for a number of years and at the meetings at which I have been present it has generally been held that the cost of establishing and running such an

organisaton would be difficult to justify on a cost benefit basis.

With regard to items (d) and (e) on page 2 of your letter:

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(d) I consider this can best be provided by some increase of relevant staff in existing laboratories.

(e) I do not agree with this proposition which would place a greater work load on laboratories for no apparent gain. Surely this covers matter of intent-- if an accused has purchased what he believes to be drug A and pleads guilty

to its possession then why should laboratory time be taken up in analysing the specimen? I think most laboratories are occupied sufficiently in analysing drug and other specimens concerned with cases in which not guilty pleas have been entered.

(CT)

The Honourable I. Medcalf, MLC, Western Australia's Attorney- General and Minister for Federal Affairs, reported to the Commission on the situation existing in that State:

In Western Australia, forensic science work is carried out by the Government Chemical Laboratories of the Mines Department, the State Health Laboratories, the Western Australian Police Department and to a limited extent the Western Australian Herbarium attached to the Department of Agriculture. The

latter provides a forensic botanical service mainly in relation to the identification of the cannabis plant.

I have therefore co-ordinated the information in relation to these Departments and am replying accordingly.

The Government Chemical Laboratories in its Forensic Chemistry Division carries out work in the following categories:

1. Illicit drug analysis.

2. Toxicology.

3. Examination of physical evidence from scenes of crime, other than ballistics and finger prints.

4. Blood alcohol analyses from driving offences.

5. Blood/urine alcohol analyses from fatal traffic accident victims.

6. Examination of oil spillages for the Harbour Police.

7. Testing the competence of police officers in use of the breathalyser and general liaison with the police on the breathalyser.

8. Doping control in sport.

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The State Health Laboratory Service of the Public Health Department provides an on-call 24 hour service for drug analyses on patients, addicts, overdose victims, etc. and the benefit of specialist clinical opinion in toxicology and pharmacology, it does all the autopsies, including staffing and

running of mortuaries, throughout Western Australia. It is also involved in identificaton of human tissues, forensic serology, forensic biology, research, development and teaching.

Much of the work is, of course, done in conjunction with the Government Chemical Laboratories and the facilities at the State Health Laboratories are also extensively utilised in the treatment of patients. The Scientific Bureau of the Western Australian Police Department caters for:

Fingerprints.

Scenes of crime examination and evidence collecting.

Photographic service-- recording evidence at scenes and preparation of Court exhibits, including photomicrographs.

Questioning documents.

Ballistics.

The bulk of forensic science work is for the Western Australian Police Department and is carried out by the Government Chemical Laboratories and the State Health Laboratories. According to all concerned, a very satisfactory service is provided.

It is therefore doubtful whether there is a need for the

creation of a separate forensic science laboratory in Western Australia with its attendant establishment and administrative costs.

Any such proposal therefore would require in-depth

consideration by all bodies interested in this area.

The suggestion made in your letter regarding the establishment of a National Forensic Research Institute has merit in that there would be great advantage to forensic science generally and law enforcement agencies throughout Australia in

particular.

(CT)

The Tasmanian Police responded as follows:

Analytic examinations on behalf of the Drug Bureau of the Tasmania Police Department are made by forensic chemists, employed by Government Analyst Laboratories which are under the jurisdiction of the Department of Health Services.

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The Government Analyst Laboratories are situated in Campbell Street, Hobart, adjacent to the Royal Hobart Hospital and in close proximity to the Hobart Police Headquarters. The laboratory employs the following personnel:

14 Qualified Analytical Chemists 2 Technical Officers 4 Laboratory Assistants 2 Receptionist Typists

This staff performs a vast majority of forensic pathology or toxicology and often analytical examinations on behalf of Government and semi-Government departments throughout the State.

The law has a frequent need of immediate scientific knowledge both in pursuing its enquiries and preparing evidence for consideration by the judiciary and Tasmania's law enforcement bodies are not exempt from this principle.

Consequently, a constant demand is made upon the forensic chemists of the Government Analyst Laboratories and generally the co-operation and the performance of the service cannot be faulted.

Personnel attached to the Drug Bureau have established a good liaison with the forensic chemists and this assists in obtaining prompt responses to matters requiring urgent attention.

In the case of routine examinations, analysis reports are usually available within 14— 21 days and this delay does not present any significant problems in the judicial process.

The arrangement which exists between the Tasmania Police Department and the Government Analyst is that where possible, the Police officers seizing the drug effect personal delivery of the exhibit for analysis. Whether the exhibits are

personally delivered or otherwise, the package is appropriately labelled for identification purposes and conveyed to the Government Analyst under Drug Bureau seal.

The accompanying delivery invoice has provision for a receipt to be returned to the officer making the delivery.

After analysis, the exhibit is either retained by the Analyst for production in Court or returned to the Drug Bureau for future destruction by officers attached to the Department of Health Services.

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The suggestion that there be created in each State Capital a forensic science laboratory funded from Federal and State sources has been considered. Obviously this would be

beneficial particularly in larger States, but the advantages which would accrue in this State, because of the present standard of proficiency and availability of chemists attached to the Government Analyst Laboratories, do not appear

significant enough to warrant the expenditure which would be involved in making the provision. (CT)

The Northern Territory Police responded in the following terms:

We regard the establishment of such a laboratory as being an attractive proposition in some respects; however, we do have certain reservations. It has been our experience when dealing

with laboratories other than our own, to have difficulties in regard to priorities at times when the workload is heavy. We envisage that these difficulties would inevitably arise if a State Forensic Science Laboratory was established. We, therefore, favour the expansion of our own facilities and have planned to do this. Nevertheless, we do not reject the

proposition outright and we feel that it is a matter which could be taken up at the next meeting of Forensic Chemists. We understand that the next conference is to be held in Perth in August 1979.

The present arrangement for Forensic Science in the Northern Territory is as follows:

(i) The basic role of the section is to a large extent, the collection of evidence, photographing and documentation of crime scenes and forwarding of exhibits to appropriate agencies for investigation. Most of the detailed forensic work is carried out in South Australia.

(ii) The section occupies a whole floor of the Police

Headquarters building, has a chemistry laboratory, an instrument room, exhibit search room, microscope room, ballistics workshop and armoury, photography studio and laboratory, document examination room, and a large area of

office space in which there are several cubicles for specialised forensic examinations.

(iii) The section has six members, all trained in crime scene investigation, as well as being, or in the process of becoming, expert in one particular facet of Forensic Science, such as ballistics, handwriting, and photography.

(iv) In 1974, the Bureau of Customs, under an arrangement with this Force, temporarily stationed a chemist in the Forensic Science Laboratory for the purpose of drug analysis for the Narcotics Bureau and the Police Force Drug Squad. The position became a permanent posting of

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the Australian Government Analytical Laboratories in 1975, and was considerably widened in scale, so that the chemist now performs other forensic chemical testing for the Police Force. A fairly comprehensively equipped organic chemistry laboratory has been set up, but as yet no

inorganic analytical instruments are available, which naturally limits the amount of testing which can be carried out. To date the costs have been borne entirely by AGAL, but it is proposed that in the near future the

salary and equipment costs will be borne by the Police Force. The creation of a position for a second Chemist is under consideraton.

(v) The Darwin Hospital has three Pathologists, one of whom is employed virtually full time on forensic pathology. He is called up to perform post-mortem examinations almost anywhere in the Northern Territory in cases of violent or suspicious deaths. Alice Springs Hospital has a full time pathologist who performs post-mortem examinations for that area, but occasionally calls for assistance from Dr Manoch or Dr James from South Australia. The Darwin Hospital has a qualified serologist who, with assistance from South Australian Forensic Biology laboratory of Dr Harry Harding and his staff, carries out blood grouping on blood stains from criminal investigations. A toxicologist has recently commenced duty at the Darwin Hospital.

(vi) Other outside agencies from which assistance is obtained from time to time are-- Mines Branch, which has qualified geologists and mineralogists, botanists employed at the CSIRO in Darwin, and at the Animal Industry and

Agriculture laboratories in Darwin and Alice Springs. (CT)

The reply from the Australian Capital Territory Health Commission ran as follows:

The suggestion put to your Commission for creation of a forensic science laboratory in each State capital city would appear to have several advantages, such as those you have outlined in your letter, but I have considerable doubt whether there would be a sufficient work load at present in the A.C.T.

to justify the provision of such a facility in Canberra to cater solely for the local law enforcement agencies.

As indicated above, toxicological analyses of post-mortem samples are undertaken by the Commission's Forensic Chemistry Section in order to assist local Pathologists and Coroners in determining cause of death. These procedures include drug or

poison identification. The Section also analyses and identifies samples submitted by law enforcement agencies, including the A.C.T. Police, Commonwealth Police, Narcotics

Bureau, NSW Police and the Defence Forces. The majority of this work is the identification of illicit drugs and a good

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working relationship exists between the analysts and Police and other officers involved.

Officers of the Public Health Laboratory have been appointed as Analysts under various Ordinances or Regulations, including the Poisons & Dangerous Drugs, the Poisons & Narcotic Drugs, and the Motor Traffic Ordinances. Under the provisions of the

last-named Ordinance they assist the A.C.T. Police in the training of breathalyser operators, the preparation of standard alcohol solutions and evaluation of equipment and they provide an analytical service to estimate and identify alcohol and other drugs in blood and other samples. Because of the limited number of samples taken under the Motor Traffic Ordinance, this work is carried out in association with the estimation of

clinical drug levels for forensic purposes. In this way the analysts concerned can develop and maintain the required expertise. The similarity in techniques used for estimations

and in equipment required for the purposes of examination makes it advisable to correlate the work carried out for different purposes.

The Public Health Laboratory is due to move into new premises in 1980. These will be in the central pathology laboratory at present nearing completion on site at the Woden Valley

Hospital. Improved facilities for Clinical and Forensic Chemistry, including the procedures associated with illicit drugs, have been incorporated into this new building.

Officers of the Public Health Laboratory attend annual conferences in the fields of both Toxicology and Illicit Drugs. At these conferences, they meet both State and Commonwealth Analysts to discuss methods of analysis, legislation problems and trends in drug control and usage.

As you will be aware, some standardisation of analytical methods in the analysis of illicit drugs has been proposed and, in general terms, accepted. Due to different legislation in the States, however, implementation of actual standard methods

has so far proved difficult. (CT)

The Commissioner, Australian Capital Territory Police, replied:

The establishment of a National Forensic Institute was proposed by the Australasian Police Commissioners in 1971. This led in 1973 to the formation of the Committee referred to in your letter. To my knowledge the concept has been discussed on and

off, in varying forms, since 1967.

For my part, I am committed to the view that the establishment of a national network of forensic science laboratories would be

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both progressive and desirable, and that the ensuing

rationalisation and uniformity of standards, statistical data and the collation and distribution of consequent intelligence material would contribute significantly to the effectiveness of the Australian law enforcement effort against an extremely entrenched and formidable menace.

Having said that, I wish to make it quite clear that the

service provided for the last five years by the Public Health Laboratory of the Capital Territory Health Commission has been without fault as far as police are concerned. The question, however, is not so much whether the current service is either

competent or indeed whether imperfections are absent, but whether or not there should be established specific forensic science facilities to service law enforcement agencies as a priority and with a definite commitment to specialisation and developing expertise. On that basis I support the

establishment of such facilities.

Under present arrangements drug seizures within the Territory are initially stored in a security cabinet in the Drug Squad until they can be conveyed to the Public Health Laboratory for analysis, retention pending the finalisation of court action and finally destruction in the presence of Health Commission officers. Current procedures have minimised personnel requirements while still ensuring continuity of evidence.

Insofar as proof as to the nature of a drug in question is concerned, the courts of the Territory usually view the quantity and quality of a substance as relevant factors, therefore analysis is carried out in the majority of cases.

Apart from scientific examinations and investigations conducted by police force personnel, forensic investigative work performed for the Force by outside agencies can be divided into two broad areas. They are:

(a) Statutory bodies which are frequently used in

relation to more commonly encountered exhibits;

and

(b) Individual areas of expertise in the case of less common exhibits.

Statutory/Governmental bodies commonly utilised (are):

(i) Pathology and Histology Sections, Australian Capital Territory Health Commission.

(ii) Public Health Laboratories, A.C.T Health Commission for toxicological examinations.

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(iii) Forensic Medicine Centre, NSW Department of Health, Glebe, Sydney; examination of blood, hair, saliva and spermatozoa.

(iv) Division of Analytical Laboratories, NSW Department of Health, Lidcombe, Sydney; examination of glass, liquids and trace elements.

(v) School of Textile Technology, University of NSW; examination of fibres.

Areas of individual expertise and research institutes used less frequently (are):

(i) Research School of Chemistry, Australian National University.

(ii) NSW Department of Mines, Explosives Division.

(iii) Defence Standards Laboratories, Maribyrnong, Victoria.

(iv) Botanical Sections of the Australian National University and the CSIRO.

In addition to the organisations mentioned, there are numerous persons and groups utilised in relation to individual or unique characteristics of the physical evidence under examination, e.g. paint manufacturers, glaziers, footwear manufacturers, geologists, metallurgists, et cetera.

(CT)

Most of the recommendations made to the Commission are based upon the present system, and their acceptance would continue the

fragmentation that already exists. It would be far better to have in each State a properly equipped forensic laboratory capable of handling all forensic work including drug analyses. Over and above the

development of sufficient expertise to cater for. the forensic work needed, a particular laboratory might develop a special expertise to a higher level in a special field. So, arguably, Sydney might develop a particular expertise in drug analysis while Melbourne might develop an

expertise in ballistics. The most difficult work of these kinds might be referred by the forensic laboratory of origin to the specialist laboratory for more expert opinion.

As a result of recent developments, the only federal drug law enforcement agencies requiring drug analyses are the Bureau of Customs, the Australian Federal Police and the Department of Health. There were formerly Customs laboratories in capital cities but the Department of Business and Consumer Affairs now depends on outposted Department of Science Laboratories. There would seem to be no reason why the Depart­ ment of Business and Consumer Affairs could not rely upon the forensic

science laboratory in each State. An arrangement is at present in force whereby the Commonwealth Government contributes money to State labora­ tories in exchange for the State performing forensic work for the Commonwealth. A specific example of this arrangement was given to the

Commission by Mr F. E. Peters, the former Australian Government Analyst:

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The Brisbane position was established in 1972. There is an arrangement whereby the Federal Government pays the Queensland Government approximately $100,000.00 per annum for analytical work and the use of their laboratory facilities. I arranged with the Queensland Government Chemist that we would use their facilities for drug work. The duty statement of the Chemist in Brisbane used to state...that he will undertake drug analysis work as required. It was intended that he should act as a screen and do such work as he could. More difficult samples were to be sent to Sydney as well as any in excess of the

number with which he could cope.

...(That chemist) is an employee of the Federal Government and an employee of the Australian Government Analytical

Laboratories .

(OT 3418)

The opinions which have been expressed above must inevitably occur to a person who observes the position of forensic science laboratories in Australia with a fresh eye. The fact that nobody suggested this type of system merely indicates that people have come to accept the present irrational system. Suggestions for improvement were limited to comparatively minor amendments to the present system and it would not be unfair to categorise some of these suggestions as ones dictated by elements of departmental interests. However, the situation is not one where these opinions have been reached for the first time by this Commission in its examination of the Australian forensic system. Sir Robert Mark, in his Report to the Minister for Administrative Services on the organisation of Police Resources in the Commonwealth Area and other Related Matters, considered forensic science laboratories in Appendix B to his report. It is pertinent to set out that Appendix here

in full:

FORENSIC SCIENCE LABORATORIES

and

FORENSIC SCIENCE INSTITUTE

1. A former Attorney-General appointed a Committee of Inquiry to investigate the need for a National Forensic Institute. The State Governments were neither consulted nor represented on the committee. The Committee reported in April 1974 and recommended the establishment of an

'Australian Forensic Science Research Institute'.

2. The primary function of the proposed institute was to be the conduct of research in the forensic sciences with emphasis on the natural sciences, technology and non- sociological aspects of forensic medicine. The Institute was to be a statutory authority responsible to the

Attorney-General.

3. This proposal was submitted for consideration to the 1975 Conference of Police Ministers. The State Ministers

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agreed to consider the report of the Committee. No

further action has been taken.

4. Some of the 'findings' of the Committee attached to the report by Mr Η. T. Bennett of 4 June 1976 at Appendix 8 are depressing to say the least. The following sample of the deficiencies in forensic science laboratories highlighted are from a police point of view quite

alarming:

(a) a great deal of fragmentation, not only between States but also within each State. Various experts spread between a large number of organisations and liaison uneven and often inadequate;

(b) the degree of experience of scientists in court work varies according to the amount of forensic case work carried out in the laboratories to which they are

attached;

(c) there is a great deal of variation between the tests used by comparable laboratories in the different States, their methods of reporting results and the conclusions that are drawn from these tests;

(d) the present training of forensic scientists fails to take into adequate account the presentation of scientific evidence for court purposes; and

(e) Australian forensic authorities are generally not involved in a systematic exchange of information on an

international basis. Overseas sources from whom

information may be obtained such as the Central Research Establishment in England are not being adequately utilised.

5. In the United Kingdom, Regional Forensic Science

Laboratories have been in operation for over thirty years as a Common Police Service. They are well established as an invaluable aid to criminal investigation and more particularly of recent years in view of the rapid increase

in serious crime involving the use of explosives and firearms, drug trafficking and drunken driving. In such instances scientists may provide indisputable evidence which would convict or exonerate suspects. They have been especially valuable in countering terrorist activities. Indeed, they can properly claim, with their colleagues of the Fingerprint Branch, a great deal of the credit for the 68%--70% clear up rate of all terrorist crimes in the Metropolitan Police District in the last five years. An outstanding example of this is the identification of the four Balcombe Street terrorists with two murders, 40 bombings and eight shootings.

6. It is surprising to say the least that forensic science has not developed in a more unified pattern in Australia. Police forces are certainly not being provided with the

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kind of service to which they are entitled.

Fragmentation, lack of experience, delay in producing results and poor presentation in Court are matters which cannot be tolerated.

7. Great regard must be paid to the status of Forensic

Science Laboratories. It is undesirable for them to be located in police buildings, or under the control of, or even partly staffed by police officers in the guise of technicians. The requirement is for well qualified scientists who are seen to demonstrate their neutrality. Apart from a police liaison officer with very limited duties there seems to be no reason at all for police

officers to become involved in the work of a forensic science laboratory.

8. It is imperative therefore that the inefficient and

depressing state of forensic science so far as the police forces of Australia are concerned should be examined and improved as a matter of considerable urgency.

9. The first priority is the establishment in each police force area a well planned forensic science laboratory, expertly staffed and equipped.

10. It would seem that if this stage is to be realised in the foreseeable future the project must be financed by the Federal Government and treated as a Common Police Service.

11. A natural development from this national chain of

laboratories would be the formation of an 'Australian Forensic Science Research Institute'. As happened in the United Kingdom it will soon be realised that forensic science laboratories have no time for research themselves because of the pressure of day to day work and it is an absolute necessity for someone else to assume the

responsibility. It is an on-going process because of scientific development and the rapid changes in the pattern of crime.

12. Therefore, it would seem sensible and practical even though expensive, to develop a total service in the field of forensic science. With goodwill the whole situation could be completely transformed in a period of two to three years. Most certainly the police forces of

Australia deserve a much better service than they are receiving at present and the position should be remedied at the earliest possible moment. (OT 17445--48)

It is appropriate to re-state Sir Robert's opinion that:

The first priority is the establishment in each police force area of a well planned forensic science laboratory expertly staffed and equipped. (OT 17448)

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If the Commonwealth Government determines to implement this aspect of Sir Robert Mark's report it appears that there will be established in each police force area or State a forensic science laboratory. One important task of such a laboratory would be the analysis of drugs.

The opinion of Sir Robert Mark seems to coincide with the opinion expressed above and the implementation of the recommendations would result in a system far superior to that which presently pertains. There are immense benefits to the community in having proper forensic

laboratories but there is also a great advantage so far as drug analyses are concerned in having them performed by such forensic laboratories. Standardisation of analytical techniques and the development of

knowledge regarding drugs and their places of origin would be achieved by regular communication between staff of the different forensic laboratories. Scientists presently employed by any one of the laboratories dealing with drug analysis who were minded to make a career

of forensic science could transfer their talents to a forensic science laboratory.

Enforcement agencies in the area of a particular forensic laboratory could be assisted not only in the development of intelligence but also in methods of investigation, so that detection methods used would be those most compatible with the utilisation of the techniques available to forensic scientists. Courses could be given at the laboratory. There would be a coherent national system and a national forensic

science institute would develop from the association of the regional laboratories.

A common approach to the analysis of drugs, the security of drugs, and the recording of information would solve one of the great

difficulties that the Commission has found in every area of its investigations, that is, the absence of reliable statistics recorded in a common form. Dr M. C. Hall, Principal Research Officer with the Commonwealth Police in Canberra, said:

A further difficulty arises from the fact that many drugs seized are not subjected to scientific analysis. Whilst this eases the considerable workload posed for the botanist or forensic chemist who assists the police, the true nature of materials seized can only be assumed for the purposes of production of this statistical report. In addition,

adulteration of 'street' drugs can conceal the true nature of material sold as being of a particular drug type and in the absence of a scientific analysis, the proportion of illegal material present in these seizures is unknown.

(OT 4058)

The course recommended here, which accords with the recommendations of Sir Robert Mark, would not only avoid duplication of human effort but also duplication of equipment. There seems little doubt that sophisticated apparatus such as the gas chromatograph--mass spectrometer

or the enzyme-multiplied immuno-assay technique type is required for forensic analysis, particulary of drugs. It must also be remembered

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that samples being analysed for court proceedings, especially drugs, should always be the subject of strict security precautions that are not always possible in general laboratories. Mr J. B. Rutherford,

Stipendiary Magistrate for the Gold Coast in Queensland, told the Commission of an occasion when a drug exhibit was removed from the premises occupied by the Government Analyst, Brisbane, when these premises were broken and entered (OT 4627).

There seems to be no difficulty in attaining the necessary degree of international liaison in the area of forensic science generally and that relating to drugs in particular for the system of forensic laboratories that commends itself to the Commission. The appropriate place for that liaison would ultimately be the National Forensic Research Institute. The benefits of liaison would be available to all members of the

Institute, that is, the scientific laboratories and through those members to law enforcement agencies throughout Australia. It is important to conserve as much as possible the time of the trained personnel, who are required to analyse drug samples and then to attend court hearings to present the result of their analyses. Once a system of forensic laboratories was established training would be given directed to the presentation in court by the forensic scientist of his findings.

Mr J. E. Ryall, a chemist in the Tasmanian Government Analyst Laboratory, Department of Health Services, said:

The problem probably stems basically from the fact that there is nowhere in Australia any formal course on forensic science. I am often called upon to give expert evidence in court under the Road Safety (Alcohol & Drugs) Act, the Poisons Act and the Coroners Act. In a number of instances this evidence is tendered by way of certificate of analysis, deposition or affidavit. In other instances I am summonsed or subpoenaed to appear and tender evidence in person.

There is no training for expert witnesses even in elementary court procedure. In the majority of cases there is little or no briefing with prosecutors either in Magistrates Court or in

Criminal Court and yet it should not be left to the initiative of the expert to establish liaison with the prosecutors. There is no critical evaluation of the performance of an expert witness except by the jury so he has no way of knowing whether he has performed well or poorly or said too much or too

little...

In 1974 the Commonwealth Government was considering the establishment of an Institute of Forensic Science. Among other things training for 'experts' in court procedure would have been available. Unfortunately the concept of such a national

institute seems to have been put aside for the time being. One can only hope that in time this 'idea' may be revived and become a reality.

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In contrast to the liaison between prosecutors and 'experts' from my limited experience in being called as an 1 expert' for the defence there is very thorough briefing before the case comes to court.

(OT 1411 — 12)

CONCLUSIONS AND RECOMMENDATIONS

Conclusions

The Commission has concluded that Australian drug law enforcement presently lacks the support it should have from modern science. The absence of that support is more evident in some places than others. If the Commission's recommendation that all drugs which come into the possession of police or Customs be analysed quantitatively as well as

qualitatively is accepted, then immediate steps will have to be taken throughout Australia generally to improve laboratory facilities to allow such analyses to be made. It would be wasteful of resources if

improvements to laboratory facilities were made only in the area of drugs. There is a very evident need to furnish laboratory support to all aspects of police work and whatever improved facilities are provided

in relation to drugs must conform with an overall plan for scientific support. As drugs constitute an immediate and pressing problem the Commission has concluded that a start must be made in this area; that start must be made harmoniously with an overall plan.

The Commission finds itself in agreement with Sir Robert Mark's conclusions on forensic science requirements in Australia. It believes that in each State and Territory there should, as an ideal, be a body corporate financed by Commonwealth and State moneys providing scientific and forensic services to Commonwealth and State police operating in that area. Although priority would be given to police work, the body would be able to provide like services for other Commonwealth and State

agencies which require the presentation in a court of scientific evidence. The ability to apply the methods of science to the

investigation of a question and then clearly to present the results in evidence to a court must be recognised as professional work.

For police the body should provide:

* scientific assistance in investigation and detection;

* able presentation of evidence in court; and

* a prompt and independent service.

Achievement of these objectives will, in the Commission's view, save countless thousands of dollars by improving the capacity of police and by saving their time. In addition an enormous amount of court time will be saved.

It may take some years to achieve the ideal. It is essential

however, that a start be made now. In some States forensic science

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facilities are evolving towards a rational system along the lines that this Commission believes appropriate. Some States might act more quickly than others and it is desirable that those States who desire to proceed quickly should not be held back until unanimous agreement is

reached. It is important that the ideal is seen as the ultimate

objective. The Commission realises that an intermediate stage may well involve the forensic scientific services being brought together in a State department such as a Health Department.

Recommendations

The Commission recommends that:

** A national system of forensic science laboratories should be set up along the lines expressed in the following recommendations.

** A forensic science laboratory funded by Commonwealth and State moneys should be set up as soon as possible in each State and

Territory to provide forensic services to Commonwealth and State agencies operating within that State.

** Forensic science laboratories should be set up progressively without waiting for unanimous agreement between Commonwealth and States as to the exact form they should take in every State.

** Each forensic science laboratory should be autonomous and

independent of the police and other Government departments.

** Each forensic science laboratory set up should:

- be well planned and expertly staffed and equipped;

- be independent of police as to premises, staffing, and

administration;

- be required to give priority to police work over the work of other agencies and the public;

- have a capacity to analyse all drugs which come into the

possession of police and the Bureau of Customs;

- be required to report periodicaly to the State Drug Information Centre the results of such analyses;

- be given initially resources in the fields of:

. toxicology . botany

. forensic biology . ballistics . documents . photography . general chemistry

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** No start should be made on a national forensic science research institute until at least three State forensic laboratories have been operating for twelve months.

The Commission sees the development of a national forensic science research institute, as did Sir Robert Mark in his report to the Australian Government dated 6 April 1978, as a natural development from established forensic science laboratories, not as an

institution which can be created without a working base.

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Chapter 4 Forged Prescriptions

Certain drugs that may be legally supplied, such as methadone, pethidine, dextromoramide (Palfium), pentazocine (Fortral), and diazepam (Valium), find their way into the hands of illegal users through diversion from licit sources. One method of diverting licit supplies is

forging and uttering false or altered medical prescriptions, that is, either by presenting entirely false prescriptions written on stolen prescription pads or by making alterations to a genuine prescription to change the type of drug and/or increase the quantity originally prescribed. On balance, expert evidence suggested that entirely false prescriptions were the most frequent and involved greater amounts of

drugs. Some quantitative support for this opinion was evident in the results of a survey of its members conducted in 1978 by the Pharmacy Guild of Australia, when 75 per cent of respondents confirmed a greater experience of this type of forgery.

FREQUENCY OF PRESCRIPTION FORGERY

The Commission found it impossible to quantify accurately to what extent prescriptions are forged. Even a sophisticated and accurate recording system can provide details of detected forgeries only. While these data may show changes in the frequency with which this method is used to obtain drugs illicitly, leaving aside the effect of varying

levels of vigilance by the authorities, their value as an indicator of the absolute magnitude of the problem would always be open to question since no information could be obtained on undetected forgeries. The problem is akin to that of making a realistic quantitative estimate of

the extent of illegal importation of drugs. Evidence presented to the Commission that was of some value in attempting to quantify the extent of the problem is summarised here.

The Frequency of Prescription Forgeries under the National Health Act

The Commonwealth Department of Health provided data on detected forged prescriptions presented under the National Health Act, that is, National Health Scheme (NHS) prescriptions, for the years 1975 to 1977. Comparable statistics were not available for the years 1978 and 1979

owing to changes in the system of collecting data. However, a new and more comprehensive post-computer analysis of presented NHS prescriptions for possible forgeries is being investigated by the Commonwealth Department of Health.

Nationally, detected forged prescriptions totalled 333 in 1975, 489 in 1976, and 628 in 1977.

The following tabulations present an analysis of the drugs most frequently the subject of prescription forgeries.

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1975

Drug Number Percentage

Dextromoramide (Palfium) 92 27.6

Methadone 157 47.2

Diazepam (Valium) 44 13.2

Pethidine 5 1.5

Pentazocine (Fortral) 4 1.2

Nitrazepam (Mogadon) 4 1.2

Total 306 91.9

1976

Dextromoramide (Palfium) 97 19.8

Methadone 172 35.2

Diazepam (Valium) 118 24.1

Pethidine 47 9.6

Pentazocine (Fortral) 8 1.6

Nitrazepam (Mogadon) 13 2.7

Total 455 93.0

1977

Dextromoramide (Palfium) 153 24.4

Methadone 123 19.6

Diazepam (Valium) 157 25.0

Pethidine 20 3.2

Pentazocine (Fortral) 29 4.6

Nitrazepam (Mogadon) 74 11.8

Total 556 88.5

In interpreting these figures it has to be borne in mind that the number of forged prescriptions falling outside the scope of the National Health Act would probably be greater than the number detected under the Act. Witnesses suggested that this was because of the small quantities

allowable on NHS prescriptions.

Details of detected NHS forgeries presented below on a State-by­ State basis show a number of variations, some of which could be

explained by witnesses appearing before the Commission.

New South Wales and the Australian Capital Territory: Commonwealth Department of Health evidence indicated that forged prescriptions presented under the National Health Act in New South Wales and the A.C.T. in 1975 totalled 109 and included 66 for methadone, 17 for

dextromoramide, and 9 for diazepam. The 1976 figures increased to 202, including 95 for methadone, 45 for dextromoramide, 20 for pethidine, and 15 for diazepam. The total in 1977 was 349, including 130 for

dextromoramide, 106 for methadone, and 40 for diazepam.

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Mr R. W. Goggins, Assistant Director, Pharmaceutical Section, Commonwealth Department of Health, Sydney, said in evidence in April 1978 that the number of forgeries for narcotics and psychotropics detected by his office was around 20 a month (OT 9754). A senior NSW Health Commission official stated that large amounts of narcotic drugs were obtained by addicts presenting fraudulent prescriptions which were

often dispensed before the pharmacist realised that they were forgeries, but he could not make any accurate estimate of the quantities of drugs obtained in this way because there was no central collating point for

these data. Forgeries might be detected by the police, the Commonwealth Department of Health or the New South Wales Health Commission. Some cases of forgery might not be detected until 6 or 12 months after

dispensing, and it had to be assumed that many were never detected. He added that the standard of forgery had improved over the years and that detection was becoming increasingly difficult.

Victoria: Altogether 113 forged prescriptions were presented under the National Health Act in Victoria in 1975, according to Commonwealth Department of Health evidence. Of these, 42 were for methadone, 26 were for dextromoramide, and 35 for diazepam. In 1976, 174 forgeries were

detected, the majority of which were accounted for by 101 for diazepam, 20 for dextromoramide, 19 for pethidine, 10 for methadone, and 10 for nitrazepam.

The 255 detected forgeries in 1977 included 115 for diazepam, 53 for nitrazepam, 22 for dextromoramide, 27 for pentazocine and 5 only for methadone. Dr J . E . Aldred, Senior Medical Officer, Poisons Division, Victorian Department of Health, estimated that about 200 prescription

forgeries were detected throughout Victoria each year. He thought the number of undetected forgeries would be small and that the majority would be detected by alert pharmacists (0T 2647).

Queensland: Forged prescriptions presented under the National Health Act in Queensland in 1975 totalled 33 and most (31) were for methadone. Only 7 forgeries were detected in 1976, all for methadone. No forgeries were detected in 1977.

Mr A. A. Green, a pharmacist employed by the Commonwealth Department of Health, said that all seven of the 1976 forgeries were written on a pad obtained from one institution and all were presented in the same month (OT 5203). At the time of giving evidence (February 1978) Mr

Green agreed it was somewhat astonishing that the latest figures then available showed that no forgeries had been detected in the six months ended 30 June 1977 (OT 5205). He believed this was the result of

increased vigilance by the Department becoming known to would-be forgers (0T 5204).

South Australia and the Northern Territory: According to the

Commonwealth Department of Health, 52 forged prescriptions were presented under the National Health Act in South Australia and the Northern Territory during 1975, 40 being for dextromoramide. In 1976, 24 forged prescriptions were detected, the majority (21) again being for

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dextromoramide. There was a further fall to only eight forgeries in 1977, three of which related to nitrazepam.

Mr B. Foster, Assistant Director, Pharmaceuticals, Commonwealth Department of Health in South Australia, said he believed over 99 per cent of forgeries would be detected because personnel were familiar with doctors' signatures (OT 6650). In Darwin, Dr C. H. Gurd, Director of Health for the Northern Territory, claimed that the special procedure

operating there had virtually eliminated prescription forgery as a means of obtaining narcotics illegally (OT 5881). The pharmacist sends prescriptions for narcotics to the hospital to be dispensed, and the hospital sends the prescribed drug back to the pharmacist concerned and keeps a record of the transaction. Pharmacies do not hold stocks of narcotic drugs. In final hearings in March 1979 he maintained that prescription forgery was still not a real problem in the Northern Territory.

Western Australia: During 1975, 26 forged prescriptions were presented under the National Health Act in Western Australia, according to Commonwealth Department of Health evidence. Of these, 17 were for methadone and 9 were for dextromoramide. The 1976 total rose to 82 and

included 60 for methadone, 11 for dextromoramide, and 8 for pethidine. In 1977 only 16 forgeries were detected, including 12 for methadone.

Giving evidence in November 1977, Inspector D. T. Ayres of the Western Australian Police Drug Squad expressed concern about the problem of prescription forgery. He said that during the statistical year 1976 — 1977, 31 cases were reported to police in the State and from 1 July 1977 to 30 November 1977,a further 38 offences had been reported. Inspector Ayres thought that a lot of prescription forgeries were not detected (OT 542). Mr W. Griffiths, Principal Pharmacist in the Pharmaceutical Services Branch of the Western Australian Public Health Department, said it was likely that some of the methadone on the illicit market was obtained by forgery of prescriptions (OT 865).

Tasmania: No forgeries were reported for prescriptions presented under the National Health Act in Tasmania during the period 1975 — 77. Mr M. Murton, a pharmacist employed by the Commonwealth Department of Health in Tasmania, said it was believed that the reasons for this were

that (1) methadone maintenance is not a recognised form of treatment for heroin addiction in Tasmania; (2) Tasmania has only 3 per cent of the Australian population and people and doctors are better known; (3) Tasmanian cities are smaller and more isolated, and lack the big-city problems seen in the mainland State capitals (OT 1358).

Mr F. D. Potts, Chief Inspecting Pharmacist in the Pharmaceutical Services Section of the Department of Health, Hobart, commented that the incidence of prescription forgery in Tasmania, presumably both inside and outside the NHS, was fairly low. The majority of such cases

involved alteration of the quantity of the drug to be supplied, from 50 to 150, for example. He suggested that the prescriber should be required to write out the quantity in full rather than use only figures

(0T 1392).

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The Number of Offences Involving Prescription Forgery

Another way of looking at the extent of the problem of prescription forgery is in relation to the number of such offences reported by the different law enforcement agencies. The Commonwealth Police publication 'Drug Abuse in Australia, 1977' (published in Canberra in October 1978) gave the following latest available data for drug offences involving prescription forgeries 'cleared by charge' on a national basis for the years 1971 to 1977 inclusive. An offence is considered to be 'cleared by charge' if a charge has been laid against a person in respect of that

offence. The outcome of the subsequent legal proceedings is not taken into account.

Year Number Percentage of total

offences involving drugs

1971 140 3.61

1972 186 3.76

1973 254 3.93

1974 66 0.76

1975 343 2.24

1976 447 2.30

1977 616 2.78

(Open

Other statistics from the same

(Open Exhibit 42, p.58)

source indicated a generally

increasing tendency by offenders involved in the diversion of licit drug supplies to prefer the method of prescription forgeries to the other major alternative available to them-- namely, the theft of drugs from pharmacies or medical practitioners.

Evidence received in confidence from the Commonwealth Police provided additional information on the pattern of these offences through a more detailed analysis of the 1976 data. It was submitted that:

In relation to the 136 offences of break, enter and steal of doctors' surgeries there were 38 crimes reported in which a total of 206 blank prescription pads (averaging 100 forms each) were stolen. A total of 153 offenders were charged in 1976 with 447 offences of forging prescriptions.

It is not known exactly how many blank forms were recovered from the 153 charged offenders nor is it on record at ACIC (Australia Crime Intelligence Centre) by what means they obtained them, e.g., theft, purchase or gift. It seems that

many blank forms must still be in circulation.

(Confidential Exhibit)

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The Frequency of Prescription Pad Thefts

The reference recorded immediately above to the number of

prescription pads reported stolen during 1976 was the only apparently reliable quantitative evidence received by the Commission in this connection. However, other testimony suggested that the forms actually reported as being stolen represented only a very small proportion of the total falling into the hands of drug offenders. Evidence bearing on the possible extent of this activity is recorded below on a State-by-State basis .

New South Wales and the Australian Capital Territory: The President of the NSW Branch of the Pharmacy Guild, Mr J. P. Matthews, told the Commission that his organisation was greatly concerned by reported prescription pad thefts, said to be running at approximately 20 per month. The witness emphasised that it was likely that these represented

only a small percentage of the total, most having come to notice only through the actual detection of a forged prescription. Mr Matthews urged that doctors should be required to improve the security of their prescription pads (OT 12907--08). He also indicated that the theft of just a few forms from the top of a pad would rarely be noticed by a

medical practitioner (OT 12909).

Victoria: Mr G. M. Oscar, President of the Pharmaceutical Society of Australia, was unable to give figures for the number of thefts of prescription pads in Victoria, but he observed an alleged laxity in security arrangements adopted by the medical profession despite frequent warnings (OT 2724). Mr Oscar's statement was fully supported by the Commonwealth Director of Health in Victoria, Dr R. C. Webb (OT 2838).

Queensland: Detective Inspector T. N. W. Ferguson, Officer-in­ Charge of the Queensland Drug Squad, stated that if a doctor's surgery was broken into, it was usual for prescription pads to be among the items stolen (OT 2060). However, he was unable to give any indication of the

real magnitude of the problem since he believed many of these offences were not reported. A senior Queensland Health Department official confirmed that his Department was rarely informed of a theft of prescription pads, and he remarked that the virtually undetectable

removal of a few forms from an unattended pad was thought to be a very common occurrence (OT 2258).

South Australia and the Northern Territory: Again, no quantitative evidence on the frequency of prescription pad thefts was received from South Australia or the Northern Territory although, in view of the special procedures adopted for the prescription of Schedule 8 drugs in the latter, there would seem to be little incentive for stealing a pad for the purpose of forgery there. In respect of South Australia, however, evidence originally presented by a State Health Department official to that State's Royal Commission into the Non-Medical Use of Drugs indicated that the problem was one of some concern. The witness

stated that it was not possible to precisely quantify the extent of prescription pad thefts, and his Department was forced to rely on doctors directly reporting their losses or pharmacists detecting forgeries at the point of presentation (OT 8609).

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Western Australia: In confidential session, a senior Western Australian Police officer informed the Commission that while 26 prescription pads had been reported stolen in that State during 1977, this figure would considerably understate the real extent of this

activity because doctors were under no obligation to report such thefts. A witness who had himself presented forged prescriptions agreed in confidential session that the theft of pads was a common occurrence. A Perth psychiatrist, Dr G. I. Tewfick, stated that his surgery had been broken into and the middle portion torn from a pad. Dr Tewfick offered the opinion that prescriptions for drugs of addiction should not be written on ordinary pads (OT 975). Mr R. W. Shearer, a Perth

pharmacist, made the point that since prescription forgeries must 1 start somewhere', i .e ., in the doctor's surgery when a pad is stolen, the medical profession should be obliged to strengthen security arrangements (OT 1017).

Tasmania: No quantitative evidence on the thefts of prescription pads was presented from Tasmania. Given the relatively low frequency of prescription forgeries in this State, it is somewhat less of a problem.

METHODS EMPLOYED BY FORGERS

Totally false prescriptions written on stolen prescription forms have already been noted to be of greatest concern to the authorities. False patients' names and addresses are always entered on forged prescriptions, and it is common for them to be presented at a pharmacy

remote from the medical practitioner whose forms are being used. In none of the examples of forged prescriptions inspected by this Commission had an attempt been made to duplicate precisely the doctor's

signature. Evidence presented to the Commission from a number of sources suggested that prescription forgers tended to carefully choose their mark in presenting prescriptions for dispensing. For example, in confidential session an experienced forger informed the Commission:

Addicts would know who would be particularly diligent in chasing up and examining scripts, and they would go to the pharmacies where they knew the proprietor would be relatively easy to convince it was a valid script.

(CT)

Even more disturbing was the suggestion made in confidence by a Sydney witness that some pharmacists were known to dispense

prescriptions even when they recognised them to be forgeries.

A number of refinements in the forger's art was also reported. While forged NHS forms are always stolen because they are difficult to reproduce, the Commission was told that it was not uncommon for offenders to print their own private prescription forms, complete with

false doctors' names and telephone numbers, using 'Letraset' equipment. One witness mentioned a case where a pharmacist who attempted to confirm a suspect prescription by contacting the given telephone number was told by a 'nurse' to hold the line while she checked the 'patient's' card

since the 'doctor' was unavailable. The 'nurse' then confirmed the prescription.

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While some offenders steal prescription forms for their own use, the Commission was also informed that there was a flourishing black market in stolen forms. The going price per form was said to be $1 in Adelaide (September 1977) and $2 in Melbourne (April 1978).

SECURITY OF PRESCRIPTION PADS

Criticisms of the arrangements generally adopted by the medical profession for the security of their prescription pads have been noted. These criticisms came particularly from representatives of the pharmacy profession. Hospital administration desks as well as doctors' surgeries were alleged to be easy targets for thefts by potential forgers.

The official view of the Commonwealth Department of Health was outlined in a submission presented by its Deputy Director-General, Dr C. P. V. Evans, who informed the Commission:

...practices which enabled unqualified persons to obtain prescription forms included the increased use of locums, who tended to discard a pad rather than return it to the surgery, doctors discarding rather than destroying obsolete pads and private hospitals leaving blank pads in accessible places for

the convenience of visiting doctors. (OT 3826)

Dr Evans said that the problem had been discussed by representatives of the Department and the Australian Medical Association (AMA) in 1975:

The matter of accountable prescription forms as a means of reducing the problem was raised by the Department but was considered by the AMA representatives to be impracticable. They considered that the issue of regular reminders to the profession was the only way of reducing the availability of

forms and undertook to give further publicity to the matter in AMA publications. State Health authorities were advised of the AMA's offer. (OT 3826)

However, a Queensland specialist physician, Dr V. B. Shepherd, accused the Department itself of contributing to the problem. Dr Shepherd stated that because the Department provided NHS prescription pads free of charge to the profession to maintain uniformity for processing purposes, there was a tendency for the recipients to regard

them as being of no intrinsic value and therefore to neglect their security. The situation, said Dr Shepherd, was further aggravated because the minimum order size was 20 pads, vastly in excess of the needs of a large number of doctors not in normal practice (OT 15326). He suggested that this policy had led to 'almost... a pollution of the medical community with prescription books' and he recommended:

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...the supply of free prescription books to medical

practitioners throughout Australia by the Commonwealth Government should cease. I think the doctor should be presented with the real cost of printing these books and that this would lead to a greater care of them by a natural process.

(OT 15326--27)

Dr Shepherd had further criticism for a recently announced

Commonwealth proposal to withdraw from free supply to private hospitals prescription pads not endorsed with a doctor's name, address and computer code number. He indicated that he believed this was a short­ sighted approach which could be expected to contribute to security problems by vastly increasing the number of pads kept on hand at every

sister's station in every private hospital in Queensland (OT 15327).

OTHER METHODS OF PREVENTING PRESCRIPTION FORGERY

Registers of Medical Practitioners' Signatures

Since very few prescription forgers attempt the precise duplication of the medical practitioner’s signature whose forms they present, it has been suggested that pharmacists would have a much better chance of detecting false prescriptions if they had access to a register of medical practitioners' signatures. Such a register is maintained in

each capital city office of the Commonwealth Department of Health as an aid to NHS prescription verification.

Both State and Federal Health Department witnesses addressing themselves to this proposition agreed that it had considerable merit, especially in its deterrent effect, and a number did not foresee any great practical difficulties standing in the way of its implementation. However, one informed New South Wales witness believed that the distribution of a register containing something like 5000 signatures to

the 2100 pharmacies in that State would be an 'enormous effort' whose implementation would 'need to be balanced against the magnitude of the problem' (OT 9754).

An opinion was sought from Dr C. S. H. Reed who, at time of giving evidence, was President-elect of the New South Wales Branch of the Australian Medical Association. Dr Reed saw value in the proposal as a deterrent to would-be forgers but he expressed concern that the widespread availability of registers of doctors' signatures might lead

to their use in forgeries unconnected with prescriptions (OT 9801). He accepted that it might be possible to introduce a system whereby the signatures used by doctors on medical prescriptions would differ from those used on cheques and other commercial documents (OT 9802).

Verification of Prescriptions by Pharmacists

The verification of suspect prescriptions with doctors by pharmacists is a widespread, although not uniform, practice. The

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apparent laxity of some pharmacists in this regard has already been noted. In fact, pharmacists are generally obliged to satisfy themselves as to the validity of any prescription presented to them. For example, Mr N. J . Geneve, President of the Pharmaceutical Council of Western Australia, outlined the situation applying in that State:

...pharmacists are under a duty imposed upon them by the

Pharmaceutical Council to check all suspect prescriptions for narcotic drugs with the prescriber. Regrettably not all prescribers treat such inquiries with the courtesy and

attention that they deserve and which could reasonably be expected as between one health professional and another. It must be stressed that these strictures certainly do not apply to the majority of medical practitioners who treat pharmacist enquirers with every consideration.

(OT 1024)

Speaking as a member of the medical profession, Dr C. S. H. Reed urged pharmacists to continue to question doctors whenever doubts arose over scripts. He accepted that there was no easy solution to checking after hours, perhaps at midnight, when the pharmacist was often reluctant to telephone the doctor (OT 9800).

Mr Geneve explained in his evidence that guidelines for prescription verification had been issued to Western Australian pharmacists in the September 1977 edition of the Council's newsletter. The relevant section appearing under the heading 'Forged prescriptions for drugs of addiction' is perhaps worth quoting in full:

In 1976 there were 93 known forged prescriptions of Eighth Schedule drugs. In future Council intends to regard the dispensing by a pharmacist of a forged Eighth Schedule prescription as being a breach of Section 32 (6) (c) of the Pharmacy Act ranging from mere carelessness to infamous conduct

in a professional respect, depending on the circumstances of the particular case. If any such case comes to notice Council will summon the dispenser to show cause why he should not be

dealt with under Section 32. It will be for the pharmacist then to show that he took all reasonable and effective steps available to him to detect the forgery. If he does not

convince the Council, he will be liable to the penalties provided by Section 32 ranging from having his name erased from the Register to censure, depending on the degree to which Council regards his omissions as culpable.

This notice should alert all pharmacists to the need to be particularly careful in dispensing prescriptions for Eighth Schedule drugs. Forgers are known to steal prescriptions pads

and write on the forged prescription the name of the doctor without necessarily attempting to copy his or her signature.

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It follows that if the doctor's signature is not known steps must be taken to verify the prescription. (Open Exibit 150, p .3)

This approach was supported by other witnesses including Professor I. H. Pitman, Professor of Pharmaceutics in the Victorian College of Pharmacy, who also made reference to the United Kingdom Misuse of Drugs Regulations 1973, which require that a pharmacist must satisfy himself

that a prescription is valid and that if the signature is not familiar to him he must check with the prescriber that the prescription is genuine (OT 2710). In confidential session, a Melbourne pharmacist expressed his belief that members of his profession who carelessly dispense forged prescriptions for drugs of addiction should be liable to a penalty. In support of this argument the witness quoted an article

from the Pharmaceutical Journal of Great Britain dated 3 January 1976, which described the prosecution of a pharmacist for supplying controlled drugs on three forged prescriptions.

A senior NSW Health Commission officer employed as a pharmacist and inspector, giving evidence in April 1978, outlined legislation then being drafted in that State. The witness explained that the legislation would require a pharmacist to validate a prescription with a doctor before dispensing it unless he either knew the patient or was familiar with the doctor's handwriting. If the doctor could not be contacted, a minimal quantity might be dispensed until such time as the doctor could be contacted.

The legislation was subsequently introduced on 2 March 1979 by amendment to the Regulations of the State Poisons Act 1966. A

new Regulation 64(6) and (7), which reads as follows, came into effect on that date:

(6) Subject to paragraph (7), no person shall dispense a

prescription for, or supply upon a prescription, any of the

following drugs of addiction, namely--

dextromoramide (Palfium); hydromorphone (Dilaudid); methadone; morphine; pethidine,

unless--

(a) he is familiar with the prescriber's handwriting;

(b) he knows the person for whom the drug is prescribed; or

(c) he has verified with the purported prescriber that the prescription was written by him.

(7) Where a person cannot dispense a prescription for, or supply upon a prescription, a drug of addiction because of the provisions of paragraph (6), he may, subject to the Act and these Regulations

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(other than paragraph (6)), dispense the prescription for, or supply upon the prescription, a quantity of the drug of addiction

sufficient for no more than 2 days' treatment.

Officers of the Health Commission who gave confidential evidence at the final Sydney hearings of the Commission in August 1979 stated that the new legislation had led to a marked decrease in the number of forged prescriptions being dispensed and that the Government's initiative had been well received by the medical and pharmacy professions. It was explained that the drugs specified in the new regulations were Schedule 8 substances which past experience had shown accounted for the great bulk of detected forgeries.

Despite two somewhat disturbing side-effects-- namely, the increased use of forged medical practitioners' referral letters as a method of obtaining illegal drugs and an observed increase in the success which known and suspected addicts appeared to be having in obtaining legal prescriptions from doctors-- the witnesses maintained that this approach to the problem was more effective than the use of special prescription pads for Schedule 8 drugs which had recently been the subject of trials

in this country (see following section). Indeed, the Commission was told that the New South Wales Health Commission would not favour the national introduction of the latter scheme on either a compulsory or a voluntary basis. The voluntary approach was not favoured because, if

the Western Australian pilot study experience was any guide, it was said that the acceptance rate would leave an unacceptably large number of non-complying doctors in a State as large as New South Wales.

It should be noted that the intentions of the New South Wales legislation, which is unique in actually specifying a number of drugs for which special prescription verification procedures are required, are reflected to varying degrees in the provisions of other jurisdictions. In the A.C.T. the dispensing pharmacist must satisfy himself that the prescription is signed with the usual signature of the physician

(Poisons Regulations 12 (g)). Compliance with this duty would appear to require him to follow a rule equivalent to the new New South Wales Regulation 64 (6). In Queensland the wording of Regulation H3 of the Health Regulations makes it clear that all the 'provisions, limitations

and conditions' relating to the writing of prescriptions must have been complied with before they are dispensed. It appears, therefore, that Queensland pharmacists also are already under an obligation to take positive steps to verify the prescription, which is similar to the

requirements of New South Wales Regulation 64 (6).

In the legislation of the other States (Victoria: Drugs of Addiction and Restricted Substances Regulations 18 and 22; South Australia: Narcotic and Psychotropic Drugs Regulations 30 (1); Western Australia: Poisons Regulations 52 (5); Tasmania: Poisons Regulations 17 (9)) the provisions governing the dispensing of prescriptions appear to be

comparable with those of New South Wales, except that nothing equivalent to Regulations 64 (6) and (7) has been introduced. They might, therefore, be regarded as deficient in this respect, although reference should also be made to the stated policy of the Western Australian Pharmaceutical Council of regarding the dispensing of a forged Schedule

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8 prescription as a breach of Section 32 (6)(c), of that State's Pharmacy Act. The Northern Territory lacks the detailed regulations relating to the dispensing of prescriptions found in the other jurisdictions. In general, a pharmacist is himself only protected from criminal liability if he has an honest and reasonable belief that a prescription is genuine.

In short, while legislation exists under the various jurisdictions which seeks to inhibit the dispensing of all drugs on forged

prescriptions, the new New South Wales Regulations reflect an awareness of the particular problems caused by this method of diversion of licit supplies of drugs of addiction. Perhaps, also, their very 'newness1

will result in a more rigorous approach to their enforcement.

A RECENT INITIATIVE: SPECIAL PRESCRIPTION PADS FOR SCHEDULE 8 DRUGS

Background

In the Poisons Regulations of each State the distribution of certain Schedule 8 drugs-- variously referred to as 'dangerous drugs', 'drugs of addiction', etc.-- is the subject of stricter controls than those applied to other less abusable substances. Many witnesses who appeared before the Commission suggested, however, that these controls needed to be further strengthened, and that one way of achieving this would be to

introduce a requirement that all Schedule 8 drugs must be prescribed on special serialised prescription forms. In fact, during this inquiry there was an opportunity of observing a pilot study of this approach conducted in Western Australia. A proposal for a similar trial scheme in Tasmania was abandoned following representations from the medical and pharmaceutical professions.

The concept of special, serialised prescription forms for dangerous drugs of addiction has its origin in the 1961 Single Convention on Narcotic Drugs, Article 30, paragraph 2 (b)(ii), which states:

The Parties shall... if the Parties deem these measures

necessary or desirable, require that prescription for drugs in Schedule 1 (i.e., of the Single Convention) should be written on official forms to be issued in the form of counterfoil books

by the competent governmental authorities or by authorised professional association. (OT 22110)

The Commentary on the Convention (p. 340) makes the following reference to this provision:

The counterfoil books mentioned in clause (ii) contain prescription forms, each form consisting of two parts: one to be retained by the prescribing physician, and the other to be given to the patient. The part kept by the doctor must contain

the basic data of those included in the patient's prescription. The physician has thus a record of all prescriptions which he

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issues. Where the use of counterfoil books is required, the physician must preserve these books including the counterfoils for a period of not less than two years. (OT 22110)

The Commission heard evidence to the effect that this approach had been adopted with success in reducing the frequency of presentation of forged prescriptions in a number of signatory countries including the Federal Republic of Germany, Fiji, several South American countries, and the USA (California and Idaho). An accompanying desirable side-effect was an observed reduction-- quoted as 40 per cent in the Federal Republic of Germany (OT 4389)-- in the level of legal prescribing of narcotic drugs partly as a result of doctors becoming more aware of defects in their prescribing habits and partly because the authorities were able to monitor more effectively prescribing patterns.

Included among the witnesses who supported the national

implementation of this scheme in Australia were:

pharmacists and medical practitioners appearing in a private capacity, e.g., Mr L. G. Higinbotham of Melbourne, a pharmacist with over 40 years' experience (OT 2732) and Dr G. I. Tewfick, a Perth psychiatrist (OT 976);

various Health Department officers, including Dr D. de Souza, First Assistant Director-General, Therapeutics Division, Commonwealth Department of Health (OT 21048), Dr J. E. Aldred, Senior Medical Officer, Poisons Division, Victorian Department of Health (OT 2670—

71 and OT 22275), Mr F. D. Potts, Chief Inspecting Pharmacist, Pharmaceutical Services Section, Tasmanian Department of Health Services (OT 1392A— 92B), Mr K. F. Keefer, Chief Inspector, Drugs and Poisons, Queensland Department of Health (OT 2259) and Dr C. H. Gurd, Director of Health for the Northern Territory (OT 21556); and

representatives of a number of organisations with diverse interests in drugs and the problems of drug abuse, e.g., Ms B. Bond, Executive Secretary of the South Australian Branch of the Royal Australian Nursing Federation (OT 8630) and Mr N. R. Kelly, Executive Director of the Australian Pharmaceutical Manufacturers' Association

(OT 12625).

There was some debate as to whether use of special prescription pads for Schedule 8 drugs would have its major impact in decreasing

prescription forgeries or whether, in fact, its side-effect of reducing the extent of legal prescribing of these substances would prove to be of greater advantage. For example, Professor M. J. Eadie of the Department of Neurology and Neuropharmacology, University of Queensland, considered the use of special pads a reasonable idea (OT 4974). He added that he did not consider it would cause doctors any great difficulty, although they would have to carry an additional pad. Professor Eadie thought that, while to a small extent it would deter unnecessary prescribing, the main effect would be to make it more difficult for forgers to obtain forms.

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An opposing point of view was expressed by Mr R. C. McCarthy,

Principal Pharmacist in the South Australian Health Commission, who agreed that special prescription forms could reduce the incidence of prescribing of narcotic drugs (OT 7125). However, he did not accept that they would lessen the incidence of forgery since he believed that a pharmacist presented with a prescription on a special form might be prepared to accept it without question. He thought specific rules on prescription verification could well suffice since, in his opinion, a

far greater diversion problem existed through users obtaining genuine prescriptions by false pretences or the injudicious prescribing of narcotics by a minority of the medical profession.

Some evidence of the need to 'sell' the scheme to members of the medical and pharmacy professions was presented, although it seemed to be generally agreed that objections from these sources could be overcome. In fact, when asked what obstacles he saw to the use of special pads, Mr R . W. Manning, Director of Public Relations for the Pharmacy Guild of Australia, said he saw none from the point of view of the pharmacist and

indicated that his organisation would be prepared to co-operate in any way (OT 12909).

The Western Australian Pilot Study

The Western Australian pilot study utilised special prescription forms supplied by the Commonwealth Department of Health for Schedule 8 drugs. (It had been intended to use the same forms in Tasmania.) The forms had pink identification strips and were printed in triplicate and

serially numbered. Medical practitioners' names and addresses were not printed on the forms. Pharmacists were instructed to follow the following procedures:

(1) Private prescriptions

- pharmacist to forward original prescriptions once a month to the State Health Department for relay to the Divisional Office of the Commonwealth Department of Health; and

- pharmacist to retain one copy if so directed by State Health

Department.

(2) NHS prescriptions

- pharmacist to forward original prescriptions to Commonwealth Department of Health Divisional Office in the monthly claim for payment but in separate groups placed at either the front or the back of general or pensioner bundles;

- duplicate copy to be retained by pharmacist; and

- triplicate copy to be forwarded to State Health Department.

(3) Repatriation Pharmaceutical Benefits Scheme prescriptions

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- pharmacist to - forward original prescription with normal claim for payment to the Department of Veterans' Affairs which in turn would forward the prescriptions to Commonwealth Department of Health Divisional Office for price checking and screening;

- duplicate copy to be retained by the pharmacist; and

- triplicate copy to be forwarded to State Health Department.

The Commission had access to a number of reports on the Western Australian study (which ran officially from April to October 1978) prepared by the State health authority. They all indicated a belief that the trial had been a most worthwhile exercise. In fact, the Department was sufficiently impressed to continue with the experiment after the completion of the official trial period and, when the original

supply of pads had been finally exhausted, to request the Commonwealth Director-General of Health to provide a new supply. The Director- General acceded to this request.

Certain of the more important results of the trial as reported by the Department are summarised below.

A total of 1335 pads were distributed and 48 per cent of all Western Australian doctors received pads.

Of the 5610 prescriptions for Schedule 8 drugs examined during the trial period, 3857 (69 per cent) were written on the special forms.

No dispensed forgeries were detected on the special forms during the trial period but 16 were detected on the ordinary forms. A pharmacist detected an attempted forgery on a special form and the doctor was contacted through the serial number. He subsequently discovered that seven forms had been stolen from his pad. Two other complete pads were reported stolen but prescriptions from them were not presented during the trial period.

The Department's overall assessment was as follows:

The value of the trial prescription forms is unquestionable in that forgeries were non-existent, stolen pads were readily identifiable from the serial numbers, and in the main, the medical profession accepted their use as being of value for the above reasons.

The regular scrutiny of all drugs of dependence, during the period of the trial enabled the Department to detect certain trends in the prescribing of these drugs, which will be the subject of further investigation...

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The Department has welcomed the opportunity of conducting this trial, and it has increased co-operation between the

Commonwealth Department of Health, the medical profession and this Department. (OT 20545)

The reactions of other interested parties could fairly be described as being mixed, and the Commission made arrangements to hear these views during the final sittings in Western Australia in May 1979.

A representative of the Western Australian Division of the

Commonwealth Department of Health suggested that while the study had been a successful educational exercise for participating pharmacists there was some concern about three dispensed forgeries detected on special forms after the end of the official trial period. It was

thought that these might reflect an increasing tendency by pharmacists to accept Schedule 8 prescriptions without question simply because they were written on the special forms (OT 22339).

The Pharmaceutical Council of Western Australia indicated through its Deputy President, Ms G . M. Heedes, that in its judgment the trial had been most successful and, in summary, submitted that:

The Council believes that whatever disadvantages may have been disclosed by the pilot study they must have been greatly outweighed by the benefits and consequently recommends that a similar scheme, perhaps suitably modified, should be introduced nationally on a permanent basis.

(OT 22347)

Ms Heedes agreed that, while there was some risk of complacency creeping into pharmacists' verification procedures for special Schedule 8 prescription forms, the Council would not accept this as a defence from a pharmacist who had actually dispensed a forged prescription.

The Pharmaceutical Council's views were not shared by the Western Australian Branch of the Pharmacy Guild of Australia. Its President, Mr P. V. Hughes, stated that in the Guild's opinion the scheme had failed because of significant non-compliance and non-participation by the medical profession (OT 22357). The witness subsequently agreed that to

call the scheme a failure was, perhaps, an unfortunate choice of words and that it would be more accurate to describe it as not having been extended to its full potential (OT 22360--61). He maintained, however, that the scheme had certain basic deficiencies, for example, pharmacists had become complacent in their verification procedures, and he also pointed to the fact that the average medical practitioner's knowledge of what drugs were actually included in Schedule 8 was extremely poor.

The General Practitioners' Society in Australia expressed complete opposition in principle to the scheme through its Western Australian representative, Dr I. F. Gullard. The Society suggested that no real advantages were discernible, and the pilot exercise and its possible

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extension to a national compulsory scheme were said to be a 'complete waste of the tax payers' money' and yet another bureaucratic attempt to regulate a profession that was already 'over-regulated' (OT 22365). Dr Gullard confirmed that doctors were faced with an enormous task in keeping abreast of changes to Schedule 8 and he saw this as a further complicating factor (OT 22369--70A).

The representative of the Western Australian Branch of the Australian Medical Association, Dr L. G. Blake, told the Commission that while it was difficult to make a definitive statement on a control system which was, in effect, still evolving, he was able to offer some general comments. For example, he questioned whether restricting the special pads to Schedule 8 drugs was the most appropriate criterion given the fact that doctors were not regularly informed of changes to the Schedule (OT 22419--20). He also expressed surprise that the Pharmacy Guild had described the scheme as a failure, given the fact that almost 70 per cent of prescriptions for Schedule 8 drugs had been written on the special pads during the trial period. In summing up, Dr Blake suggested that perhaps a more critical evaluation was required:

The main thrust needs to help discern the potential value of such a scheme at a national level; this objective requires an assessment of several factors, including the effectiveness of the scheme in preventing forgeries, or at least in determining

the extent of forgeries which do occur. The likely co­

operation of doctors is another factor which needs to be determined, and you must also think in terms of the difficulty in forging, the detectability of the forgeries, the security of the pads.

(OT 22423)

Support for the scheme from the law enforcement area came from Inspector D. T. Ayres, Administration Officer of the Western Australian Police Drug Squad. When asked if he saw definite merit in the use of serialised, coloured prescription pads, Inspector Ayres replied:

'Without any doubt at all, yes. It is certainly a step in the right direction'. He continued:

There are lots of advantages to it, sir. The one which jumps readily to mind is that prescription pads are numbered so that if there is a forgery detected on any one, or if a pad is

stolen it is only a matter of notifying the pharmacists of the number, and if they continue to use them we would be notified immediately. I think it would frighten them off from using any more than, perhaps, one.

(OT 22393)

Reactions to the Proposed Tasmanian Study

Mr F. D. Potts, Chief Inspecting Pharmacist of the Tasmanian Department of Health Services, appearing before the Commission in December 1977 and February 1978, indicated strong support for the implementation on a national basis of special prescription forms for Schedule 8 drugs. At the Commission's invitation, Mr Potts offered (OT

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4393) to investigate the feasibility of introducing a pilot scheme in Tasmania similar to that then about to commence in Western Australia. Mr Potts very briefly summarised the events that followed in the synopsis of a submission he presented during final hearings of the Commission in Hobart in May 1979:

Following years of discussion at various levels and the hearing before the Royal Commission in February last year, moves were made in Tasmania to introduce regulations under the Poisons Act 1971 to require the use of serially numbered triplicate prescription forms.

Discussions were held with the AMA and Pharmaceutical bodies, (in July 1978) and after consideration of these discussions and other matters, the Minister accepted a recommendation from the Poisons Advisory Committee that regulations requiring the use of special prescription forms be introduced.

After a Press announcement on the introduction of the

regulations and the sending of circulars to pharmacists and doctors, there was a strong reaction against the regulations, spearheaded by the Society of General Practitioners in Tasmania. This reaction was in contrast to the constructive

attitude shown by other groups interstate in evidence that they had given to the Royal Commission as reported in various journals.

Although there appeared to be no valid arguments against the proposal, it was decided not to proceed with the regulations because:

(a) We believe the use of such special prescription forms was an important control measure, and it was feared the militant action on the part of some elements of the

profession may prejudice the adoption of such a scheme nationally.

(b) The enforcement of the regulations against these

rebellious members of the professions would have placed an impossible workload on the Pharmaceutical Services Section of the Department.

The scheme could have worked well and without any fuss or bother if the organisations concerned had shown a responsible and positive attitude to it. (OT 22108)

It is important to note that the Tasmanian trial scheme was to be introduced by regulation, unlike the Western Australian study, which was conducted on a voluntary basis. The evidence recorded below suggests this may have been one of the major factors in the non-acceptance of the proposal by the medical and pharmaceutical professions in Tasmania.

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The records of the meeting of 19 July, a subsequent meeting held on 30 October, and copies of correspondence exchanged by the Tasmanian Department of Health Services and the medical and pharmacy bodies included in Mr Potts' submission (OT 22108--46 and Open Exhibit 576) reveal a rather confusing chain of events. It is clear that there were misunderstandings on both sides regarding the exact nature of the proposal (whether it was to be a trial only or a continuing procedure) and the degree of support and/or opposition being voiced by the parties involved.

Representatives of all parties were given the opportunity of addressing the Commission during final hearings in Hobart in May 1979.

Mr Potts then elaborated further on his general reaction recorded above, laying particular stress on drug users' own assessments of the effectiveness of the scheme and on what he regarded as the

shortsightedness of the medical and pharmaceutical professional associations in failing to extend their appreciation of any new suggestion beyond its direct effect on the professional activities of their members (OT 22140--41). He also explained that because of some problems associated with the voluntary scheme in Western Australia it had been considered advisable to introduce the identical scheme in Tasmania by regulation. Mr Potts mentioned that a list of 29 of the most commonly prescribed Schedule 8 drugs was available to any doctor

requesting it and, in any event, various reference works such as the Australian Drug Compendium, the Prescription Proprietaries Guide and the Pharmaceutical Benefits List were always readily available to a doctor in doubt as to the scheduling of any particular drug (OT 22147--48 and 22158--59).

Representatives of the organisations criticised by Mr Potts reacted strongly. Dr D. P. Mackey wrote to the Commission on behalf of the Southern Tasmanian Branch of the General Practitioners' Society in Australia (GPSA) rejecting the scheme simply because 'it would not work'

(OT 22020). Articles appearing in the December 1978 issue of the Society's journal 'The Australian GP' indicated that these objections had been made known to the Tasmanian Government in a petition signed by a number of medical practitioners and pharmacists which was presented to Parliament by the Opposition Whip. When he appeared before the Commission, Dr Mackey:

* said he believed that all doctors in Tasmania should have been consulted prior to the implementation of the scheme (the GPSA was not represented at the 19 July meeting) (OT 22023);

* asserted that even if the system had been proposed on a voluntary basis it would have 'been worse than useless because...you have given the person who steals these prescription pads a target...' (OT 22030); and

* stated that an informal survey he had undertaken of 100 doctors revealed that their knowledge of precisely which drugs and compounds of drugs were included in Schedule 8 was extremely poor (OT 22033).

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Dr J. M. Cartledge, Honorary Secretary of the Tasmanian Branch of the Australian Medical Association (AMA), stated that the

representatives of the professional organisations had advised Government officials present at the 19 July meeting that the scheme was of doubtful merit and had left with the impression that it would not be implemented. It was with some surprise then that, on 20 September, the AMA received a

draft of proposed regulations introducing the scheme. At this point members of the Association began indicating to the office-bearers that they believed the use of the special pads could, in fact, be counter­ productive (OT 22002--04). Among the reasons given were the 1 aura of

respectability' which might develop around prescriptions written on the special pads and problems in maintaining the security of the pads (OT 22004--05). Some members believed the trial was not being conducted on a 'properly controlled scientific basis' and because of the very small numbers of fraudulent prescriptions for narcotic drugs presented in Tasmania, suggested that its effect would be difficult to measure

statistically (OT 22006--07). Dr Cartledge did acknowledge that failures in communication had occurred and that the AMA had not fully appreciated what was behind the whole scheme. Having received certain explanations during the course of his appearance before the Commission, he was prepared to agree that his Association could still be regarded as having an open mind on the matter (OT 22017).

A submission from the Tasmanian Branch of the Pharmacy Guild began by indicating a willingness to 'support any reasonable proposal that could be demonstrated to have significant effect on reducing the illicit availability of narcotic drugs which are available on prescription' (OT

22075A). However, 'two major areas of discontent' were identified in relation to this particular proposal-- namely, the failure of the authorities to adequately demonstrate its benefits and their additional failure to obtain the co-operation of the medical profession before committing themselves to its implementation (OT 22075C). In addition to pointing up alleged deficiencies in the proposal such as the 'aura of

respectability' which might surround the special prescription forms, the submission was also particularly critical of what it saw as a 'policing' role being forced upon pharmacists. A spokesman, Mr D . M. Tremayne, indicated that the Guild had been under the impression that the Tasmanian proposal involved a phasing-in period followed by permanent

application rather than the trial envisaged by the authorities; neither was it aware of any direct connection with the study in Western

Australia (OT 22078--80).

The views of the Pharmaceutical Society of Tasmania presented by Mr R. W. Scanlon, the immediate Past-President, generally supported those of the Pharmacy Guild. The Society emphasised its opinion that the advantages of the scheme had not been sufficiently demonstrated,

especially in view of the low frequency of narcotic drugs prescription forgery in Tasmania-- quoted as 0.23 or 0.25 per cent of all narcotics scripts or approximately 30--40 per annum (OT 22095). Mr Scanlon himself described the proposal as using a 'sledgehammer to crack a nut' and suggested that the pilot study would have been better conducted in one of the more populous States where prescription forgery was known to be a problem of greater significance (0T 22099B--99C).

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Mr R. E. Hill, President of the Pharmacy Board of Tasmania,

presented a submission on behalf of his organisation which again criticised a number of aspects of the proposal. The Board was

particularly unhappy about the omission of pre-printed doctors' names and addresses from the trial forms. It also drew attention to the fact that 'some prescribers lack knowledge of the drug schedules and show an

unwillingness to conform to present or future requirements' (OT 22101). Mr Hill was able to support the last statement by reference to his own experience. He indicated that he had just recently spent two hours one evening correcting 200 prescriptions which had to be returned to doctors because of various errors-- the results of two months' prescribing (OT 22106).

CONCLUSIONS AND RECOMMENDATIONS

Conclusions

The evidence presented above on the reactions of various

professional bodies and individuals to the trial use of special serialised and distinctively coloured prescription forms for Schedule 8 drugs shows that, despite the widespread use and reported success of similar systems overseas, there is a division of opinion within the Australian medical and pharmaceutical professions on the value of such

special forms. The main objectors to the scheme, not surprisingly, came from the States where the trials were introduced or were to be

introduced. However, the rejection of the proposal by NSW Health Commission officials in favour of recently introduced legislation requiring prescription verification by the pharmacist for certain specified Schedule 8 drugs has also been given weight.

Arguments against the serialised pad proposal fall generally into these broad categories:

(1) Opposition by the professions to any new form of regulation.

(2) The problem is not one of sufficient magnitude to warrant the introduction of such a scheme.

(3) Under the present system most pharmacists check suspect Schedule 8 scripts, and use of the new form could lead to complacency on their part.

(4) Many doctors are not conversant with the drugs and drug compounds included in Schedule 8.

(5) The issuing of a special prescription pad would inconvenience doctors by requiring them to have two pads.

(6) If thefts of pads (or parts of pads) were not quickly reported, the system could break down.

The arguments supporting the proposal were:

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(1) The degree of regulation would be little more than that currently operating; Schedule 8 drugs are already subject to special

restrictions in all States.

(2) Whilst diversion of narcotics from the licit to the illicit market via prescription forgeries may not presently be a problem for individual States of a magnitude comparable with illegal importation of drugs, it is of sufficient importance nationally to require

remedial action.

(3) The proposal could result in the verification of Schedule 8 prescriptions which might not normally otherwise be verified.

(4) In cases of doubt on the particular scheduling of a drug, reference books are readily available. However, a special list of the

relatively small number of commonly prescribed Schedule 8 drugs could be issued to all prescribers by the relevant health

authorities.

(5) The use and safeguarding of special prescription pads should not present any more difficulty to prescribers than their current obligations.

(6) If thefts of pads (or parts of pads) were immediately reported by doctors and quickly notified to pharmacists, the misuse of stolen prescription forms could be virtually overcome.

After reviewing the arguments and hearing much evidence on the point, the Commission is of the view that the benefits from using a distinctive serialised prescription pad for Schedule 8 drugs far outweigh the disadvantages. If implemented, the Commission would favour

the pads being personalised with the prescriber1s name and address. It would prefer also a system whereby an additional copy in all cases remained in the book after prescribing. The suggestion of a counterfoil would involve some duplication of effort by the prescriber. Such a

system could add to the opposition from some medical practitioners.

The so-called 'NSW system', which as detailed above has provisions similar to those already existing in some other States, has many advantages if judged by the evidence of the NSW Health Commission. It is a system which does not place any substantially increased burden upon the community, any expense continuing to be borne largely by the pharmacists themselves. Many of those who oppose the serialised prescription pads point to the additional expense which, if implemented,

the Commonwealth Department of Health would probably have to bear. One might safely assume their concern is not so much for the Commonwealth purse as in a search for an additional excuse.

The Commission was impressed by an approach stated by Mr F . D . Potts, namely that the public, as consumers, had a very real interest in the final result and that this should be contrasted with the interests of those of the medical and pharmaceutical professions who opposed the

scheme. These interests were largely motivated by considerations of possible inconvenience to themselves.

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Regrettably, much of the opposition to the implementation of the scheme was based on misunderstanding or lack of appreciation of the aims of the scheme. One argument which in itself constituted an indictment of some medical practitioners was that many doctors did not know what drugs were contained in Schedule 8. Recourse to appropriate compendiums could speedily solve this problem. An alternative, and doubtless more practical, solution would be to provide medical practitioners with a

list of those Schedule 8 drugs most frequently prescribed, each particular drug having its trade name also included.

In the final result the Commission has concluded that if the optimum course was to be pursued, both systems would be adopted, one placing the prime responsibility upon the prescriber, the other upon the pharmacist. Working together it could readily be assumed that virtual elimination of forged prescriptions would follow.

Regrettably, practicalities must be considered and to endeavour to legislate for serialised prescription pads at this stage could only mean further delay. The Commission therefore concludes that the appropriate course is to urge the States to adopt the 1 NSW approach1, preferably in identical terms, identifying the most abused drugs and varying the list as circumstances demand. At the same time the voluntary adoption of the use of serialised prescription pads should be commended pending the

implementation of legislation as hereafter recommended.

The so-called 'side-effects' from the use of the NSW system, namely an increase in the number of forged referral letters and an increase in the number of addicts or users legally obtaining prescriptions, are the types of problems which will flow from any attempt to prevent illegal actions by a particular course. The wrongdoer will try another. That one likewise has to be countered.

An indirect benefit of employing special prescription pads that has often been mentioned is that it tends to limit the prescribing of Schedule 8 drugs by increasing the prescriber's awareness. As previously stated, in the Federal Republic of Germany a decreased use of 40 per cent was reported and many witnesses were of the view that substantial reductions might also be expected in Australia if the system were introduced on a national basis. This would in turn, to some degree, limit the availability of drugs capable of abuse.

Finally, the Commission again emphasises the pressing need in Australia for National and State Drug Information Centres recommended elsewhere in this report (see Part XIV). The dearth of knowledge of the extent of the problem under discussion has been used here as an argument against the implementation of special prescription pads. The validity of the argument has been made more difficult to test since 1977 when the method of detecting forged prescriptions presented under the National Health Act was terminated in favour of a new and comprehensive

computerised system to be devised by the Commonwealth Department of Health. Recent information from that Department indicates that a final decision on the format of the system has been delayed pending the result

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of any recommendation from this Commission on methods of detecting and combating forged prescriptions.

Recommendations

The Commission recommends that:

** The States and Territories should forthwith adopt legislation in the terms of Regulation 64(6) and (7) of the State Poisons Act 1966 (NSW).

** State and Territory Health authorities should circulate from time to time to all medical practitioners a list of the most commonly used ΝΉ & MRC Schedule 8 drugs showing both generic and trade names.

** States and Territories should introduce legislation requiring prescribers of any drug referred to in such a list as mentioned in the previous recommendation to use specially serialised and coloured prescription forms taken from a specially prepared pad, containing

such number of forms that after proper use thereof one completed copy of each prescription remains in the pad.

** The Commonwealth Department of Health should continue to provide assistance to States using or intending to use serialised

prescription forms for the prescribing of Schedule 8 drugs.

** The Commonwealth Department of Health should reintroduce urgently a suitable system to detect forged prescriptions presented under the National Health Act.

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Chapter 5 Financial Controls

FINANCIAL ASPECTS OF THE ILLEGAL DRUG TRADE

Those who engage in the illegal importation, production and trafficking of drugs generally do so to make money. The significance of this factor varies. The user imports, produces or buys a surplus over and above his own needs so that by selling that surplus he generates a cash flow to

continue to support his habit. The members of a criminal group who have no intention of themselves using drugs may wish to avail themselves of the opportunity to make large profits.

Quite apart from the question of profit, the illegal importation, production and trafficking of drugs necessitates the use of money. Money is needed to purchase the drug and to finance the services necessary for its illegal importation or production-- inducements must be offered to couriers, cultivators paid, travel paid for, and so on. Once a sale is made the proceeds have to be distributed, any corrupt officials paid, and the financier's investment and return on the investment paid to him. In other words, the sale of a drug is preceded and followed by a chain of monetary transactions.

The drug, the people who produce, supply and use it, and the money which makes it all possible are the three essential elements in the illegal drug trade. In Australia effort is presently directed to the drugs. This effort ranges from controls in the form of requirements

that a particular drug be supplied only by a licensed pharmacist pursuant to a doctor's prescription to endeavours at the Custom's barrier to detect illegal importation and to seize the drug.

Endeavours to discourage the cultivation of plants from which drugs are produced in overseas countries and attempts to detect drug plantations in Australia are encompassed in the effort. Effort is devoted also to the people. Law enforcement seeks to identify offenders against the

drug laws and secure their conviction. Thus the courier or dealer is prosecuted and imprisoned; less often an organiser or financier is detected, prosecuted and convicted. In another sphere of activity drug users are directed to treatment centres and otherwise provided with

support. Efforts are made to educate people to a responsible attitude about drugs.

The evidence received by the Commission shows that little attention in Australia is directed to the money-- the third essential element in the drug trade. The position is otherwise in other countries. Thus the Commission was interested to note evidence which it received in respect of 'Operation Julie'. Police in the United Kingdom broke up an

organisation which manufactured and trafficked in 95 per cent of the United Kingdom's supplies of LSD-- and 60 per cent of the world's supplies. A court order was made forfeiting 750 000 pounds Sterling with provision for all the police forces which contributed to the

operation to be reimbursed out of those funds, a large proportion of which was. held in Swiss banks. To assist in the operation the

assistance of the City of London Fraud Squad was recruited in the persons of two officers who, with other investigators, established a

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special squad to deal with financial matters (Open Exhibit 663). The position in the United States will be looked at later in this Chapter.

Many reasons can be advanced for the lack of attention by law enforcement agencies in Australia to the money aspect of illegal drug activities. Whatever they are, the Commission regards it as essential that the money aspect of drugs and crime receive greater attention. This is not simply because the illegal trafficker should be deprived of his illgotten gains. However admirable such a motive may be, it may be doubted whether, standing alone, it justifies the substantial commitment of resources required to identify and quantify the money gained in a particular case of illegal importation, trafficking or production of drugs. The significance of the money required for, and generated by, the illegal importation, production or trafficking of drugs, and the justification for its receiving closer attention in the Commission's view, lies in the following considerations:

1. Following the movement of money towards and away from the illegal transaction assists in appreciating the ramifications of the activities of a particular organised group. It may lead to the identification and ultimately the conviction of those who otherwise remain aloof from the criminal activity but who have a major impact on it-- those whose effects on the illegal drug trade far outweigh their numbers--- the financiers and organisers.

2. It is money and the further accumulation of money, resources and assets which money permits, which underpins the groups of criminals who are engaged in the illegal importation, production and trafficking of drugs. Thus:

- money renders the group less vulnerable to successful law enforcement action. The loss of a shipment is not fatal to a group which has accumulated sufficient money and assets to finance the acquisition of a replacement shipment and arrange for its illegal importation, continuing its activities notwithstanding the particular loss of the operating funds and expected profit;

- money finances methods which make the task of law enforcement most difficult. A shipment of drugs may be split among a number of couriers to minimise the effect of one being caught. A person whose background is unlikely to attract attention from

the authorities can be offered sufficient to induce him to act as a courier. The extra cost of trans-shipping goods can be borne so that they enter Australia from a place not normally associated with drugs.

3. Money facilitates the corruption of authority---not only in Australia but also overseas-- and so facilitates the illegal activity.

4. Money gives access to expertise and to equipment to facilitate the illegal activity. Thus the evidence received by the Commission establishes that those engaged, particularly the upper levels, in illegal drug production, importation and trafficking may have

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recourse to the best legal and accounting advice. Those giving the advice are not necessarily aware of the illegal activity. They may believe they are advising legitimate businessmen, such is the aura that access to large sums of money creates and the influence it

commands. Sophisticated equipment may be acquired, for example to permit law enforcement radio communications to be intercepted and overheard.

Considerations such as those just canvassed underpin the 'organised basis' of illegal drug activities. It is those who work on this basis who are the most effective illegal importers, producers and traffickers. They present the greatest difficulty for law enforcement.

There are other considerations which may be even more important for Australia. Money in the hands of criminals who engage in the illegal importation, production and trafficking of drugs for motives of profit and greed has other implications. As was said in Part IV Chapter 7,

1 The Organised Basis of Drug-related Crime', those who have the greatest impact in the illegal drug trade do not restrict their criminal activities to drugs. The evidence received by the Commission shows that it is more than likely that profits from criminal activities such as illegal betting and gambling finance drug trafficking or the illegal

importation or production of drugs. It is also more than likely that profits from drug trafficking go to finance other criminal activities such as prostitution and pornography. Funds generated from any or all of these criminal activities may be invested in business enterprises of varying degrees of legitimacy. A business which had previously had no

contact with criminals is then run by them. Some persons named in confidential evidence received by the Commission as being involved in the drug trade were also alleged to engage in criminal or fraudulent commercial transactions in Australia and in other countries-- so called

'white collar crime'.

It is necessary to have an appreciation of the scale on which the illegal drug trade generates money. In Part IV Chapter 7, figures are given indicating that as much as $A16 million leaves Australia each year to buy heroin to supply Australian addicts. It is there demonstrated that when the proceeds of that supply and their leaving Australia to be

'laundered' are taken into account the figure could be as high as $A100 million.

It is true that these estimates reflect the absence of hard data in Australia. It must, however, be remarked that the acquisition of such data may lead to the figures being revised upwards rather than

downwards. It will be recalled that, in the fairly modest trafficking operations used in an example in Part IV Chapter 7, in three months two prostitutes selling heroin generated profits estimated to be of the order of $130 000. If these two suppliers take a place as street

dealers below the wholesalers at the bottom of the pyramid shown in Figure IV.1, and it is remembered that such a pyramid is only an

example, the overall figures start to assume an alarming perspective. Further emphasis is given by the calculation in Part IV Chapter 5, 'Trafficking', dealing with the progressive cutting of 450 grams (one pound) of heroin with a diamorphine content of 85 per cent to produce of

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the order of 8000 street doses selling at $120 each-- generating approximately $1 million. In the same chapter there is mention of the case of a trafficker who purchased 735 grams of heroin for $2000, paid a courier $7000 to smuggle it into Australia for sale to a dealer uncut for $40 000, and so made a profit of more than $30 000.

The above data relate to the supply of heroin and particularly, in the case of the overall figures for funds leaving Australia, to the supply of heroin to addicts i .e ., those whose requirements have reached a sustained level. No account is taken of heroin for use by those whose habit has not reached that stage. No account is taken by the figures quoted of the money used in, or generated by, the illegal importation of Buddha sticks, hashish, or hashish oil, all of which are imported into Australia regularly and illegally in quantity. No account is taken of drugs illegally produced in Australia. Those who engage in the illegal production, importation or trafficking of drugs frequently engage in other illegal activities which also generate money. They do not differentiate between the money made by illegal activity related to drugs and money generated by unrelated illegal activities such as illegal gambling and betting, prostitution and pornography. The prospect of persons engaged in the illegal importation, production or

trafficking of drugs also being involved in corporate or white collar crime was adverted to earlier. The figures given in respect of heroin together with the considerations just mentioned, are sufficient to indicate the sums of money generated by all these criminal activities must be large-- in any terms.

CONTROLS IN THE UNITED STATES

The economic aspects of crime are the subject of concern by governments and law enforcement authorities in other countries-- notably the United States. The Commission therefore devoted some effort to gaining an appreciation of the position in that country. Mention is made in Part IV Chapter 7, 'The Organised Basis of Drug-related Crime', of the 1970 findings of the Judiciary Committee of the United States House of Representatives in respect of the large sums of money generated by the activities of criminals and the use made of it, which gives rise to undesirable consequences for individuals, business, the economy and indeed society in the United States as a whole. Such considerations have, in the United States during the 1970's, led to an increasing emphasis on the financial implications of crime with the development of new investigative resources, skills, powers and remedies to deal with the matters. Existing organisations have been reorganised and redeployed. These activities reflect, on the part of the government and those responsible for law enforcement, certain views founded on experience and considerable public agitation on the matters of organised crime and its financial implications during the late 1950's and 1960's in the course of Congressional and other inquiries-- with press, radio and television playing their part. The following points reflect some of the more important of those views: 1

1. There are groups of individuals who carry on criminal activities of all kinds in an organised hierarchy.

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2. Such criminal activities drain 'billions of dollars' from the American economy by unlawful conduct such as the corruption of officials, the avoidance of revenue laws, defrauding innocent investors, interfering with free competition, imposing burdens on

free trade, and threatening the security and general welfare of citizens by the introduction of systematic violence.

3. The magnitude of the effort necessary to deal effectively with such criminal activities demands an implementation of efforts in the scheme of determined priorities, and identifying areas of major concern and the individuals to be the subject of maximum attention.

4. Law enforcement effort in the United States has been fragmented, unco-ordinated and dominated on occasion by considerations directed to the advancement of particular law enforcement agencies' interests.

5. Law enforcement efforts which involved concentrating on particular offences, identifying the offender and his immediate associates and seeking to convict them were ineffective. Such an approach simply served to remove 'dead wood1 from criminal groups and provided

'upward mobility' and 'on-the-job training' for the 'bright young men' in the ranks of groups. The essential and continuing structure of the group was left intact yet it was this which constituted the greatest threat.

6. The most effective way to deal with large scale continuing criminal activity was to cut off the money flow generated as a consequence of the activities, take away from the group the assets accumulated by the organisation and dry up the cash flow which otherwise was available for the continuing exploitation by those who replaced those who had been removed.

7. The substantial cash flows generated by large scale continuing illegal activity were increasingly used to control legitimate business, in many cases by 'devious methods', and those businesses were operated in a way detrimental to the public welfare and

national economy.

Evidence for the above statements is contained in Open Exhibits 645 and 646, the reports of the Judiciary Committees of the United States Senate and House of Representatives in respect of the Organised Crime Control Act, Open Exhibits 643 and 644, reports of organised crime

control bodies in the States of Florida and California, and Open Exhibit 661, a report by counsel assisting the Commission in respect of

organised crime in the United States of America.

In the light of such considerations, priorities in the United States of America for Federal law enforcement and Federal support of State and local enforcement have been determined. The priorities, in descending order, are white collar crime, public corruption, narcotics trafficking and organised crime. Appropriate statutory remedies have been developed to more effectively deal with the economic aspects of criminal activities. Thus, under the Racketeering Influence and Corrupt Organisations Statute (title 18 United States Code, s.1962), it is provided, inter alia,:

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It shall be unlawful for any person who has received any income derived, directly or indirectly, from a pattern of racketeering activity...to use or invest, directly or indirectly, any part of such income, or the proceeds of such income, in acquisition of any... enterprise which is engaged in, or the activities of which affect, interstate or foreign commerce.

(Open Exhibit 646, page 17)

It is Federal power in respect of interstate or foreign commerce which gives the United States Government as distinct from a State or local government the necessary legislative powers.

There are cognate sections prohibiting the acquisition, or maintenance of, any interest in, or control of, any enterprise through a pattern of racketeering activities and prohibiting a person employed by, or associated with, an enterprise to engage in a pattern of racketeering activities. 'Enterprise' is very widely defined and includes a 'group of individuals associated in fact'. In addition to substantial criminal penalties for breach of the Statute, a person aggrieved by a breach can bring a civil action leading, for example, to the divesting of an

interest in an enterprise or the dissolution or reorganisation of it. The most far-reaching effect of the provision is, however, that an interest acquired or maintained in an enterprise in violation of the legislation and any interest in, security over, claim against, or property or contractual right of any kind affording a source of

influence over an enterprise which is in breach of the legislation, may be declared forfeit to the United States, seized by the Attorney-General of the United States and disposed of subject to the rights of innocent persons. The legislation makes provisions for injunctions before trial

or other steps to prevent circumvention of the legislation before a trial can be heard. By this power legitimate business undertakings acquired with money from criminal activities have been seized and sold. A corrupt State revenue authority has been taken over and reorganised.

The United States Federal Government's Internal Revenue Service directs special attention to suspected narcotics traffickers and financiers who are suspected of violation of the Internal Revenue (Income Tax) Law. It acts in co-operation with other Federal, State and local enforcement agencies. Similarly, in the field of exchange control, authorities responsible for exchange control regulations act in concert with law enforcement agencies in using documentation brought into existence as a consequence of exchange control regulations to identify major drug traffickers and to obtain evidence to lead to their conviction in addition to the evidence already mentioned (Open Exhibit 665). .

AUSTRALIAN CONTROLS

At the beginning of this Chapter attention was directed to the amount of money generated by the illegal importation, production and trafficking of drugs and to the potentially undesirable and harmful effects arising as a consequence. There was comparatively little hard evidence received by the Commission establishing that this potential was being fulfilled. This would be comforting if it could be said that the

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shortage of evidence was, as a consequence of careful attention and monitoring, to provide a factual basis for saying that the potential was not being fulfilled. The Commission is, however, of the view that this is not the case-- although what is known is sufficient to give cause for

concern. It may be remembered, for example, that in Part IV Chapter 7, 'The Organised Basis of Drug-related Crime1, connections between criminals in Australia and the United States which have been identified are referred to. The activities which Mr Justice Moffitt reported on in

1974 as a result of his inquiry in respect of certain matters related to 'Allegations of Organized Crime in Clubs' (Open Exhibit 647) are a case of the fulfilment of the potential referred to. Payment to criminals for employment in positions in which they never work, charging for goods and services which are not provided or charging for them in excess of commercial rates impose burdens on those who pay and who, in the case of

Mr Justice Moffitt's report, were the members of the licensed clubs in New South Wales. If the activities are sufficiently widespread, wider segments of the community pay. A number of the individuals identified by Mr Justice Moffitt and whose activities were adversely commented on by him have, according to confidential evidence received by this

Commission, continued to engage in illegal activities ranging from gambling, prostitution and receiving stolen property to drug trafficking in more recent times. They have acquired property and other assests--no doubt with money generated by criminal activities. They have continued to associate with known criminals in Australia and overseas. Mr Justice Woodward in his recent report on drug trafficking in New

South Wales named a number of them as being engaged in the illegal importation, production and trafficking of drugs. It would therefore be surprising if the potential earlier referred to was not being fulfilled.

The Commission is persuaded that law enforcement in Australia must be more effective. Emphasis is given to its concern by:

* the increase in the incidence of drug use referred to in Parts III and IV of this Report;

* the matters set out in Part IV Chapter 7, 'The Organised Basis of Drug-related Crime';

* the evidence of the increasing incidence of criminals and recourse to violence in relation to the drug scene; and

* the matters canvassed earlier in this Chapter.

The key, the Commission is convinced, is co-operation and the co­ ordinated and concerted direction of all available resources to areas in which they will be most effective. New techniques have to be found and implemented. Throughout this Report the Commission makes many

recommendations seeking to give effect to this. In the area of

financial control, the Australian Taxation Office (see Part VII Chapter 8), the Reserve Bank of Australia and, to a lesser extent, the private banks (see Part VII Chapter 9) have administrative responsibilities. The laws administered by those organisations and the nature of that

administration do provide opportunities to increase the resources available to law enforcement and hence increase its effectiveness. These opportunities must be availed of.

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It is true that the income tax laws in Australia, unlike those in the United States, do not make tax avoidance a criminal offence. Such a provision has made the taxation law and its enforcement an important weapon in the armoury of law enforcement in that country. That the law

in Australia is not the same is not necessarily the end of the matter. Confidential evidence received by the Commission (not from the Australian Taxation Office) leads it to the view that many criminals in Australia do lodge income tax returns. The accuracy of the returns

lodged is another matter. Information contained in an income tax return may be invaluable to a law enforcement agency which is investigating the illegal importation, production and trafficking of drugs. Discrepancies between the income which can possibly be earned from a disclosed

legitimate source and the income actually enjoyed and manifest in accumulated assets and life style may indicate the nature and extent of a criminal activity related to drug trafficking. Material contained in a return may, in the context of information otherwise available, be invaluable. It may indicate sources of funds, lines of communication and associations, and open other lines of inquiry by, for example, identifying such things as bank accounts and similar matters. The Commissioner of Taxation and his officers have extensive powers to demand and procure information relevant to the discharge of their responsibilities to administer the tax laws. Officers of the Australian Taxation Office engage in collecting information. They have developed techniques and acquired skill and experience in financial exercises directed, for example, to establishing that a person's assets are disproportionate to his disclosed income. In an appropriate case, access to any one or more of these holdings and skills may be of assistance to law enforcement. It will not always be, but law

enforcement presently does not have access to any of this information. Indeed, confidential evidence received by the Commission from senior officers of the Australian Taxation Office establishes that even where, in the course of their duties, the officers acquire information establishing with a high degree of certainty that a particular person, the subject of their attention, is or was a drug trafficker, the provisions of Section 16 of the Income Tax Assessment Act preclude that

information being made available to a police force.

The evidence received by the Commission shows that satisfactory co­ operation exists between officers of the Australian Taxation Office and enforcement agencies in the sense that once a drug offender is

identified by law enforcement agencies and is before the courts, the Australian Taxation Office generously, in terms of its overall commitments, devotes resources to ensuring that the individual does not escape payment of tax. None of the information acquired in the course of this exercise can, however, be made available to law enforcement agencies and it is not.

The Commission understands that the Australian Taxation Office is under a number of constraints. First is the inhibition imposed by the secrecy provisions of Section 16 of the Income Tax Assessment Act. The provisions of this section are set out in Part VII Chapter 8,

'Australian Taxation Office'. In essence, that section prohibits an officer of the Commonwealth or of a State, who acquires information provided or obtained as a consequence of the Income Tax Act, from disclosing or using that information save for the purpose of the Act and

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in the course of its administration. In the same way documents and information are not to be produced in court. There are, however, exceptions provided by Section 16. Authorised persons are not prohibited from communicating information to the Repatriation Commissioner, the Director-General of Social Services, the Director- General of Health and the Commissioner for Employee's Compensation for the purposes of the administration of the law for which they are responsible, and subject to the same secrecy provisions as are applied to the Commissioner of Taxation and his servants. No doubt the basis of these exceptions are that each of the bodies referred to distributes Commonwealth funds. However compelling a justification this might be, the Commission believes that the opportunity to increase the

effectiveness of law enforcement against those who have the major impact in the illegal importation, production or trafficking of drugs, in terms of benefits to Australian society as a whole, provides at least an equally compelling reason for an appropriate exception in the favour of law enforcement. The Commission was impressed by arguments advanced by senior officers of the Australian Taxation Office in confidential session of the advantages of the present situation where the system encouraged frankness, even from criminals, in the declaration of income and in the payment of tax on that income. The argument would be more compelling if the Commission had not, in the course of its hearings, heard evidence of a number of major traffickers who it is persuaded

would not be honest in the declaration of their income to the

Commissioner of Taxation. In any event, the Commission is inclined to the view that the impact of the illegal importation, production and trafficking of drugs on the Australian community, when it is engaged in by criminals on a large scale, may outweigh considerations thus advanced.

The second of the factors referred to above arises in the context of policy and priorities in the allocation of resources. The Commission was told confidentially by officers of the Commissioner of Taxation that the resources at the Australian Taxation Office had in recent times been heavily committed to dealing with 'legal' tax avoidance schemes and

those involved in them. The Commission is not in a position to offer any decided views as to the priorities which should be adopted by the Australian Taxation Office. It does, however, wish to remark that the beneficial effect on Australian society and the welfare of Australia, brought about by the break-up of organisations having a major role in the illegal importation, production and trafficking of drugs with the

assistance of information or expertise provided by the Australian Taxation Office, may not be measured simply in terms of the tax and penalties recovered.

The final of the three considerations mentioned may be a lack of appreciation of the need for, and benefits of, a concerted approach of the kind advocated by the Commission. The implications of a particular situation may be entirely different upon the collation of all

information from a number of sources than appears from a single piece of information. There must be an end to the present situation of 'tunnel vision' in the fight against drug traffickers, in this as in other areas. It is for such reasons that the Commission recommends the

setting up of National and State Criminal Drug Intelligence Centres and National and State Drug Information Centres.

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CONCLUSIONS AND RECOMMENDATIONS

Conclusions

A large proportion of the drugs illegally trafficked in Australia, particularly heroin, hashish and hashish oil, is imported. Money to purchase these drugs goes overseas. The need to comply (or appear to comply) with Foreign Exchange Control Regulations dealt with in Part VII Chapter 9, and the reviewing of applications to ensure compliance, means that records of transactions supplying or purporting to supply important particulars are brought into existence. The Commission believes that access to those records by law enforcement authorities, either on a case basis or in order to establish patterns and identify directions of activity, may prove valuable. The magnitude of the funds involved and the seriousness of the problem and its consequences justify

consideration of such matters. Emphasis is added by the tendency to permit the recovery of money from drug traffickers. If such provisions are to be effective, the money involved must be identified and traced.

The Commission emphasises that it is not advocating that officers of the Australian Taxation Office or the Reserve Bank become law

enforcement officers or discharge law enforcement functions in respect of those engaged in the illegal importation, production and trafficking of drugs. That is the work of police forces. Nor does the Commission think that the considerations it advances in this Chapter are the answer to illegal drug trafficking. It believes it is part of the answer. It believes it has raised matters in respect of the financial implications of drug transactions which deserve serious consideration and which, upon exploration, may advance the cause of law enforcement. In addition to access to information, access to the skills offered by the Australian Taxation Office and the Reserve Bank may be necessary for police officers properly to assess and utilise the information. On occasions it may be desirable for officers of the police force and of one or both of the organisations mentioned to work together side-by-side in the analysis of documentary records.

It is also necessary to appreciate that the Commission is not recommending unlimited haphazard access to the information or skills referred to. The Commission is convinced that the commitment of resources involved, and the intrusions on privacy necessarily involved, means that the access it proposes should be available only in carefully

selected cases where it is established that it will be used against those having a disproportionate effect in the areas of the illegal importation, production and trafficking of drugs. Even then the access must be subject to careful control. It is to be recalled that one of

the reasons for recommending the setting up of the Criminal Drug Intelligence Centres nationally and locally is to lead to more effective targeting. In the initial stages at least, some work will have to be done to acquire more information and in training law enforcement officers in an appreciation of the uses of the materials to be made available to them before a more precise approach can be formulated.

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Recommendations

The Commission recommends that:

** Continued and increased attention be given to:

- the financial implications of the illegal importation, production and trafficking of drugs;

- the utilisation of existing resources within the Australian Taxation Office and the Foreign Exchange Control Section of the Reserve Bank of Australia in assisting in law enforcement; and

- further endeavours to identify and develop new resources in this area.

** Existing foreign exchange controls should be more strictly enforced.

** The Australian Federal Police should be encouraged:

- to engage in that enforcement;

- to take steps to establish the accessability of records held by the Reserve Bank in respect of Foreign Exchange Control transactions; and

- to build up a degree of experience and expertise in the

utilisation of those records.

** Efforts should be made to determine the aggregate amount of money generated by the illegal importation, production and trafficking of drugs in Australia, and the sources and destinations of such funds.

In the view of the Commission it is only in the light of the most complete information, including the kind referred to, that the impact of the illegal drug trade on Australian society, the Australian economy, and Australia and Australians as a whole, can be fully appreciated. It is only when that impact is fully appreciated that responsible and effective decisions, for the allocation of

resources and in respect of the adequacy of existing laws, can be made.

** Law enforcement agencies should pay close attention on a continuing basis to the financial implications of the individual illegal importation, production and trafficking cases they are dealing with. This requires:

- increased attention to the financial aspects of the illegal importation, production and trafficking of drugs in the investigation of particular cases;

- training investigators in the implications of the financial aspects of transactions and in the means to deal with them in terms of training, expertise and appropriate powers; and

- equipping investigators, where the requirement has been demonstrated to exist, with additional resources.

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It will be said rightly that implementation of these suggestions will impose burdens on law enforcement agencies which are already heavily burdened. So it will. This must be balanced against any increased effectiveness. Such an assessment can only be made on the basis of information.

** Careful attention should be paid to the identification of

appropriate targets for the application of the resources being spoken of in this Chapter. Not every transaction relating to the illegal importation, production and trafficking of drugs will be worthy of detailed attention by enforcement agencies in respect of its financial implications. It is once again apposite to refer to the proposed role of the Criminal Drug Intelligence Centres in the area of developing targets.

** Section 16 of the Income Tax Assessment Act 1936 should be amended in three respects:

1. It should be amended to give law enforcement agencies access to the records of the Australian Taxation Office.

This access could be limited to members of the National or a State or Territory Criminal Drug Intelligence Centre. Access would be on the basis of an order obtained from a Judge of the Supreme Court of the State or Territory or of the Federal Court of Australia. The application would be supported by sworn material-- which could be on the basis of information and belief and which would remain confidential to the court.

The material would be directed to establishing that access to the Office's records might assist law enforcement in

identifying or apprehending a member or members of a group responsible for continuing illegal importation, production or trafficking of drugs on a scale to supply a number of users. Information thus obtained from the Australian Taxation Office or officers thereof should not be able to be produced in any court save as part of the case against a drug trafficker. Otherwise, officers of a Drug Intelligence Centre would be

subject to the confidentiality provisions of Section 16.

The Centre should in due course report to the judge who makes the order the outcome of acting upon that order. A summary of the report for statistical recording will also be furnished to the Drug Information Centre.

2. Section 16 should be further amended to permit the Australian Taxation Office to provide a member of a law enforcement agency with information coming into the possession of the Office indicating that a person is engaged in the continuing illegal

importation, production or trafficking of drugs. The police officer receiving the information could claim absolute privilege against disclosing his source of information.

3. Section 16 should be further amended to permit the Australian Taxation Office to communicate general statistical information significant to drug trafficking to the nearest Drug Information Centre.

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An example is the total amount in unpaid taxes recovered from time to time against those who have been convicted of offences against the uniform Drug Trafficking Act.

** Support to the Australian Taxation Office in respect of the

investigation of, and recovery of taxes and penalties from, those identified to the Office as engaged in the illegal importation, production and trafficking of drugs should be increased.

*-· The provisions of Regulation 6 of the Regulations governing the Reserve Bank should be amended to make it clear that the Reserve Bank may authorise a Criminal Drug Intelligence Centre in respect of persons or companies reasonably believed by the Director of such

Centre to be engaged in drug trafficking:

- to have access to records;

- to permit it to copy documents; and

- to obtain information from the bank and its officers,

in respect of transactions, subject to foreign exchange controls.

** Greater attention should be given to the removal from Australia of Australian bank notes and cash in breach of the Foreign Exchange Control Regulations. Increased attention to security checks on outgoing flights should provide an opportunity in this regard.

Increased attention by law enforcement agencies to the financial implications of the illegal importation, production and trafficking of drugs will result in an increased flow of information which

should lead to increased detection of those who engage in this activity.

** Consideration should be given to such steps as checking, on a random basis, passengers and others departing Australia for destinations commonly visited by those who engage in the illegal importation of drugs, to discover breaches of those Regulations.

** The implementation of the foregoing recommendations should be periodically reviewed for:

- Assessing the appropriate degree of allocation of resources to the activities in question.

- Improving techniques.

- Developing more appropriate legislation and administrative procedures to achieve the maximum impact of law enforcement on the financial aspects of the illegal importation, production and trafficking of drugs.

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Chapter 6 Drugs in the P ost

The Royal Commission received a substantial body of evidence, both open and confidential, establishing that drugs enter and leave Australia through the postal system and are transmitted within Australia through that system. So far as the legal importation and exportation of drugs and

the legal transmission of them through the internal postal system are concerned,there was no evidence to suggest that the present laws and administrative arrangements are not adequate. There was no evidence that drugs legally transmitted by post are diverted to illegal

trafficking or use in the course of their transmission.

Part IV Chapter 2, 'Methods of Importation of Illegal Drugs', deals with the various methods by which drugs are illegally imported into Australia. The postal system, as it there appears, is an important means of sucii importation. Heroin, because of its high value in proportion to bulk, particularly lends itself to illegal importation in

the mail. When LSD was fashionable it too lent itself to illegal

importation in the mail. There are other drugs presently not used to any great extent in Australia which also lend themselves to illegal importation in the mail.

Details of the number of seizures of illegally imported drugs effected as a consequence of Customs examination of mail entering Australia are found in the column headed 1 Parcel Post Examination' in an 'Analysis of drug seizures recorded by Narcotics Bureau' being the Annex

to Part VI Chapter 4. When considering evidence of the number of

seizures it is important to know that confidential evidence received by the Commission established that groups of criminals use the post to import drugs on an organised basis. Thus 700 grams of hashish were found in a hollowed-out book posted from overseas. Investigations showed that the same group posted over a period of time a number of

similar parcels every month. Other groups posted between 30 to 40 letters a month each with a small amount of pure heroin concealed and in that way imported amounts of 12 to 16 grams a month over a period

of months. In terms of street grams that is at least 48 to 64 street grams a month. By such methods a significant amount can be imported. An individual seizure of an attempted importation by post, if properly investigated, may therefore have a great significance.

The Commission also received evidence that on occasions illegal drugs were transmitted by mail within Australia. The Commission was informed by Mr J. L. Brady, Secretary of the Australian Postal

Commission, that 89 undeliverable domestic postal articles were found to contain narcotic drugs in the period 24/10/74 to 23/11/77 (OT 3376). It was because the articles were undeliverable that they were investigated and drugs found. Mr Brady made the point that there was no way of

gauging from this figure even a rough estimate of the extent to which drugs are being carried in domestic mail.

Part VII Chapter 10, 'Postal and Telecommunications Authorities', discusses the organisation and operation of the Australian Postal

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Commission which, trading as Australia Post, provides Australia's postal services. Some idea is there given of the magnitude of Australia Post's undertaking. Mention is made in the same Chapter of the Bureau of Customs discharging its responsibility to detect illegally imported drugs entering Australia by the postal system as part of its

overall function of maintaining a barrier against prohibited imports and of protecting the revenue. A Sub-Collector and support staff of the Parcels Post Sub-section of the Bureau of Customs in each Collectorate are stationed at the principal mail exchanges to discharge the Bureau of Customs' responsibilities to detect prohibited imports in mail from overseas and to ensure the payment of appropriate duty on all imported goods. In the course of carrying out this duty incoming mail is screened for illegally imported drugs.

Evidence received by the Commission indicates there is considerable scope for misunderstanding among officers of Australia Post, the Bureau of Customs and the State police of their respective functions and responsibilities concerning drugs illegally imported or trafficked in mail. This is epitomised by one case of which the Commission heard

confidential evidence. A woman, Mrs M. , took delivery of a parcel posted from overseas addressed to Mrs M. but not to her address. On examination, she realised the parcel was not intended for her. On closer examination, what was subsequently identified as approximately 1000 grams of hashish was found concealed in the parcel. The woman handed the parcel to the police who commenced investigations to find the intended addressee. This was done and the co-operation of the postal authorities

sought in arranging delivery of the parcel at a post office and in surveillance of the recipient after delivery. This co-operation was refused. The Narcotics Bureau became involved. A demand was made by the postal authorities of the police that they return the parcel

(including the drug) to postal authorities or risk prosecution under the Postal Services Act 1975 and the Regulations thereunder. The police refused to comply. They continued their investigation. Arrests were made in the State in question. An additional five packages imported by mail were found. They contained 3388 grams of hashish with a street value of $60 000. Individuals were subsequently arrested overseas. Although extreme, the example is by no means the only case of its kind heard of by the Commission. The point is not whether any agency is in

the right or the wrong. Such occurrences are inimical to Australia's efforts against drug trafficking. Insofar as they arise because of difficulties in respect of legislation, the legislation should be amended. Insofar as they arise because of breakdowns in communication, that breakdown should be repaired.

Legislative control over the inspection of mail is contained in the Customs Act 1901, and the Postal Services Act 1975, and the

Regulations and By-laws thereunder. Section 35 of the Customs Act provides that goods imported through the mail are subject to the control of Customs equally with goods otherwise imported. 'Goods' are defined to include all kinds of moveable personal property. (Envelopes and writing paper are moveable personal property). Section 93 of the Postal Services Act forbids the opening of, or tampering with, mail save with the authority of the Australian Postal Commission or the addressee. Provision for the opening of mail is made, however, in the Postal

Services Regulations. Australia Post construes the Customs Act as being

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subordinate to the Postal Services Act and Postal Services Regulations with the result that mail from overseas can only be opened in conformity with the Postal Services Regulations. Neither Australia Post nor its

staff has any role in the surveillance of drug trafficking other than providing Customs with facilities to examine postal articles and in opening them in accord with the Regulations.

A distinction is made between letters and other postal articles. A letter is not defined by statute but a standard letter is a letter weighing not more than 500 grams and with maximum dimensions of 120 mm x 235 mm x 5 mm (0T 3367).

Postal Services Regulation 41, so far as is material, provides:

41. (1) A letter received from a country or place outside Australia, being a letter that may contain goods--

(a) on which duties of customs are payable; or

(b) the importation of which is prohibited under a law of Australia,

shall, upon a request by the Commission, before delivery to the addressee, be opened by the addressee or his representative in the presence of an

authorised person and an officer of Customs for examination by the officer of Customs...

(3) A letter that is--

(a) received from a country or place outside

Australia; or

(b) posted in a postal receptacle or box or at any office of the Commission for transmission to a country or place outside Australia,

and bears on the envelope, wrapping or other cover a statement indicating that the letter contains an enclosure on which duties of customs may be payable, may be opened by an authorised person in the presence

of an officer of Customs for examination by the

officer of Customs...

(5) Where the addressee or his representative, or the sender or his representative, as the case may be, fails to comply, within a reasonable time, with a request by the Commission under this regulation, or refuses to pay duty as so assessed, the goods on which duties of Customs are payable shall be dealt with in accordance with Regulation 46.

Officers of Australia Post told the Commission that all incoming overseas surface and air mails are made available to Customs, in the

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first instance, for screening for prohibited imports. These articles fall into several categories and the action taken varies as follows:

* Letters-- endorsed with a Customs declaration to the effect that they may be opened officially.

If requested by a Customs official, an Australia Post official opens the item and, if it contains a prohibited drug, it is passed to Customs for disposal according to law.

* Letters-- not endorsed

If so requested by Customs, Australia Post retains the item and sends the addressee a card (pursuant to Regulation 41) requesting him to call and arrange for Customs clearance of the letter. When the addressee, or his nominee, calls, he presents the card to the Customs officer who obtains the letter from the custody of Australia Post. The addressee opens the letter in the presence of the Customs officer. If it contains a prohibited drug, it is retained by Customs; if not, it is given to the addressee.

If the advice card is refused or is returned unclaimed, two

nominated Australia Post officials open the letter in the presence of a Customs official. If the letter contains a prohibited drug, it is passed to Customs. If not, it is delivered in the normal manner (OT 3368) .

In respect of postal articles other than letters the Commission was told that, if so requested, Australia Post opens the item. If it is found to contain a drug or other prohibited import it is passed to Customs for disposal according to the law.

There were many complaints to the Commission by law enforcement officers that the notification of the addressee of a letter pursuant to Postal Services Regulation 41 simply warns illegal importers that a particular importation has been discovered and alerts them to the

interest of law enforcement agencies in their activities. The Commission has much sympathy for this view. On the other hand, the Commission does not regard the opening of an envelope simply to ascertain whether it contains a drug illegally imported as an invasion of privacy in the real sense. It is but an exercise of Australia's sovereign right to control goods permitted to enter the country.

Once an envelope is found to contain a drug illegally imported there is a case, in the Commission's view, for permitting the reading of its contents. Knowledge of the contents might:

* assist in the detection of organised importation through the mails;

* identify groups smuggling drugs otherwise than through the mails; or

* identify persons breaking the laws of other countries by trafficking in drugs.

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The Commission also considers that the Postal Services Regulations should permit Customs to reseal a letter or other postal article in which drugs have been found and require Australia Post to deliver that letter or article to the addressee in the normal way without any

indication that a drug has been found.

Like considerations apply to domestic mail. Confidential evidence received by the Commission from officers of Australia Post indicated that postal articles of domestic origin known or suspected to contain an illegal drug are, in accordance with current Australia Post instructions, forwarded to the addressee or returned to the sender. Whilst it understands that Australia Post's paramount concern is the sanctity of the mail and the need to deliver it promptly and without undue delay,

the Commission thinks it desirable that there be provision for the police to be involved when an illegal drug is found by an officer of Australia Post in the mail. In such a case the postal article should be

dealt with as though it were overseas mail.

There is need for uniform, accurate and informative statistics of the occasions upon which illegally imported drugs are detected in the mail. The statistics contained in the Annex to Part VI Chapter 4 came into existence as a consequence of the Commission's interest in the

topic of seizures. The Bureau of Customs should regularly report mail seizures to the proposed State Criminal Drug Intelligence Centres.

Drug detector dogs have a role in detecting drugs in the mail. They are discussed in Part XIII Chapter 1. The Commission also heard of the use of ' χ-ray' or fluoroscope techniques in detecting the presence of articles in the mail. The Commission is not in a position to come to a

final conclusion as to the efficiency of these techniques relative to dogs. There is no doubt that the best available techniques should be used.

The Commission does not favour making special provision empowering law enforcement agencies to read the mail, save in the limited

circumstances outlined above when drugs are actually found. In other cases existing procedures for searches are sufficient.

RECOMMENDATIONS

The Commission recommends that:

** The Postal Services Regulations should be amended to make express provision that:

- A letter received from a country or place outside Australia which may contain goods the importation of which is prohibited, may be opened by an authorised officer in the presence of an officer of Customs.

- If no illegal import is found in any postal article received from a country or place outside Australia which is opened the

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article may be re-sealed and dealt with in the normal course of post. A notation that the article was opened for Customs inspection may be placed in the article before this is done.

If a drug illegally imported is found in any postal article received from a country or place outside Australia which is opened then the drug may be handed to Customs to be disposed of.

- At the request of a Customs officer or a police officer

Australia Post should deliver the postal article, with or without the drug, in the normal course of post and without any indication it was opened. Any document contained in the postal

article may be read by an officer of Customs or police but its contents shall not be used or disclosed save to further the investigation of an illegal importation or in evidence against an illegal importer.

- If a drug, the possession or use of which is illegal, is found in any postal article in the internal postal system, then the drug may be handed to a police officer to be disposed of. At the request of a police officer Australia Post should deliver the postal article, with or without the drug, in the normal course of post and without any indication it was opened. Any document contained in the postal article may be read by a police officer but its contents shall not be used or disclosed save to further the investigation of an illegal importation or in evidence against an illegal importer.

** Statistics should be provided to the State Criminal Drug

Intelligence Centre in the State where the drug is fdund, of all illegally imported drugs found in postal articles and of all drugs found in the domestic mail.

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C h a p t e r 7 Interception o f C om m unications

The interception of communications as an aid to more effective law enforcement against criminals who deal in drugs was discussed at length in evidence received by the Commission. The points of view ranged from those which advocated wide powers of interception as essential to

effective enforcement to those which were opposed to permitting any interception as an unwarranted invasion of privacy. There were, of course, many witnesses who adopted varying positions between these extremes.

The communications, the interception of which may aid drug law enforcement, can take place by telephonic or like systems which in Australia are operated by the Australian Telecommunications Commission described in Part VII Chapter 10. Such communications also take place

either in documents, which may be transmitted in a number of ways, or in conversations. Modern technology is developing increasingly sophisticated methods of interception of communications, particularly oral communications of all kinds. Methods which were seen as extremely advanced two or three years ago now verge on the old fashioned. It is

not proposed in this Chapter to enter into a detailed discussion of the technology. It must nevertheless be recorded that as the technology improves the potential for encroachment upon privacy becomes greater.

This Chapter is concerned with whether, as a matter of principle, law enforcement agencies ought to be permitted to intercept

communications in aid of drug law enforcement and if they should, the conditions under which they should.

The present law on the interception of communications is outlined in Part V Chapter 5 'Interception of Communications'. To recapitulate briefly, under the Australian Constitution provisions dealing with telephone, telegraphic and like systems are within the legislative

competence of the Commonwealth. There has been for some time provision for the interception of communications by these systems in cases of national security. Recently the Narcotics Bureau was empowered to intercept telephonic and like communications in aid of drug law

enforcement. Those powers have more recently still been passed to the Australian Federal Police. Some States have legislated to provide for the interception of communications generally but not in uniform terms.

Other States have made no provision.

With specific reference to documents, the exercise of general powers of search and seizure given to law enforcement agencies may result in possession being taken of documents and thus in the interception of communications contained in the documents. These powers are dealt with

in Part V Chapter 6 'Searches and Seizures'.

ARGUMENTS FOR AND AGAINST INTERCEPTION

Evidence received from law enforcement agencies and officers in support of power to intercept communications is canvassed in Part VI

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Chapter 7 'State Police Forces'. In addition to the evidence there mentioned, the Commission received confidential evidence from some State Police forces and from the Narcotics Bureau of a number of instances in which it was claimed the ability to intercept telephonic communications would have been useful, if not essential, for more effective law enforcement. The instances referred to by the Narcotics Bureau were cases which had occurred at a time when the Bureau had no power to intercept telephonic communications. The Commission's evaluation is that a power to tap telephones in most of the instances referred to would have greatly improved law enforcement effectiveness. It is more likely

than not that drug traffickers who have never been prosecuted could have been successfully prosecuted.

Many of the arguments advanced against permitting electronic surveillance without consent centred on what the Australian Law Reform Commission described in Chapter 7 of its Report No.2 an interim report 1 Criminal Investigation' as: 'the relative balance between the enforcement of the criminal laws and individual privacy and liberty'. A number of witnesses saw this balance in terms of the introduction of electronic surveillance being worse than living with the problems its use was designed to solve.

Mr. R. N. Wesley-Smith, when presenting a submission on behalf of the Northern Territory Council for Civil Liberties, quoted an article by Professor D. Aitken of Macquarie University which appeared in the 'National Times' of 13--18 February 1977. This expressed a view that the community would not be prepared to endure 'anything and everything' to stamp out drug trafficking. The U.S. Prohibition experience was cited. The article argued that greater police powers such as the power to tap telephones would not stop drug trafficking but would result in a more powerful and more corrupt police force. It went on to say that increased powers of this type were unlikely to be used solely for their intended purpose and that the relative social costs and benefits did not favour increased powers to intercept communications.

The Queensland Council of Civil Liberties in its submission of 30 August 1978 commented similarly on powers of law enforcement agencies:

Bugging someone else's phone without their consent or placing a device on their person or property would however be an

infringement of property rights and ought to be punishable at law. In such cases the offender should be liable to criminal prosecution and/or an action in tort. In addition any evidence so obtained should be inadmissible in a Court of law.

(0T 15391--92)

The Council went on to argue that in Australia the

telecommunications system was owned by the Government and if selected persons were allowed to intercept communications over the

system, consumers could not go to another service which guaranteed privacy. Hence the 'privilege of eavesdropping' had to be exercised

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with great caution, complete with safeguards in the form of appropriate warrant procedure, judicial review and particularity, and limitation of the practice by law to:

...certain serious offences involving danger to life or

property,or the national security. (OT 15392)

A rather different perspective on the interception of communications is expressed in the view of the Committee of the Privy Council appointed in 1957 to enquire into the interception of communications in the United Kingdom:

...'If the police were to be deprived of the power to tap

telephone wires in cases of serious crime, the criminal class would be given the use of the elaborate system set up by the State and use it to conspire and plot for criminal purposes to

the greater injury of the law abiding citizen... Thus, in the view we take, if the power of intercepting telephone

conversations were to be taken away from the police the law abiding citizen would get nothing in return and might indeed suffer the greatest loss'. (Open Exhibit 457, pp.2--3)

The Commission also heard evidence from Senator (then Senator-elect) G. J. Evans, a former member of the Australian Law Reform Commission and vice-president of the Federal Council of Civil Liberties. Senator Evans directed the Commission's attention to the work of the Australian Law Reform Commission in the area of police powers and criminal

investigation. He produced to the Commission the Australian Law Reform Commission's Report No. 2 'Criminal Investigation' previously referred to. Senator Evans also drew the Commission's attention to work which had been done preparatory to the report and in particular to the work of Mr W. B. Fisse. Mr Fisse's working paper for the Australian Law Reform

Commission 'The Powers of the Australian Police Force' became Open Exhibit 457 and proved to be of considerable assistance.

U.S. Debate

The Commission was aware that the question of law enforcement agencies being empowered to intercept communications has been, over the years, the subject of considerable debate in the United States. Enforcement agencies in the United States have exercised power to

intercept communications for some time. On the other hand, there are considerations arising from provisions of the United States Constitution which have no legal relevance in Australia. The Report of the National Commission for the Review of Federal and State Laws relative to wire tapping and electronic surveillance, under the chairmanship of Associate Justice W. H. Erickson of the Supreme Court of Colorado, presented to the United States Congress in April 1976 was tendered to this Commission as Open Exhibit' 133. On page (xii) the Report referred to the

conflicting views held by those who at one extreme believed that a total ban on electronic surveillance was necessary for the protection of individual privacy and, on the other hand, advocates of strong law

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enforcement who hesitated to limit the use of techniques claimed to be a vital tool in fighting crime, particularly organised crime. The majority of the United States National Commission found electronic surveillance to be particularly effective in conspiratorial types of

crimininal activities but commented adversely on a number of aspects of the implementation of the power. A minority of the fifteen members of the Commission disagreed. Part of this disagreement was founded on the view that the costs of electronic surveillance were high compared with

the result. This view must be read in the light of specific

requirements of the United States legislation empowering the interception of communications by electronic means but imposing considerable burdens on manpower both in conducting the surveillance and in reproducing intercepted communications in documentary form.

CONTROLS ON INTERCEPTION POWERS

As is stated in Part VI Chapter 7 'State Police Forces', the many police officers who favoured the granting of power or increased power to intercept communications, recognised the necessity for controls on the exercise of such powers to protect the privacy of the individual. On the other hand, most of those who gave evidence before the Commission in

favour of inhibiting power to intercept communications, recognised that there were some circumstances where the disadvantages of permitting the interception of communications were temporarily outweighed by the threat constituted to individuals or society by certain actions and the capacity of a properly controlled power of interception to avert the threat or permit it to be effectively dealt with. It seemed to the Commission that the issues then are:

* the circumstances in which the interception of communications is to be permitted;

* the establishment of objective criteria by which those circumstances can be identified;

* the formulation of appropriate safeguards; and

* the implementation of those safeguards.

In Chapter 7 of its interim report (Open Exhibit 184) the Australian Law Reform Commission said:

Legislation is necessary to rationalise, simplify and make more relevant to modern law enforcement conditions the existing law with respect to surveillance devices. Systematic

recommendations about the use of such devices by persons other than members of the Australia Police are clearly beyond the scope of this reference. It appears to the Commission to be undesirable to approach the important question of the use of

surveillance devices in such a piecemeal fashion. The necessity for the use, and the possibility of such use of such devices by State Police, National Security Officers, Private Investigators or Corporations engaged in or threatened with industrial espionage all need to be taken into careful account in drawing appropriate legislation in this connection. Such legislation indeed may need to be drawn on a uniform basis.

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For all these reasons the Commission takes the view that the subject of surveillance devices is better dealt with by­ separate legislation than by the legislation specifically proposed in this report.

It may however be useful to state some tentative views which have been reached as to how this problem should be tackled in respect of police officers. First, we see no distinction in principle between telephone tapping and other forms of

surveillance involving the use of electronic listening devices. Secondly we think that the police ought not to be denied all the advantages of modern technology in fighting crime which itself uses it. Monitoring of conversations without the

consent of either party ought to be permitted in certain narrowly defined circumstances. Such authorisation should only be granted by a Federal Judge or a Judge of the Supreme Court of a State or Territory and should be available only in respect of very serious offences. Such judicial authorisation should

only be available when other investigative procedures have been tried and failed or would be impracticable. The authorisation should state with great particularity the offence, persons and places that are to be the subject of the surveillance. It

should contain such other specific terms and conditions as the Judge considers advisable in the public interest and should be valid for a period not exceeding ten days. (Open Exhibit 184, pp.106--07)

The Australian Law Reform Commission was reporting in the context of proposals, which were not proceeded with, to constitute an Australia Police administered by a Department of Police and Customs. This Commission is in substantial agreement with the views of the Australian

Law Reform Commission expressed in the passage set out above. In the same way as that Commission's concerns were limited by the reference which led to its Interim Report, this Commission's concerns are limited by its terms of reference.

Part IV of this Report deals with the factual terms of reference. Activities necessarily involved in the illegal production, importation and trafficking of drugs are dealt with there in some detail. The point is made, for example, in Part IV Chapter 7 'The Organised Basis of Drug-

related Crime', that those who have the greatest effect on the illegal drug trade operate as part of organised groups and carry on their activities extended in time over a wide geographical area. These activities necessarily involve a number of people in different geographical localities, complex planning, and the co-ordination of activities. For reasons dealt with in Part IV Chapter 7 'The Organised Basis of Drug-related Crime', Part VI Chapter 7 'State Police Forces'

and Part XIII Chapter 5 'Financial Controls', it is the illegal production, importation and trafficking carried on in this organised way which present the greatest difficulty in identifying those who are the most influential in these activities, in disrupting the activities and

in obtaining convictions. Reliable and flexible communications are essential to such activities. The Commission is satisfied that telephonic communications and face to face discussions are the most important means of such communication. It is of the view that the

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judicious use of a power to intercept communications taking place by such means will enhance the effectiveness of law enforcement agencies in dealing with this type of criminal.

The Commission proposes a uniform Trafficking Act to be enacted by the Commonwealth and the States. The proposal is detailed in Part XIV, Chapter 3. The Act is to be directed against drug activities of a major kind. The Commission considers it the appropriate place in which to make provision for the interception of communications so as to aid drug

law enforcement. Such legislation will enforce the legislative competence of the enacting parliaments. It is not necessary at the moment to give such powers for the surveillance of illegal drug users and petty pedlars.

The Commission also proposes a system of National and State Criminal Drug Intelligence Centres (Part XIV, Chapter 4). A State Criminal Drug Intelligence Centre will receive for assessment and appropriate dissemination all information relating to criminal activities concerning drugs in the particular State. These Centres will also have access to the National Criminal Drug Intelligence Centre which will have an Australia-wide viewpoint and will be responsible for liaison with overseas agencies. A State Criminal Drug Intelligence Centre should

therefore be in the best position to place in perspective the activities of any particular individual or group engaged in the illegal

importation, production and trafficking of drugs. For this and other reasons advanced in Part XIV Chapter 4, the Commission proposes that the State Criminal Drug Intelligence Centres be responsible for the interception of communications.

As has already been mentioned, interception of communications passing over the telephonic or like systems of communication is a matter of Commonwealth legislative competence. The interception of communications taking place outside that system is essentially a matter of State legislative responsibility. It is therefore convenient to deal with these two aspects of the interception of communications separately.

Telephone Communications

When the interception of communications passing through the telephonic system is spoken of, it must be understood that this means what it says-- communications actually being transmitted. In other words, a message may be intercepted before it enters the system, for example, by a bugging device which permits the speaker to be overheard as he speaks into the telephone. In the same way a message might be

intercepted after it has passed through the system. Such cases are not presently under consideration. These are aspects of matters to be dealt with later.

Because the interception of communications passing over the tele­ phonic system is so random and has such widespread ramifications, the Commission considers that interception should not be permitted, save on the order of a Judge of the Federal Court of Australia, or of the Supreme

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Court of a State or Territory. An application for such an order should be made by the director of a State or of the National, Criminal Drug Intelligence Centre or his authorized delegate. It should be supported by material which can be based on information and belief. The material

should establish as a condition precedent to the exercise of the court's jurisdiction:

(a) that the activity in question is drug trafficking in terms of the proposed uniform trafficking legislation;

(b) the desirability of resorting to the interception of communications notwithstanding the availability of other investigative procedures;

(c) the type of communication sought to be intercepted;

(d) the identity, as far as reasonably possible, of the person whose communications are to be intercepted and the place at which, and the means by which,the communications are to be intercepted;

(e) the identity of the person who is to supervise the making of the interception. This person should be a member of a State, or of the National, Criminal Drug Intelligence Centre;

(f) the arrangement to be made to eliminate or minimise the interception of communications unrelated to the matter being investigated;

(g) whether any private premises are to be entered without the consent of the occupier. If they are they should be so identified.

The requirement (a) above will establish that the activities in question are of a major kind. The Commission prefers the requirement in (b) to the Australian Law Reform Commission's suggestion that it be shown that other investigative procedures have been tried and failed or would be impracticable. The Commission believes that it is unlikely

that actual investigation will be able to proceed so logically as to permit other investigative procedures to be tried before progressing to the interception of telephonic communications. Similarly it does not regard impracticability of other investigative procedures as an

appropriate test if it can be shown that the interception of

communications may have a decisive effect upon the outcome of an investigation of a major drug ring.

A Judge having the above information may make an order authorising the interception of communications subject to such terms and conditions as he considers it desirable in the public interest. An order initially should be taken for a period not exceeding 10 days. Prior to or upon the expiration of the period, the relevant Criminal Drug Intelligence Centre should be able to apply for a further order for a period not exceeding 30 days. The Commission believes that the longer period is justified because the results of the initial period of authorised

interception will be available to the court, and the court will therefore be better informed as to the desirability of authorising further interception.

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The court should be empowered to grant further extensions, to be limited to 30 days, after it deems it appropriate to do so, having regard to the circumstances set out above.

Within 10 days of the expiration of a period authorised by any order to intercept telephonic communications, the relevant Criminal Drug Intelligence Centre should submit to the Judge who made the order, or, if he is not available, to some other Judge of the court which made the order, a written report containing full particulars of the times, dates and communications intercepted, or of any attempted interception and all the information relevant to the investigation obtained on that interception. A copy of that report should be retained by the National Criminal Drug Intelligence Centre. In this way there will be a central record of all interceptions and the Judges will soon acquire a fund of knowledge relating to the interception of telephonic communications which will enable them more effectively to ensure the interceptions are properly carried out.

Where any record is made of a communication intercepted pursuant to a court order, so much as does not relate to drug trafficking or

criminal offences of the kind subsequently mentioned, should be destroyed within five days of its being made and that destruction recorded in the report to the court referred to above. Those responsible for the interception of communications pursuant to such an order, or who have access to any intercepted communications, should be obliged to keep any information so acquired confidential and to use it only for the purpose for which the interception was authorised, i.e. to investigate drug trafficking. There should be one exception to this. Where, in the course of an authorised interception, information is acquired relating to the commission or proposed commission of a criminal offence carrying a maximum term of imprisonment of five years or more, that information should be able to be passed to the relevant police force subject to the same restrictions as apply to the information in the hands of those originally authorised to carry out the interception.

Other Communications

The Commission believes that the interception of other types of oral communication should be permitted on the authority of the director of the relevant State, or of the National, Criminal Drug Intelligence Centre. The officer should authorise interceptions only when he is satisfied that it is in aid of the investigation of 'drug

trafficking' and that such interception is desirable in the service of condition precedent (b) to the obtaining of a court order as set out earlier. Records should be kept of each occasion in which the use of a

listening device is authorised, and of the results of that use, and copies of those records forwarded to the National, Criminal Drug Intelli­ gence Centre. Where the placing or maintaining of a listening device necessitates the entering upon the property of a person without the con­ sent of that person, it should be necessary to obtain the authority of a magistrate in the same way that this is necessary to obtain a search

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warrant. The magistrate should be satisfied that the action is desir­ able as an aid to combat drug trafficking.

The Commission recommended in Chapter 6 of this Part of the Report that communications passing through the postal system should be able to be read only when illegal drugs had been found in the envelope or packet in which the communication was contained. The Commission accepts the proposition that logically there should be no distinction between

communications passing through the telecommunications system and communications passing through the postal system. The Commission is not, however, persuaded that the balance between the desirability of protecting the privacy of the mail and the use of the interception in favour of drug law enforcement is so decisively in favour of the latter, in the case of the postal system,as it is in the telephonic system. It is possible under the present law relating to search warrants for documents passing through the postal system to be seized and read. The Commission acknowledges that different considerations may apply in other areas; for example, where national security is involved.

AVAILABILITY OF INTERCEPTION DEVICES

This Chapter has so far dealt with the interception of communications in aid of law enforcement. The Commission heard evidence that criminals used commercially available devices to intercept law enforcement communications. It was suggested that the importation into Australia, and the sale in Australia, of those devices was not unlawful although their actual use was. The Commission believes that careful

consideration be given to controlling the importation of such devices so that they are available only to those who have a legitimate use for them.

RECOMMENDATIONS

The Commission recommends that:

** Police should be permitted by law to intercept oral communications in aid of drug law enforcement.

** The use of such power to intercept should be restricted to cases where drugs are illegally imported, produced, or trafficked on a substantial scale.

** In the case of the interception of communications by telephonic or like systems, the interception should be permitted only on the order of a Judge of a Supreme Court of a State or Territory or of the

Federal Court of Australia.

** Before authorising interception the Judge should be satisfied:

- that the activity in question is drug trafficking in terms of the uniform drug trafficking legislation;

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- as to the desirability of resorting to the interception of communications notwithstanding the availability of other investigative procedures;

- as to the method of communication sought to be intercepted, and the means to be employed in doing so;

- as to the identity, as far as is reasonably possible, of the persons whose communications are to be intercepted and the place at which and the means by which they are to be

intercepted;

- as to the identity of the person who is to supervise the making of the interception and who should be a member of a State or of the National Criminal Drug Intelligence Centre;

- with the arrangement to be made to eliminate or minimise the interception of communications unrelated to the matter being investigated;

- whether any private premises are to be entered without consent of the occupier and if so, they should be identified.

** The Judge may permit interception subject to such conditions in protection of the public interest as he thinks desirable.

** The order to intercept should initially permit the interception for a period limited to 10 days. There should be provision for further authorised interceptions for a period not to exceed 30 days upon applications duly made and authorised.

** The result of interception should be reported to the Judge who permits it, or in his absence, to another Judge of the same Court.

** Provision for the interception of communications in aid of drug law enforcement should be contained in the Uniform Drug Trafficking Act proposed by the Commission.

** The closest Criminal Drug Intelligence Centre (National or State) should be responsible for initiating an application to intercept.

** In the case of an interception of a communication made other than by a telephonic or like system of communication, the Director of the Criminal Drug Intelligence Centre for the area in question should be empowered to permit such interception where he is satisfied it is desirable in aid of law enforcement against drug trafficking.

** Where it is necessary to enter the property of a person without the person's consent in order to place or maintain a listening device, it should be necessary to obtain the authority of a magistrate in the same way that it is necessary to obtain a search warrant.

** Careful consideration should be given to controlling the importation of devices which may be used by criminals to overhear radio and other communications by law enforcement agencies.

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C h a p t e r 8 Task Forces

The point has already been made in this Report that those who engage in the illegal importation, production and trafficking of drugs do so without the constraints of territorial, legislative and administrative boundaries within which Australian law enforcement agencies must

operate.

Another factor of which the Commission was aware was that a police force responsible for enforcing within defined territorial boundaries the law of a State or Territory often reacts to the prevalence of

particular types of crime by the formation of special squads with designated responsibility for a particular type of crime.

The principle of such specialist squads has proved highly successful on occasions. As many authoritative witnesses told the Commission, this type of specialisation does not provide an answer to those latter-day groups and individuals whose multi-faceted activities can range across a wide spectrum of crime, from illegal gambling, drug trafficking,

receiving of stolen goods, and white collar crime to virtually any sort of business enterprise of varying degrees of legitimacy.

The disadvantage of a specialised State or Territory police squad attempting to deal with the type of criminal mentioned above is multiplied when, as exemplified by the evidence quoted in Part IV, such criminals do not confine themselves to a particular city, State or,

indeed, country.

It became increasingly apparent during the Commission's hearing of evidence concerning drug law enforcement in Australia that effective action against such criminals often requires a combination of the resources of a number of law enforcement agencies and, on many

occasions, the resources of other agencies not traditionally identified with the pursuit of criminals. Investigations of such criminal activities are, by their nature, of such complexity as to require investigators from law enforcement and other agencies who have access to

all available information about all the people under investigation and about all the activities in which the suspects may be involved. Only in this way may all available resources be concentrated on the most vulnerable individuals at their most vulnerable points.

It is worth repeating at this point a variation of an example already used in other Parts of the Report. Illegal importation of cannabis oil may originate with the purchase of the oil in Lebanon. The funds paying for the purchase may have left Sydney disguised as a commercial transaction and the oil may enter Australia in the same way. Those who provide the funds may have no other connection with the transaction. They may regularly finance drug trafficking in this way but it is very difficult to obtain evidence against them. The funds may be obtained from directly engaging in large scale receiving of stolen property where the prospect of obtaining evidence to sustain a

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conviction is good. The individuals and their associations may be known to the New South Wales police robbery squad which has an informer in the group. The oil may be intended for distribution in Brisbane. Those documents brought into existence to comply (or give the appearance of complying) with Australia's foreign exchange control laws, and held by the Reserve Bank, may be useful in identifying individuals whose involement might not otherwise be known. An offence against the foreign exchange control laws may be committed. The Australian Federal Police has responsibilities in respect of such an offence and it may have cause

to use information obtained through its intelligence holdings in respect of those responsible for the movement of funds. The Queensland Police may have an undercover agent on the fringe of the group responsible for the oil's distribution in Brisbane. Bureau of Customs information holdings in respect of commercial transactions may permit the particular shipment to be identified. The transaction may be but one of a series of similar transactions. It is only when all known information is collated and assessed that the extent and significance of the

transaction and those involved can be identified and law enforcement resources deployed to the greatest effect. This can only be achieved by combining in a co-ordinated and concerted fashion all the resources of law enforcement and other agencies in order to identify all those engaged in a particular aspect and to convict them.

A means of achieving this co-ordinated, concerted approach is the task force. The term 'task force' is one which is increasingly used in private enterprise, public administration and law enforcement. In the law enforcement context it is a concept of considerable currency in the United States and is applied to a group of investigators drawn from

different agencies working together as one unit in respect of a specific 'target' or problem.

OVERSEAS EXPERIENCE

The task force concept is by no means unique to the United States. A spectacularly successful task force operation drawn to the attention of the Commission was 'Operation Julie', in which the concerted action of various United Kingdom police forces led to the arrest of 122 people and the smashing of a drug ring manufacturing and distributing 95 per cent of the United Kingdom's supply of illicit LSD and an estimated 60 per cent of the world's total supply. Details given to the Commission

in evidence incorporated as Open Exhibit 663 show that 'Operation Julie' involved police officers drawn from at least 10 United Kingdom police forces.

The United Kingdom, however, has a unitary system of government and although there are a number of separate police forces, there is substantial central direction and individual forces have more in common than not. A much greater challenge to the concerted operation of a number of agencies is provided by a system with a diversity of

government in which the various component governments have a law enforcement function and agencies to carry out that function. This is the case in the United States where legislative power is shared among the Federal Government, State governments and various units of county, city and town and other local governments. Each level of government has

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its own law enforcement agencies and there is considerable diversity even at any one level of government. For example, there are of the order of a dozen Federal Government law enforcement agencies and all of these as well as the relevant State and city agencies can be operating within a single city.

U.S. Experience

Because Australia possesses three tiers of government and law enforcement agencies at both the Commonwealth and State level, the Commission considered it appropriate to interest itself in the experience of United States efforts to co-ordinate and concert operations of law enforcement agencies by the use of task forces.

The Commission heard both open and confidential evidence from witnesses experienced in the application of the task force concept in the United States. Mr F. J . Veyvoda, Chief of the Organized Crime Control Bureau of the New York City Police Department, gave evidence

concerning two such task forces operating in New York against drug traffickers. One unit, the New York Joint Task Force, consists of members of the Federal Drug Enforcement Administration, the New York State Police, and the New York City Police. Mr Veyvoda told the

Commission this unit was a fully integrated command in which law enforcement agents of all three levels of government acted in a co­ ordinated effort against drug traffickers. The other unit, the Unified Intelligence Division, also comprised Federal, State and City law enforcement officers. Their responsibilities included intelligence­ gathering through surveillance of major criminal elements involved in

the illegal drug trade.

In the course of separate visits to the United States, first by the Commissioner and Senior Counsel assisting him and later by Junior Counsel assisting the Commissioner, the Commission studied a number of task forces. Task forces were seen in operation and detailed

discussions held with law enforcement officers who had had experience of task forces at all levels of responsibility.

These enquiries showed that the United States experience had led to the adoption in most instances of the following principles which had come to be seen as fundamental:

(i) The hierarchy of the participating agencies must be committed to the success of the task force.

(ii) A task force must be precisely and realistically targeted on individuals or an area of concern.

(iii) The loyalty of the members of the task force is to the task force and not to· parent agencies.

(iv) The task force must be self-contained in premises removed from the premises of any of the participating agencies.

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(v) Written agreements between participating governments or agencies are frequently signed to avoid misunderstandings and arguments.

The Commission heard submissions which argued that it is desirable that a task force be housed as part of the principal participating agency. The Commission considered those arguments but does not accept them. The Commission heard arguments that the concept of loyalty to the task force was unworkable. The rebuttal of these suggestions is to be found in the many task forces throughout the United States functioning effectively in accordance with the above principles.

THE JOINT TASK FORCE

Mention was made in Part IV, Chapter 7, 'The Organised Basis of Drug-related Crime1, of the Joint Task Force, an investigation team of Commonwealth and New South Wales law enforcement officers established on the joint recommendation of the Australian Royal Commissioner, the Honourable Justice E. S. Williams, and the Honourable Justice P. M. Woodward, the Royal Commissioner conducting the New South Wales Royal Commission into Drug Trafficking. This Royal Commission was aware of the difficulties likely to arise in the implementation of the task force concept in Australia. For this reason it and the New South Wales Royal Commission recommended the setting up of a task force to operate for 12 months and that a report be made at the end of this period to the

Commonwealth and New South Wales Governments containing recommendations, inter alia, upon the future of the task force.

An agreement between the Commonwealth and New South Wales

Governments establishing the Joint Task Force and defining its objectives is incorporated into the evidence of this Commission as Open Exhibit 653. The agreement embodies, with some alterations and

additions, the terms of a draft agreement document prepared jointly by the Australian and New South Wales Royal Commissioners and forwarded to the respective governments at the time of the Commissioners'

recommendation to set up the task force. The terms of the agreement draw upon the memorandum of understanding between the U.S. Federal Drug Enforcement Administration, the New York State Police and the New York City Police setting up the New York Task Force and the Unified

Intelligence Division, the units referred to earlier in this Chapter. A copy of the American memorandum of understanding is incorporated into the evidence of this Commission.

The agreement between the Commonwealth and State Governments makes provision for the Joint Task Force to be managed by a Management Committee of two officers (one a law enforcement officer) each from the Commonwealth and New South Wales appointed from outside the Joint Task Force. The Management Committee is responsible to the Commonwealth and New South Wales Governments. Responsible to it is an Operations

Committee consisting of four members of the Joint Task Force, including the Task Force Leader and his deputy. The agreement sets out the responsibilities of the Management Committee, the Operations Committee, and the Leader of the Task Force. It also makes provision for

contributions of manpower and equipment by the respective governments, the sharing of expenses between them, and like matters. Both

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governments agree to give the Joint Task Force access to any information held by them or their agencies to which access might lawfully be given. Provision is also made for skilled accounting expertise to be available to the Joint Task Force if it is required.

In the light of their experience the Task Force Leader and the members of the Joint Task Force have developed a Task Force Manual which deals with the day-to-day problems that arise in the course of running the Joint Task Force. The manual, a copy of which is a confidential

exhibit before the Commission, makes provision for such things as the authority of individual members of a task force; the exchange of powers, bearing in mind that members of a task force come from different agencies with various powers; the organisation of a task force into

units, and similar matters. The manual stresses, as did the

recommendations of the Royal Commissioners to the respective governments and the agreement between the governments, that the allegiance of members of the Joint Task Force is to the task force alone and not to

any other person or organisation.

The Commission has received copies of the regular reports made by the Task Force Leader to the Management Committee and heard confidential evidence from an officer of the Deputy Commonwealth Crown Solicitor's Office in Sydney about arrangements developed between himself and his

opposite number from the New South Wales Crown Solicitor's Office for provision of continuing legal support for the Joint Task Force pursuant to the terms of the agreement between the Commonwealth and New South Wales Governments.

The Joint Task Force has successfully completed an operation against a target group and at the time of writing this report was investigating other targets.

Pilot Study

The Joint Task Force was seen by this Commission as an innovation in Australia which must be regarded as a pilot study. The Commission was told by many people that for a variety of reasons the concept would not work. There have been, as was expected, difficulties. These

difficulties have been overcome. When it comes time to assess the operations of the Joint Task Force it must be remembered that it commenced operations at a time when unusual factors were at work and affecting the members of the participating agencies. There was the

resignation of the New South Wales Police Commissioner and subsequent developments in that force; the formation of the Australian Federal Police incorporating the Commonwealth Police was in train; and an

inquiry into allegations of corruption of members of the Narcotics Bureau was announced. Subsequently the abolition of the Bureau was announced. Any one of these events could be expected to be unsettling for the individual agencies and for the Joint Task Force.

The point of referring to the Joint Task Force in this Chapter is to indicate that there is already in Australia an accumulation of practical

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experience which can be availed of and which should facilitate the setting up of any further task forces. The Commission believes that the Joint Task Force has so far operated satisfactorily, despite its being such an innovation and despite its having commenced at a time of such unsettling events in various law enforcement agencies.

The Commission continues to favour strongly implementation of the task force approach. It reiterates the recommendation that it and the New South Wales Royal Commission into Drug Trafficking made at the time they recommended setting up the Joint Task Force: 'there is an urgent need to develop co-operative modes of investigation probably using the Task Force or Strike Force in agency models of co-operation developed in the United States to eliminate wasteful duplication of effort and to increase efficiency'.

IMPLEMENTATION

The Commission sees the implementation of the task force concept in Australian law enforcement activities as leading to a concentration of effort and resources, now often fragmented or duplicated, on particular, identified problems. A 'problem' may at first be identified in terms of people, for example a group of people suspected of engaging in many kinds of criminal activities. At other times a 'problem' might be

identifiable only in terms of activities, such as a heavy influx of dangerous drugs of a particular type into one or several Australian cities. At another level the problem might be the development of new investigative methods or of an economical and effective but uniform approach to training.

The life expectancy of a particular task force would vary according to the particular tasks involved. For example, a task force set up by agreement between the Commonwealth and a State Government on drug- related crime could, unfortunately, expect to have an indefinite life expectancy while a task force established to investigate a relatively narrow field of activity such as pilfering on the waterfront of particular cities might, after a relatively short period, be disbanded

if action was found to be required only against one group of people.

While the Commission emphasises that governments and law enforcement agencies must be flexible in selecting possible targets for task force action, the Commission does not advocate indiscriminate application of the concept to every drug trafficking group, or indeed every other criminal group, which comes to the attention of police. For example, the Commission believes that the only drug smuggling groups which would justify the attention of a task force would be those which, by virtue of

such considerations as the quantity of drugs they illegally produce, import or traffic, the period of time over which they have operated and the extent of suspected distribution, demonstrate that they present difficulties for other law enforcement methods.

Other drug trafficking groups, perhaps even relatively large ones, should continue to be the focus of police drug squads. The Commission

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has recommended elsewhere that part of the resources of State police drug squads should be routinely allocated to long-term investigations of people believed to be regular and large-scale traffickers. However, once a group or activity appears to be beyond the resources or scope of

a single squad, consideration should be given to a task force approach. If a task force is set up, the police drug squads would not have to commit their resources directly to any further investigations of such

targets.

Precision Required

The Commission believes very careful consideration will need to be given to identifying precisely the individuals or activities to become the centre of attention of a task force. The task force will have to be ruthless in not becoming involved in peripheral matters. Any

possibility of an over-lap with normal police activities or any possibility of some individuals or activities escaping the attention of both task forces and existing police units because of confusion or

misunderstanding about responsibilities will have to be carefully watched. The Commission believes that in the field of drug-related crime, the National and State Criminal Drug Intelligence Centres, which it recommends in Part XIV of the Report be set up, would have an

important role to play in this regard.

Personnel for Task Forces

The Commission does not see the members of a task force being drawn only from law enforcement agencies. A task force to investigate information that drugs were being landed by aircraft in remote areas of Queensland for distribution in Sydney and Melbourne and that birds were being smuggled out of the country for sale in the United States could

include personnel drawn from several agencies. It could include an officer of the authority responsible for fauna protection in Queensland and who regularly patrols the area where aircraft landings are alleged to occur. Officers of the Commonwealth Department of Transport, which has overall responsibility for surveillance of the Australian coastline,

and officers of the Queensland and New South Wales State Police and of the Australian Federal Police might also be included. The reason for State police representation is obvious; the Australian Federal Police representative could have particular knowledge of relationships between

Australian and American criminal figures. The Australian Federal Police also has responsibility for liaison with law enforcement agencies of other countries. Because of the international implications of the example cited above, it might be considered advantageous to include a United States law enforcement officer in the task force.

It may be appropriate to include officers of a State Commission for Corporate Affairs in a task force. Confidential evidence given to the Commission indicated that some drug traffickers also engage in activities which could be of considerable interest to Corporate Affairs Commissions. · The activities often have common features in group associations, methods of operation and so on.

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The Commission emphasises that there is no question of members of a task force who are not policemen acting as policemen. They would be members of a task force in order to provide the benefit of their

personal knowledge and experience and ready access to their parent organisation and its resources as related to particular aspects of a task force's investigations. The Commission sees individual task force members’ ready access to the resources of their parent organisation and

their experience in being able to isolate and appreciate information holdings of these organisations as being of great potential value to a task force. The presence of such individuals in a task force should go a long way to overcoming the traditional inhibitions to total effort caused by the division of public resources among many and varied bodies and different levels of government.

The degree of involvement of a particular officer in a task force will vary from officer to officer and from time to time. It may not be necessary for an officer from a particular organisation to be present the whole of the time. The officer should, however, be present for at least part of the time in order to provide the face-to-face contact which is so essential to building a co-ordinated and highly motivated group with a full appreciation of and access to all sources which may prove of assistance.

NO SHORT-TERM EXPECTATIONS

As outlined in the preceding pages, the Commission sees the size, composition, objectives and expected duration of any task force as being variable in the extreme. In simple terms, they are matters which can be decided only after careful consideration of the target-- be it peop