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Parliamentary Paper No. 228/1977

The Parliament of the Commonwealth of Australia

SENATE STANDING COMMITTEE ON SOCIAL WELFARE

Drug Problems in Australia -an intoxicated society?

Brought up and ordered to be printed 25 October 1977

The Commonwealth Government Printer Canberra 1977

Reference:

Continuing oversight of relevant aspects of the Report of the Senate Select Committee on Drug Trafficking and Drug Abuse

A report on the extent and nature of the inappropriate use of alcohol, tobacco, analgesics and cannabis

© Commonwealth of Australia 1977 ISBN 0 642 03067 7

Printed by Authority by the Acting Commonwealth Government Printer

MEMBERS OF THE COMMITTEE Senator Peter Baume (New South Wales), Chairman Senator W. W. C. Brown (Victoria) Senator D. J. Grimes (Tasmania)

Senator J. I. Melzer (Victoria) Senator T. J. Tehan (Victoria) Senator M. S. Walters (Tasmania)

Secretary

R. P. Joske The Senate Parliament House Canberra

Contents

A Declared Strategy

Recommendations .

The Drug Debate •

Page

1

3

13

CHAPTER 1 Modes of Control and National Strategy 15

Introduction . 15

Modes of Control . 16

Punitive Model . 17

Punitive-Diversionary Model 17

Laissez-Faire Model 17

Educative Model 17

Health Model 18

Economic Model 18

International Conventions 18

Current Australian Practice 18

A National Strategy for the Control of Drug Use and Abuse . 20

CHAPTER 2 Alcohol 25

The Dimensions of a National Disaster 25

Definitions 26

Clarification of Terminology 26

Alcohol in Australian Society 27

Social Acceptability 28

Drinking Habits of the Young 29

Extent of the Problem 30

Who Abuses Alcohol? 31

Consumption 32

Beer 33

Wine and Spirits 34

Consumption Patterns and Their Significance 36

Price and the Consumption of Alcohol 41

Low Alcohol Content Beer 44

Legislation 46

Alcohol and Health 49

Alcohol and Social Behaviour . 52

Alcohol and the Work Force . 53

Alcohol and the Australian Aboriginal 57

Licensing Laws 58

Economic Costs and Benefits of Alcohol 59

Advertising and the Media 60

Treatment Services 63

v

Driving, Road Crashes and Alcohol . Diversionary Programs Breathalyzers and Random Breath Tests Blood Tests Licences Education . Mechanical Deterrents Proposed Sub-committee on Drugs and Driving A National Strategy on Alcohol

3 Tobacco

The History of Smoking and Tobacco Extent of the Problem Who Uses Tobacco? Health Low-Tar, Low-Nicotine Cigarettes Pipe and Cigar Smoking . Non-smokers Advertising and the Media

Britain Norway Sweden United States Australia Sales to Minors Education Excise and Subsidy Conclusions

CHAPTER 4 Analgesics

Extent of Analgesic Abuse Sale and Distribution of Analgesics Who Abuses Analgesics?. Health Effects of Analgesic Abuse Availability Advertising . Education Views of Earlier Senate Committees . Summary

CHAPTER 5 Cannabis

The History of Cannabis Extent of Use Law Enforcement as an Indication of the Extent of Use Conclusions on the Extent of Use Who Uses Cannabis? Attitudes

vi

Page

64 67 68 69 69 70 71 72 72

79 80 81 81

86 90 93 93 96 96 97 97 98 98 100 101 102 103

107 107 111 115 117 119 121 122 123 124

127 127 129 134 134 135 140

Page

Extremist Literature on Cannabis 141

Health . 142

Cannabis and Driving 145

International Conventions and Cannabis 148

Major International Cannabis Studies 148

Indian Hemp Drugs Commission Report 1894 148

Panama Canal Zone Military Investigations 149

LaGuardia Committee Report 1944 149

Wootton Report 1968 149

Le Dain Report 1972 . 149

Shafer Report 1972 150

United Nations Reports 1973-74 150

Eastland Sub-committee 1974 150

The Jamaican Study 1975 151

The Greek Study. 151

The Costa Rican Study 151

Egyptian Studies 152

Major Australian Cannabis Studies 152

Senate Select Committee Report 1971 152

Health Commission of New South Wales Report 1973 152 New South Wales Joint Parliamentary Committee 1977 153 Cannabis and the Law 153

Evaluation of Stated Objectives of the Law 154

Evaluation of Implied Objectives of the Law 156

Conclusions on Stated and Implied Objectives of the Law . 157 Recent United States Experience 158

A National Strategy on Cannabis 161

Recommendations on the Law Relating to Cannabis 164

CHAPTER 6 Amphetamines and Barbiturates

Amphetamines Barbiturates .

CHAPTER 7 Supplementary Policy Considerations

Co-ordination and Research Definitions Surveys Detection Agencies Intoxication and Criminal Responsibility Transcendental Meditation

CHAPTER 8 Education

Education in Australia Conclusions .

171 171 172

175 175 175 176 177

177 178

181 181 184

vii

CHAPTER 9 Background and Conduct of the Inquiry

Background . The Collection of Evidence Other Current Inquiries Acknowledgments .

Dissents by Committee Members Senator Melzer Senators Tehan and Walters jointly . Senators Melzer, Tehan and Walters jointly

viii

Page

185 185 185 186 186

189 189 190 194

APPENDIXES

Page

Appendix 1 Voluntary Code for Advertising of Alcoholic Drinks . 199

Appendix 2 Tar and Nicotine Yields of Cigarettes Sold in Australia as at April 1977 . 200

Appendix 3 Voluntary Code for Advertising of Cigarettes in Print Media . 202 Appendix 4 Table A-Proprietary Oral Analgesics Percentages of National Sales Volume by Outlets 203

Table B-Proprietary Oral Analgesics Percentage Sales of Analgesics Related to State Population 203 Table C-Proprietary Oral Analgesics Percentages of Market Shares 204

Appendix 5 Obtaining Consumption from Data Supplied by Reckitts Pharmaceutical Division 205

Table A-Proprietary Oral Analgesics Consumption (Arbitrary Units) by State 206

Table B-Proprietary Oral Analgesics Consumption (Arbitrary Units) per Person 207

Appendix 6 Cannabis Use by 168 Undergraduates at the University of Sydney 208 Table A-Number of Occasions Cannabis Used 208

Table B-Time Since Last Use at Date of Interview 208

Table C-Age at First Use 208

Appendix 7 Age Distribution of Drug Offenders . 209

Appendix 8 Consumption of Amphetamines, 1971 to 1976 210

Appendix 9 Recommendations Made by the Senate Select Committee on Drug Trafficking and Drug Abuse, 1971 211

Appendix 10 Suggestions and Recommendations Made by the Senate Standing Committee on Health and Welfare in February 1975 in its Report on the Continuing Oversight of the Report of the Senate Select Committee on Drug Trafficking and Drug Abuse 215

Appendix 11 Resolutions of the Seventh International Conference on Alcohol, Drugs and Traffic Safety, Melbourne, 23-28 January 1977 217

Appendix 12 Witnesses 220

Appendix 13 Submissions 223

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A Declared Strategy

Australia has no declared aims in the area of drug abuse beyond well meant, but ultimately empty, calls for its eradication. The community needs a firm, agreed objective to ensure a concert of purpose. It is imperative that all governments declare a set of clearly stated goals and evaluate the success of programs aimed at achieving those goals.

The Committee urges the Commonwealth Government to declare the following seven-point strategy, developed fully in Chapter I, as its approach to drug abuse. The Commonwealth having provided the lead, State Governments should then be encouraged to make similar declar­ ations.

1. Total elimination of drug abuse is unlikely, but government action can contain the problems and limit their adverse effects. Control of drug abuse requires a long-term commitment within a publicly declared program with clearly identified goals, and with time frame,

monitoring procedures, financing arrangements and standards all specifically stated. 2. All drugs are not equally dangerous and all drug use is not equally destructive. Control efforts should therefore concentrate on drugs

having the most adverse public health effects, particularly where use puts others at risk. Programs should give priority to individuals abusing high-risk drugs and to compulsive users of any drugs. 3. Efforts to reduce the supply of and the demand for drugs are

complementary and interdependent, and Commonwealth programs should be based on a balance between them. 4. Existing programs aimed at reduction of supply and demand must be broadened. In the reduction of supply, a higher priority should be

given to increasing international co-operation in preventing the illicit production of drugs. In the reduction of demand, increased attention should be given to prevention, constructive early inter­ vention and better access to rehabilitation services. 5. Drug abuse is primarily a socialjmedical, not a legal, problem, though

such abuse may have important legal consequences and aspects. 6. Management must be improved to ensure the maximum effect from resources committed to drug programs. Better interagency co­ ordination is required. More attention must be paid to the setting

of priorities, with Commonwealth law enforcement efforts focused on high-level traffickers and Commonwealth resources focused on habitual users of high-risk drugs.

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7. The Federal Government has particular responsibility for gzvmg national leadership in coping with drug abuse. The States have an equally important role, especially in the direct provision of services. No national control program will be effective unless all governments co-ordinate their activities. The Commonwealth Minister for Health should have primary responsibility for Commonwealth action relating to all forms of drug use and abuse.

Recommendations

The recommendations made in this report are brought together and listed here for convenient reference.

CHAPTER 1 Modes of Control and National Strategy

1. That all Governments in Australia adopt the seven declarations of the proposed national strategy as the basis of the strategy for

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their approach to drug abuse. 20

CHAPTER 2 Alcohol

2. That blood alcohol level be expressed in Standard Inter­ national Units (millimoles per litre) and that the new system be phased in with appropriate publicity. 26

3. That governments and the public use the term 'road crash' instead of 'road accident'. 27

4. That government imposts on all alcoholic beverages be adjusted annually so that real prices of the beverages remain constant. 43

5. That government revenue policies operate to keep at approxi­ mately the same level the prices of the absolute alcohol contained in beer, in wine and in spirits, bearing in mind that the Government has at its disposal various revenue devices with which it can achieve this aim. 44

6. That a sales tax or excise on wine be phased in over a period which will enable the wine industry to adjust appropriately. 44

7. That the excise imposed on beers of a low alcohol content (defined as not more than 2. 5 per cent by weight) be 30 per cent less than that on other beers. 46

8. That the Commonwealth Department of Health and the health policy body in each State and Territory continually monitor the levels and patterns of alcohol consumption and formally advise their respective Governments, before each budget, of the health considerations to be taken into account when examining excise and other revenue from alcohol. . 49

9. That the Federal Government take urgent steps to introduce into the Commonwealth Public Service an appropriate program to deal with alcohol abuse, and that all possible encouragement be given to the State Public Services to follow the direction taken in Victoria. . 56

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I 0. That, in view of the demonstrated value of alcohol programs in industry, adequate long-term funding be provided by Common­ wealth and State Governments specifically for the purpose of promoting, monitoring, evaluating and designing such

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programs. 56

11. That the Federal Government give practical support and en­ couragement to Australian firms and trade unions for the development and introduction of their own alcohol-abuse programs with suitably trained personnel. 56

12. That Commonwealth and State Governments participate with trade unions and employers in further research into and de-velopment of appropriate alcohol-abuse programs. 57

13. That the Federal Government implement the recommendations made by Committees of both Houses on alcohol and its use by the Aboriginal community, and report to the Parliament on the steps which it takes in accordance with those recom-mendations. 58

14. That the Australian Capital Territory Police have restored to them the authority to enter licensed premises to deal with the problem of under-age drinking. . 58

15. That State and Territory licensing laws be more strictly en-forced than at present. 59

16. That section 60 (bona fide travellers provision) of the New South Wales Licensing and Liquor Act be repealed. 59

17. That State Governments defer relaxation of regulations re­ garding sales outlets and that the Commonwealth Government not in any way increase the availability of alcohol. 59

18. That the Commonwealth Department of Health examine the relationship between merchandising and alcohol consumption patterns and advise on the types of sales outlets most appropri-ate to attainment of the desired national goals. 59

19. That the Commonwealth Department of Health prepare and publish a comprehensive analysis of the costs of alcohol abuse in Australian society.. 60

20. That the Commonwealth Government ban the advertising of alcoholic beverages, whether by way of corporate advertising or by exhibiting of the brand name of such beverages in a planned fashion, on radio and television and in areas under direct Commonwealth control, such as in the Territories and at airports. 62

21. That, until a total ban has been implemented, the question of substantial compliance with the voluntary code for the ad­ vertising of alcoholic beverages by brewers, distillers, wine makers and all retailers of alcoholic beverages be reviewed

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22. That State Governments and local government authorities be encouraged to ban the advertising of alcoholic beverages. 62 23. That the Federal Minister for Environment, Housing and Community Development, and the State Ministers responsible

for youth, sport and recreation, appeal to sportsmen and sportswomen throughout Australia not to lend their names and prestige to the promotion of alcoholic beverages. . 62

24. That the Commonwealth Government make any grants to sporting and cultural bodies conditional on their not accepting money from manufacturers and retailers of alcoholic beverages and investigate the possibility of indemnifying such bodies for loss of revenue, at least in the short term. 62

25. That the Commonwealth Government consider refusing tax deductibility for expenses incurred in the promotion of al-coholic beverages. 62

26. That, if diversionary programs are shown to be effective, they be introduced in all States and Territories. . 68

27. That provision for the evaluation of effectiveness be incor-porated in any diversionary programs introduced . 68

28. That, if evaluation shows random breath tests to have positive effects on driver behaviour, they be introduced in all States and Territories. 68

29. That police extend Breathalyzer testing in the vicinity of all places where people drive after drinking. 69

30. That the suggestions of the Australian Law Reform Com-mission regarding screening tests of drivers be adopted . 69 31. That blood samples be taken from all persons over a specified age who are involved in serious road crashes. 69

32. That the option to issue qualified licences to convicted drink-drivers be introduced in all States and Territories . 69

33. That learner drivers be provided with information about the effects of alcohol and other drugs on driving, that questions on such effects form part of the licence test, and that literature on the interaction of alcohol and drugs with driving be sent with

notices of licence renewals. . 70

34. That, except for pilot programs, Commonwealth and State Governments give financial assistance only to educational programs which identify the dangers of drink-driving and which have been demonstrated to produce the desired be-havioural changes. 71

35. That Commonwealth and State Governments support the researching and development of mechanical devices to deter drink-driving and, when perfected, require that they be fitted to the vehicles of recalcitrant drivers, at their own expense, as a prerequisite to any renewal of their driving licences. 72

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36. That a Sub-committee on Drugs and Driving be established within the National Standing Control Committee on Drugs of Dependence, with at least the following functions-(a) To formulate and state a national policy relating to alcohol,

other drugs and driving.

(b) To monitor and assess the drink-driving problem and pro­ blems associated with driving and other drugs. (c) To monitor and assess existing drink-driving counter­ measures.

(d) To examine proposals to counteract the drink-driving problem and problems associated with driving and other drugs.

(e) To formulate guidelines for the implementation of viable proposals, each of which should have an evaluation com­ ponent built in. (f) To report its findings, and to recommend lines of action, to

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Commonwealth and State Governments. . 72

37. That the National Standing Control Committee on Drugs of Dependence be required to report publicly every two years on the activities and progress of the Sub-committee on Drugs and Driving. . 72

38. That the Commonwealth Government develop and announce a specific policy on alcohol and alcohol abuse, which should include a clear statement of the Government's intention to bring about an overall reduction in the level of alcohol con-sumption in the community. 72

CHAPTER 3 Tobacco

39. That Commonwealth and State Governments determine as national policy a commitment to a decrease in per capita consumption of tobacco. 79

40. That tar and nicotine contents be stated on cigarette packets. . 93

41. That the Commonwealth Department of Health establish upper limits for tar and nicotine contents, and progressively reduce permitted levels until all cigarettes with tar and nicotine contents in excess of the established upper limits are banned.. 93

42. That the recommendations on the rights of non-smokers made by the National Health and Medical Research Council at its 81st and 82nd sessions be implemented immediately in areas under direct Commonwealth control; and that State Govern­ ments and local government authorities be urged to implement these recommendations also. 96

6

248·1'9177-'1

43. That the Commonwealth Government ban the advertising of tobacco products, whether by way of corporate advertising or by exhibiting of the brand name of such products in a planned fashion, on radio and television and in areas under direct Commonwealth control, such as in the Territories and at

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airports. 100

44. That, until a total ban has been implemented, the question of substantial compliance with the voluntary code for the adver­ tising of cigarettes by manufacturers and retailers be reviewed annually. 100

45. That State Governments and local government authorities be encouraged to ban the advertising of tobacco products. 100 46. That the Federal Minister for Environment, Housing and Community Development, and the State Ministers responsible

for youth, sport and recreation, appeal to sportsmen and sportswomen throughout Australia not to lend their names and prestige to the promotion of tobacco products. 100

47. That the Commonwealth Government make any grants to sporting and cultural bodies conditional on their not accepting money from manufacturers and retailers of tobacco products and investigate the possibility of indemnifying such bodies for loss of revenue, at least in the short term. 100

48. That the Commonwealth Government consider refusing tax deductibility for expenses incurred in the promotion of tobacco products. 100

49. That laws which make the sale of tobacco products to minors illegal be strictly enforced, and that the penalties prescribed be increased. 100

50. That the Commonwealth Government declare as policy its intention to decrease the consumption of tobacco at the rate of 2 per cent a year for the five financial years commencing with 1978-79. . 103

51. That excise policy be one tool used to reduce the consumption oftobacco. 103

52. That the Commonwealth Government end its annual financial contribution to the Tobacco Industry Trust Account. 103 53. That State Governments cease their contributions to tobacco-growing research. 103

54. That the Commonwealth Government gradually move towards ending all specific and general subsidies to the tobacco industry within the next ten years while ensuring adequate structural re-adjustment arrangements for tobacco producers. . 103

55. That the Commonwealth Government ensure that the burden of any readjustment falls in the first instance on imported leaf. 103

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CHAPTER 4 Analgesics Page

56. That the proposals for restrictions on the sale of compound analgesics adopted by the National Health and Medical Re­ search Council at its 83rd Session, in April 1977, be imple-mented by Commonwealth and State Governments. 120

57. That all analgesics, whether sold with or without prescription, carry the following warning on the container:

CAUTION: This preparation is for the relief of minor and temporary ailments and should be used strictly as directed. Prolonged use without medical supervision could be harmful. 121 58. That all non-prescription analgesics in pack sizes containing

more than twenty-five tablets or twelve powders be available only from pharmacies. 121

59. That the Commonwealth Department of Health monitor con­ sumer usage of and attitudes towards proprietary medicines to measure the effects of various intervention strategies. 121

CHAPTER 5 Cannabis*

60. That the Commonwealth Minister for Health direct that appro­ priate studies of the health implications of cannabis use in Australia be made, in order to provide within five years a data base adequate for the introduction of a national policy.. 145 61. That the proposed Sub-committee on Drugs and Driving

within the National Standing Control Committee on Drugs of Dependence-( a) Study recent developments in cannabinoid detection in order to advise on suitable equipment, procedures and

standards for the road patrol sections of State and Territory police forces. (b) Monitor research on the effects of various levels of canna­ binoid on driving performance so that correlations can be

established for purposes including the fixing of penalties for cannabis-driving convictions. (c) In conjunction with the Australian Law Reform Com­ mission, produce model legislation to identify offences

resulting from cannabis-driving and to set appropriate penalties. 147

62. That, as soon as possible, State and Territory legislation be amended to provide for the introduction and use of appropriate methods of detecting tetrahydrocannabinol in drivers and for the imposition of appropriate penalties. 147

63. That information on the effects of cannabis on driving be included in existing education programs on road safety. . 147 64. That, as a matter of urgency, action be initiated to have cannabis moved to an appropriate schedule in the United

Nations Convention on Psychotropic Substances. 148

•see dissents by Committee members, at pages 189 ff.

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65. That the objectives of policies to control the use of cannabis be­ ( a) To reduce national consumption of cannabis in respect of both recruitment and present personal use. (b) To acknowledge and account, in law and law enforcement,

for the difference between the abuse of cannabis and of other illicit drugs. (c) To reduce, and finally to prevent, cannabis use, especially while driving or performing other complex psychomotor

functions. (d) To reduce the social harm resulting from contact with criminal suppliers. (e) To ensure that the legal controls are not of such a nature as

to inhibit rehabilitation of the user or to cause more social damage than use of the drug causes. (f) To increase respect for the law and the law enforcement system. (g) To identify those people who need treatment as a con­

sequence of cannabis abuse, and to develop effective

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treatment methods. 163

66. That the Commonwealth and the States enact cannabis legislation which recognises the significant differences between opiate narcotics and cannabis in their health effects and in the criminal impact on users and the community.. 164

67. 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 proceedings or in relation to any application by the offender for employment. (h) A conviction should not, of itself, disqualify a person for employment. 165

68. That the maximum prison penalty and fine for trafficking in marihuana be raised to levels more appropriate to the quantities involved in seizures. . 166

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69. That penalties for the possession of hashish, hashish oil and all purified forms of tetrahydrocannabinol remain at present

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levels. 166

70. That penalties for the importation, manufacture and sale of hashish, hashish oil and all purified forms of tetrahydro­ cannabinol be substantially increased in accordance with the principle of introducing higher penalties adopted at the meeting on drug abuse held by Commonwealth and State Ministers on

1 October 1976. 166

71. That where necessary Commonwealth and State Govern­ ments consider clarifying the law so as to impose, for the cultivation of a specified and limited amount of marihuana for personal use, the same level of penalty as for possession. 166

72. That appropriate diversionary programs be developed and instituted for both possessors of and traffickers in cannabis. . 167

73. That the Commonwealth Government initiate annual reviews of the effects of any changes in the law relating to cannabis to determine any need for further action. . 168

CHAPTER 6 Amphetamines and Barbiturates

74. That proposed amendments to the ordinances in the Australian Capital Territory and the Northern Territory relating to restrictions on the use of amphetamines be treated as a matter of urgency. 172

CHAPTER 7 Supplementary Policy Considerations

75. That the Commonwealth Department of Health be responsible for the development and dissemination of approved definitions of the various terms used in describing the drug problem. 176

76. That the Commonwealth Department of Health develop and disseminate a standard protocol for the collection of com­ parable data and that researchers working on drug-use prob-lems be encouraged to use this protocol. 176

77. That the Commonwealth Department of Health produce and regularly upgrade an appropriate statement of national goals, in order of priority, for research into drug use. 177

78. That the functions of the Australian Narcotics Bureau and relevant State and Territory law enforcement agencies be expressed in terms of community patterns of drug use, and that failure to affect these patterns appropriately be considered prima facie evidence of inadequate performance requiring re-evaluation of the roles, structures and funding of such agencies. 177

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79. That the Commonwealth Attorney-General refer to the Australian Law Reform Commission for inquiry and report such changes to the criminal law, if any, as may be necessary to ensure that persons who choose to use intoxicating substances are deemed to be responsible for offences which they commit

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while under the influence of such substances. 178

CHAPTER 8 Education

80. That the community be made fully aware of the objectives of the National Drug Education Program. 184

81. That all drug-education programs be evaluated against the stated aims of the National Drug Education Program. . 184 82. That funds be withdrawn from drug-education programs which are found to be ineffective.. 184

83. That, where possible, evaluation of the various State drug­ education programs be conducted by means as effective as those used by R. P. Irwin in his studies of Canberra high school students in 1973 and 1974.. 184

84. That the annual allocation of Commonwealth funds to the National Drug Education Program be increased to allow for proper evaluation of the programs under its supervision. 184

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The Drug Debate

The drug use debate has brought forth extremist views . Arguments are often biased, many cannot be justified, nearly all are emotional. In supporting calls for particular actions, some contributors to the debate have been quite ready to distort or misrepresent facts. Even research

has not displayed desirable objectivity or aimed at an impartial search for knowledge. The extreme options being presented are heavy legal sanctions for breaking a strict prohibition on one hand, and total permission on the

other. While we may reject these views, they have been taken into con­ sideration when examining the evidence. A multiplicity of options can be found between these extremes. A re-orientation is needed, away from the protection of entrenched moral positions toward a constructive debate which has as its aim the diminution of the problems drugs present to our society. Attachment to this goal rather than emotional attachments to favoured solutions will aid the search for more reasonable and more efficacious strategies.

The poor standard of the debate itself has contributed to the level and nature of drug use. One doctor has called it 'the drug problem problem'. It is important that the community understands not only all the issues but also the need for more community responsibility and involvement in this

debate. Unless the standard of debate improves appreciably, we shall not even begin properly to comprehend the problem, let alone move toward its alleviation. Drug use arises within a society of which we all are part. All people use drugs, and blanket moral protestations of their evil are largely hypocritical. It is society itself that creates the conditions which lead to licit and illicit

taking of drugs to excess, for drug use is derived from the basic mores of our society. The use of drugs is not just a problem of deviance. The Committee has endeavoured to state the problems of excessive drug use, to highlight the harmful effects caused by improper use and to set a standard and reference point for further debate. However, in com­ piling this report we have been faced with some significant problems in the collection of hard data. Opiates provide a good example. The quality of submissions on the use of opiates in Australia was poor. While any amount of soft and anecdotal evidence of their use has been available, there has been a great paucity of factual, hard data.

Consequently, the Committee has not considered the opiate problem in depth. It receives attention in this report only so far as is necessary to put in perspective our discussion of the use of other drugs. Abuse of opiates and other narcotics is serious, but alcohol and tobacco are abused by a greater number of people and at greater total social and economic cost.

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The debate on opiate use should concentrate on the actual dangers of the particular drug rather than on the complicated folklore which sur­ rounds drug use. At present, sound information on the dangers of opiate use is being rejected by potential users as being biased and clothed in hypocrisy.

The Committee has resolved to return to the problems of drug use and specifically to consider opiate narcotics. Prescription drugs, while a necessary and valuable part of medicine, also give rise to numerous problems. However, the Committee has not received the necessary information to enable it to give adequate consider­ ation to these problems.

Further, while the use of hallucinogens appears to have decreased, once again we have not received the information necessary for a useful contribution on this issue. The Committee's terms of reference permit renewed consideration of these matters also at any time.

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CHAPTER 1 Modes of Control and

National Strategy

Introduction We live in a drug-taking society. Drugs relieve symptoms, expand minds and satisfy a myriad of personal needs. The media exhort us to try chemical solutions for headaches, sleeplessness and obesity, and to make life more pleasurable by drinking alcohol or smoking tobacco. The use of prescription drugs continues to grow as the range of useful drugs in­ creases and as patients more and more expect to have drugs prescribed for their ills.

Drug taking is not new. Man has always taken drugs in some form. Western societies have predominantly used alcohol and, for the last three or four centuries, tobacco. Many eastern societies have used opiates and cannabis since recorded history and other societies have used less well known drugs such as the hallucinogenic mushrooms consumed in Mexico.

Many statements allege recent increases in the extent of the illicit use of drugs. In trying to assess present use it is necessary to examine what is known of the recourse to drugs, licit and iJlicit, in the past. The current debate is distinguished by extreme views, marked hysteria, misinformation

and lack of perspective. Indiscriminate resort to terms such as 'licit' and 'illicit' without understanding their historical roots and arbitrary nature does not aid in the setting of priorities for controlJing the use of drugs. Very little is known of the history of drug taking in Australia beyond the important place aJcohol assumed in Australia's early history (see Chapter 2). Many preparations containing drugs now illicit were formerly freely

available in Australia. The use of these drugs in Australia is not well documented, but their use in other countries has been extensively documented.

The nineteenth century saw widespread use of opiates, which was not regarded as a problem for most of that century. The unrestricted use of opiates in Australia was terminated early in the twentieth century. Like many of today's alternative society groups, the turn of the century

bohemians were conspicuously drug oriented. They drank vast quantities of alcohol and coffee. Respectable citizens of that era were horrified at the use of coffee, as are those of today at the use of some illicit drugs. The public was being warned:

The sufferer (from coffee addiction) is tremulous and loses his self­ command; he is subject to fits of agitation and depression. He loses color and has a haggard appearance ... As with other such agents, a renewed dose of the poison gives temporary relief, but at the cost of future misery. 1

Most drugs became illicit in the present century only and, despite recent efforts, statistics are still not at all reliable.

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Modes of Control

Late nineteenth century America has been described as a dope fiends' paradise, with opiates sold freely over the counter to anyone. 2 However, it must be remembered that some unknown part of this availability was legitimate at a time when there was nowhere near the range of medicinal drugs which is available today. One New England doctor/druggist (one of four in a town) reported selling 300 lb of opium per year and increasing his sales of laudanum (an opium-alcohol mixture) fourfold in 20 years, to a population, relatively stable over that time, of only 10 000. Children were tranquillised on Godfrey's Cordial-a mixture of opium, molasses for sweetening and sassafras for flavouring; pain relief was sought from a multitude of preparations (one United States drug house supplied 600 opium mixtures); and many people ate opium or drank laudanum for pleasure. 3

Drug use is part of the mainstream of activity in society. It is not a wholly deviant pursuit. The Consumers Union of United States, Inc., cites well documented cases of very eminent and influential people who were addicted to drugs. Among them was Dr William Stewart Halsted who became widely known as 'the father of modern surgery'; throughout his distinguished career he was dependent first on cocaine and then on morphine. 4

Drug use and the attitudes to that use arise out of the mores of a society. These are not fixed, and attitudes to drug use can change as the mores alter. Statements which assert that never before have people taken illicit drugs in such vast quantities do not really aid the setting of priorities and meaningful objectives. Australians are now using more of the illicit drugs but we also use much more of the licit drugs. The whole world has become more catholic in its use of drugs as modern communications bring different cultures into contact. The Middle East may well have influenced our taste for marihuana as much as the West has influenced the taste for alcohol in the Middle East.

Medicine has seen a revolution in chemical therapy in recent decades. Alcohol consumption continues to rise and tobacco is consumed in very large quantities. Many people do not realise that the use of alcohol and tobacco is drug use and that each causes vastly more damage in Australia than all illicit drugs combined. Australia is a drug-taking society and almost all the drugs used for medical or non-medical reasons are dangerous if used unwisely. Finally, drug abuse, which is primarily a social/medical problem, often has legal consequences.

With this understanding, it becomes apparent that a coherent, con­ certed and all-embracing policy should be formulated to alleviate the harmful effects of drug use. There is need for a declared policy which sets priorities and continually evaluates the measures which it promotes.

For drug use, society has evolved a number of modes of control, all of which aim to rehabilitate. These are not applied uniformly or con­ sistently, and their effectiveness is almost never evaluated. Many policies

16

rely on the adoption of one of these modes of control and consequently an understanding of them is useful. Briefly, the alternative models are as follows.

Punitive Model

The punitive model of control evolved comparatively recently. It was adopted by most countries during the twentieth century. In this model, not only is non-medical use of the drug proscribed by the law but anyone who possesses, uses or traffics in it is liable to sanctions under the law. Many drugs, including heroin and cannabis, are controlled in this manner. The aim is to deter potential users and to punish those who do use the drug or traffic in it. It is assumed that the existence of an adequate punish­

ment will deter both use of, and trafficking in, the proscribed drug.

Punitive-Diversionary Model

This is very similar to the punitive model but combines diversion with deterrence and punishment. The diversion may be compulsory under the law and can take the form of medical or psychological treatment or education. It may also be optional in the sense that the offender can

participate in the program or pay the penalty under the law. Programs of this type are now being introduced, or experimented with, primarily in connection with alcohol-related traffic offences, and they are also being expanded into other areas. For example, in March 1976, New South Wales introduced a pilot diversionary program for 'drink-drivers'.

Laissez-Faire Model

Until recently this model was epitomised by the attitude to smoking. It involves letting choice-even ill informed choice-operate. This model is supported by some on the basis of the libertarian argument of John Stuart Mill that society should not regulate self-regarding acts. There are now many uncontrolled substances which, if used in certain ways, can give a chemically induced 'experience'.

Educative Model In this model, people are taught desirable drug-taking practices. The facts, perhaps with propaganda, are presented, and the individual or group may be urged to act upon conclusions acceptable to the educator. The current position of tobacco is an example of this: school children are taught the dangers of smoking and the general public are warned that 'smoking is a health hazard'. The educative model is proposed by some as a solution to

abuse of nearly all drugs. Most education programs are designed to give information to users or potential users of drugs, and the aim of the pro­ grams is to alter or influence ·behaviour of the members of the target groups. Appropriate changes of behaviour need to be demonstrated to

provide evidence that the programs have been effective.

17

International Conventions

Current Australian Practice

Health Model

Drug use can also be viewed as a health problem. Some drugs are available freely; others are available only on a doctor's prescription; and adverse effects are treated only when the patient presents for medical attention. A particular drug is then controlled only in regard to the consequences of its use.

Abusers of aspirin and other analgesics are normally dealt with by the health model, and do not come to the attention of the law. But abusers of narcotics come primarily to the attention of the law, and their subsequent management may not include a health component. To this extent some narcotics users consider that they are at a disadvantage.

The health model addresses itself to consequences rather than to causes.

Economic Model Taxation of drugs has become an important source of government revenues and is said to have the potential to deter licit use because of the increased cost. Since the mid-nineteenth century, when the price of gin in England was increased by government initiative, governments have contemplated, and sporadically used, excise of various kinds to raise the price of certain drugs and, theoretically, to lower consumption. Increased excise can lower consumption, at least temporarily, and can alter the nature of drug taking if one preparation is substituted for another which bears a higher tax.

Drug use is not only an international problem; it is an international business. Its control demands co-operation beyond national boundaries. Two major United Nations Conventions-the 1961 Single Convention on Narcotic Drugs and the Convention on Psychotropic Substances­ provide a basis for this co-operation. These conventions specify, for listed substances, the conditions for control which signatory nations are obliged to fulfil. However, the Single Convention on Narcotic Drugs has a major fault, inasmuch as cannabis is listed in the Schedule with narcotics. This defect will be discussed in Chapter 5.

Australian Governments have never committed themselves to any sub­ stantive and comprehensive policy on drugs. Drug abuse in Australia is dealt with in a piecemeal fashion. Law enforcement authorities are expected to enforce laws, some of which have neither full community support, nor, as many police believe, full support in the courts. Health authorities struggle to deal with a health problem which is continually growing and changing. Supporting organisations provide a myriad of services, poorly integrated one with another and without any coherent overall community goal.

The predominant Australian models of control are the punitive, health and educative models. While these are seldom consciously analysed as modes of control, the implicit assumptions which they entail have been the guiding principles for the control of drug use.

18

The punitive model is extensively used in Australia. A whole range of drugs is proscribed and their use leads to contact with the law and to sanctions. It appears, though, that the courts themselves have become disillusioned with their sole reliance on this model. By taking a more liberal approach to users who come before them, they have encouraged experiments with the punitive-diversionary model. While these develop­ ments are to be encouraged, the Committee is concerned that they are taking place in a national policy vacuum. There is alse some concern that the full range of policy alternatives may not have been considered.

Punitive control does not cover a wide range of drugs and often ignores the health needs of the individual. Medicine has had to step in to 'pick up the pieces'. Health professionals have been forced to deal not only with the physical consequences of drug use but also with the social consequences of neglect and, at times, with the negative results of punitive controls.

From the debate on drug use/abuse, education almost invariably emerges as one potential strategy. Most witnesses expressed strong reservations about present drug-education programs. Other than Australian Narcotics Bureau funding and alcohol-in-industry programs, the only drug program specifically funded by the Federal Government is a

drug-education program.

The Consumers Union of the United States, commenting on the drug policy of the 1960s there-an important source of Australian ideas­ outlined disadvantages which can flow from education: To sum up, national drug policy throughout the 1960s contributed to the

rise of the current youth drug scene in at least four major ways. First, by emphasising 'drug abuse', it virtually dictated youthful drug deviance rather than other forms of deviance. Second, by publicising marijuana, LSD and LSD-like drugs, the amphetamines and other stimulants, the barbiturates and other depressants, and the opiates as well, these pronouncements in­ formed an entire generation of the broad range of mind-affecting drugs from

which a choice could be made. Third, for many the warnings actually served as lures. And finally, the supposed facts provided to inform and guide young people turned loose in the contemporary illicit-drug supermarket were almost invariably incredible, in conflict with everyday experience. Hence young people were left to flounder along without guidance they could trust­ to learn by their own trials and errors and those of their peers.

The errors young drug users made, of course, were numerous-and some of them were tragic. This we all now know. But the extent to which well­ meant, sincere, but disastrous anti-drug policies contributed to the tragedies is still only vaguely perceived, or not perceived at all. 5 Education is not a universal panacea. It is one tool that has to be used selectively and only if it can be effectual. The Committee is so far unaware

of any effectual drug education program in Australia.

In discussing the drug debate, we earlier expressed our grave concern at the current low standard of debate. While all the reasons for this are not entirely obvious, one factor is that there is a great lack of that class of data which describe the incidence of drug use in Australia. This lack of data

allows those with prejudices to advance their line undeterred by facts. It

19

A National Strategy for the Control of Drug Use and Abuse*

also leads to much frustration for people working in the field. Often the use of the statistics which do exist is either flagrantly dishonest or dangerously naive. It is necessary to get agreement on a common language for use in the field of drug abuse. There needs to be agreement as to what constitutes abuse and what constitutes use of drugs discussed in this report. Some agreed definitions would aid dialogue and understanding. For example, is there such a thing as marihuana 'use' as distinct from 'abuse'? Should we abandon the term 'road accident' in favour of the term 'road crash'? Surveys do not use the same language or definitions. Many sets of data are non-comparable because each set employs its own definitions of drug use and each has its own premises concerning risk groups and their reactions. This will be more fully discussed in Chapter 7.

There are no nationally agreed or understood goals for drug programs. Desirable achievements and outcomes are nowhere stated clearly. Government responsibility should include the provision of a framework for concerted action to reduce the level of drug abuse. So far, however, contributions by governments have been limited to sporadic legislative action and isolated grants of money. Health authorities and the various treatment agencies work on, knowing neither the dimensions nor the exact nature of the problem. They lack a general strategy that can mould their individual efforts into a more meaningful attack on drug abuse.

No successful national strategy can be planned and effected without clearly stated and agreed goals. The Committee proposes some possible goals and notes that the present lack of agreed objectives complicates current efforts to control drug use.

The Committee recommends:

That all Governments in Australia adopt the following seven declarations as the basis of the strategy for their approach to drug abuse.

1. Total elimination of drug abuse is unlikely, but government action can contain the problems and limit their adverse effects. Control of drug abuse requires a long-term commitment within a publicly declared program with clearly identified goals, and with time frame, monitoring procedures, financing arrangements and standards all specifically stated. Policies must be formulated on a long-term basis without expecting immediate success. However, target dates can be set for the achievement of sub-goals within the policy framework. Funding must not be ad hoc and must be guaranteed over time. At present, the Commonwealth Government's specific funding for the control of drug abuse is limited to the Australian Narcotics Bureau, a drug-education program and a grant for alcohol-in-industry programs. Finance for the drug education program has dropped in real terms over the last three years.

* The Committee wishes to acknowledge the Brown Paper entitled Federal Strategy for Drug Use and Drug Traffic Prevention, prepared for the President by the United States Strategy Council on Drug Abuse and made available in November 1976.

20

2. All drugs are not equally dangerous and all drug use is not equally destructive. Control efforts should therefore concentrate on drugs having the most adverse public health effects, particularly where use puts others at risk. Programs should give priority to individuals abusing high-risk drugs and to compulsive users of any drugs.

The main problems of drug abuse in Australia relate to alcohol and tobacco. Alcohol is by far the greatest problem in terms of cost to the community and social consequences. Any effective national strategy must recognise the extent of the abuse of these two drugs and the scope of the resources required to control this abuse as well as the abuse of narcotic drugs, prescription drugs and cannabis.

The Committee strongly believes that not enough emphasis is placed on alcohol and tobacco because of dominant-but incorrect-community attitudes that they are not drugs. At present, the drugs of abuse which adversely affect the health of the largest number of Australians are known. Alcohol and tobacco clearly rank first. There is significant abuse of prescription drugs. Cannabis has been used by about 8 per cent

of the community but the health risks are unknown. Abuse of minor analgesics is common and opiate abuse, which is devastating for affected individuals, may involve about 0.5 per cent of the population. Priorities need to be constantly reviewed in the light of community events. For example, because the use of opiates constitutes such a high danger to health, a small rise in opiate use could lead to a re-ordering of priorities. Similarly, the use of cannabis while driving is extremely dangerous and an increase here could lead to a further re-ordering.

3. Efforts to reduce the supply of and the demand for drugs are com­ plementary and interdependent, and Commonwealth programs should be based on a balance between them. Australia appears to be using more resources to reduce supply than it uses to reduce demand. Demand for major drugs is being actively pro­ moted and will not spontaneously diminish. While there is a demand, someone will accept any risk and find a way of supplying the drugs in demand. Fines and confiscation will be accepted as a 'tax' to be passed

to the consumer. Also, scientific development has been directed more to detecting drugs than to finding more responsive ways of reducing demand. There must be more commitment, in terms of finance and research, to reducing demand.

4. Existing programs aimed at reduction of supply and demand must be broadened. In the reduction of supply, a higher priority should be given to increasing international co-operation in preventing the illicit production of drugs. In the reduction of demand, increased attention should be given to prevention, constructive early intervention and better access to rehabilitation services. Treatment is often difficult, even under the best conditions. It is also often unsuccessful. Society would be better served by programs of effective primary or secondary prevention. Specialised training to provide skills for

21

both vocational and general problem solving should be available to people who have had a drug problem. In this regard, the Committee has been much impressed by recent developments in alcohol-in-industry programs, which are discussed in Chapter 2.

There are fashions in the use of drugs, and any national program must be able to respond rapidly to new trends and complications. With the development of new knowledge, drugs previously considered acceptable may become drugs of abuse-for example, thalidomide and tobacco­ and flexibility must be ensured by adequate funding and goal setting, continuous monitoring and an informed public with adequate access to information.

5. Drug abuse is primarily a social/medical, not a legal, problem, though such abuse may have important legal consequences and aspects. Drug abuse occurs in the context of other social problems and the strategy must take cognisance of such problems. Interventions which do not alleviate these social problems can at best achieve only partial success. In Australia, social attitudes and social a_ nd peer pressures contribute significantly to drug use and abuse. Any national response must take account of these pressures and attitudes.

Present laws need to be examined and, if necessary, amended to take account of the social/medical nature of drug abuse. Laws and legal procedures which have been shown by experience to be ineffective or inappropriate should be adjusted and updated. These amendments may take the form of tightening present legal sanctions or of lessening the effect of inappropriate controls. There is need for contemporary laws which can enjoy the respect and support of the community. A legal frame­ work which allows maximum interplay between the legal system and the social/medical helping agencies should be encouraged.

The disillusioned, lonely housewife who abuses a minor analgesic will probably substitute another drug, or at least other problem behaviour, if her analgesic supply is stopped and no other support is substituted. The worker who lives in an isolated town with few amenities and who has an alcohol problem will find it very difficult not to use alcohol if the hotel is his only point of social contact in the town. Profound changes are occur­ ring in our society and in the values on which the traditional patterns of our community and family life are based. It is against a background of problems such as alienation, isolation, unemployment and delinquency that our problems with drugs arise. Drug programs must be consistent and co-ordinated with programs which are designed to alleviate these social problems.

22

6. Management must be improved to ensure the maximum effect from resources committed to drug programs. Better interagency co­ ordination is required. More attention must be paid to the setting of priorities, with Commonwealth law enforcement efforts focused on high-level traffickers and Commonwealth resources focused on habitual users of high-risk drugs.

24819177-3

The mechanism for discouragement of use should not be more damaging to the individual than is the drug itself. Major new strategies will be required in the rehabilitation area, especially as we move from a model of control that has depended entirely on the legal system to one which may involve diversion into a social/medical model. Services at present are fragmentary and unco-ordinated. Commonwealth rehabilitation services

generally are too much vocationally oriented and trauma based, and do not readily admit drug abusers. A variety of rehabilitation programs is essential, and programs for drug abusers directed towards the achieving of specific goals, with adequate and regular evaluation, must be included.

Funding for any program in this area should be dependent on that program serving some aim within the overall strategy and the use of adequate procedures to evaluate that program. The necessary evaluation may be undertaken either within the program itself or by the appropriate Commonwealth agency. In any event, the outcome of program evaluation

should be reported to the Parliament. A further prerequisite to funding should be participation in an appropriate co-ordination mechanism. The Committee has no desire to reduce the number of alternative programs, as these probably meet different needs in the treatment area.

However, we believe that agencies should be fully aware of the range of services available to a person with a drug problem. 7. The Federal Government has particular responsibility for giving national leadership in coping with drug abuse. The States have an equally

important role, especially in the direct provision of services. No national control program will be effective unless all governments co-ordinate their activites. The Commonwealth Minister for Health should have primary responsibility for Commonwealth action related to all forms

of drug use and abuse. A necessary first step is for the Federal Government to provide definite leadership. Primary responsibility for policy in relation to the abuse of proscribed drugs and the use and abuse of other drugs should be placed

with one Commonwealth Minister and Department. The appropriate department is the Department of Health. While the Departments of Social Security, of Environment, Housing and Community Development and of Business and Consumer Affairs have roles to play, it is imperative that the current rather amorphous administrative arrangements for drug

use should be strengthened by giving a charter specifically to the Depart­ ment of Health. This Department can, and should, set up adequate administrative procedures to take advantages of the expertise in other Commonwealth departments and to ensure that relevant programs in those departments contribute to the national strategy.

At present, it appears that 'some' responsibility is spread across a number of departments. Responsibility has been apportioned according to types of drugs or programs rather than on a basis designed to achieve a concerted overall approach to the use of drugs. The present administrative

structure reflects lack of unitary purpose and also ambivalent community attitudes toward drug use.

23

The National Standing Control Committee on Drugs of Dependence (NSCC) is a co-ordinating body consisting of senior officers of the Department of Health, the Attorney-General's Department and the Department of Business and Consumer Affairs, together with relevant State departments associated with the drug abuse problem. The function of the Control Committee is to co-ordinate State and Federal responsibili­ ties in the field of illicit drug abuse and to report to meetings of the Federal and State Ministers concerned. The NSCC has working within it a Law Enforcement Working Party, a Legislation Working Party, a Health Working Party and a Drug Education Sub-committee. The Control Committee should be chaired and serviced by the Director-General of Health for the Commonwealth, and its scope should be widened to include alcohol, tobacco, analgesics and all other drugs subject to abuse. The Committee is aware of decisions by the NSCC not to broaden its charter. However, the use of alcohol, tobacco and analgesics is an immediate, pressing social problem requiring concentrated effort and attention. The present arrangement allows for little specialised, co-ordinated effort to

deal with alcohol, tobacco and other 'legal' drugs. Any drug program must cover all aspects or be damned by its own design. Specific suggestions for further activities which should be undertaken by the Control Committee are made in Chapters 2 and 5 where we outline proposals relating to the suggested establishment of a Sub-committee on Drugs and Driving within the NSCC.

R eferences 1 Sir T. Clifford Allbutt & H. D. Rolleston (edd.), A System of Medicine, vol. II, part I (London, 1909), pp. 286-7; quoted in Edward M. Brecher & the Editors of Consumer Reports, Licit and Illicit Drugs (Boston, 1972), p. 492. 2

Brecher & the Editors of Consumer Reports, p. 3. 3

Brecher & the Editors of Consumer Reports, Chapters I, 2 and 3. 4 Brecher & the Editors of Consumer Reports, pp. 33-5. 5

Brecher & the Editors of Consumer Reports, pp. 497- 8.

24

CHAPTER 2 Alcohol

The Dimensions of a National Disaster

• Alcohol has been a major factor causing the deaths of over 30,000 Australians in the last 10 years.

• Deaths from cirrhosis of the liver have risen 75 per cent in the last 10 years.

• From 1965 to 1976, the per capita increase in the consumption of beer has been 27 per cent, of wine 122 per cent and of spirits 50 per cent.

• Over one-quarter of a million Australians can be classified as alcoholics.

• One million two hundred thousand Australians are affected person­ ally or in their family situations by the abuse of alcohol.

• One in every five of our hospital beds is occupied by a person suffering from the adverse effects of alcohol.

• Two in every five divorces or judical separations result from alcohol­ induced problems. • In 1972-73, problems directly related to alcohol, including industrial accidents and absenteeism, cost the national economy more than

$500m. • Some 73 per cent of the men who have committed a violent crime had been drinking prior to the commission of the crime. • Alcohol is associated with half the serious crime in Australia. • Alcoholism among the young is increasing dramatically and as many

as I 0 per cent of school children between the ages of 12 and 1 7 get 'very drunk' at least once a month.

Alcohol is the major drug of abuse in Australia. It now constitutes a problem of epidemic proportions. Faced with the above summary of the extent of the alcohol problem in Australia today, any failure by governments or individuals to acknowledge that a major problem-and potential national disaster-is upon us would constitute gross irresponsibility.

The Committee, at the outset, calls for the immediate development of a national response to the challenge of alcohol abuse in Australia. Such a response will need to involve all governments at all levels, the health and legal professions, law enforcement agencies, industry, trade unions, business and community groups, the liquor industry itself, social welfare groups and agencies, and every member of the Australian community at large.

25

Definitions

Clarification of Terminology

The World Health Organisation (WHO) Expert Committee on Drug Dependence, in 1969, set out two main conditions 'at least one of which must exist for a drug to be considered in need of control': (1) the drug is known to be abused other than sporadically or in a local area

and the effects of its abuse extend beyond the drug taker; in addition, it s mode of spread involves communication between existing and potential drug takers, and an illicit traffic in it is developing; (2) it is planned to use the drug in medicine and experimental data show that

there is a significant psychic or physical dependence liability; the drug is commercially available or may become so. 1

Alcohol clearly satisfies these conditions. The Committee rejects the concept of prohibition and equally rejects the laissez-faire approach. We do not wish to condemn the use of alcohol. Indeed, we acknowledge the legitimate social role of alcohol-a role recognised as far back as the days of the psalmist who wrote of the 'wine that maketh glad the heart of man'.

There are no generally agreed definitions of 'alcohol abuse' or related terms such as 'alcoholism' or 'heavy or excessive drinking'. For example, J. G. Rankin and P. Wilkinson state that 'problem drinking appeared when the level of alcohol consumption exceeded 40 gms (four ten oz. glasses of beer) per day, and increased in frequency as the level increased' . 2 \VHO in 1973 accepted 120 grams as being 'excessive consumption'. 3 But in 1975 the WHO Regional Office for Europe, in a report on a project undertaken jointly with the Finnish Foundation for Alcohol Studies and the Addiction Research Foundation of Ontario, said that the level was substantially less than this and could possibly be below 60 grams. 4 The Committee has not attempted to resolve this matter but has instead relied on the definitions used by surveys. However, these definitions vary markedly and prevent any comparison of the results obtained. The whole question is very confused and requires attention. This matter is discussed in Chapter 7.

The National Health and Medical Research Council (NH and MRC), at its 83rd Session in Hobart in April 1977, adopted a recommendation by the Public Health Advisory Council that, in future, alcohol concentrations in the blood be expressed in Standard International Units. The Australian of 28 April1977 reported that, in explaining the decision on behalf of the NH and MRC, Dr P. S. Woodruff said:

The figures .08 and .05 are regarded by many members of the community as so small that they are not worth worrying about. These figures represent 17 millimoles per litre (17 SI) and 11 millimoles per litre (I I Sl).

26

The Committee also supports this proposal and recommends: That blood alcohol level be expressed in Standard International Units (millimoles per litre) and that the new system be phased in with appro­ priate publicity.

Alcohol in Australian Society

The Committee believes that use of the term 'accident', when describing an alcohol-associated road incident, suggests inevitability. Since all the available evidence is inconsistent with a deterministic view of the road toll, we have rejected the word 'accident' in favour of 'crash'.

The Committee recommends: That governments and the public use the term 'road crash' instead of 'road accident'.

Alcoholism, drunkenness and the basic problems associated with them­ such as personal misery, economic ruin and crime-have been features of Australian society since the very first days of the white man's settlement on the continent. On 26 January 1788, the first landing was made in Sydney

Cove, and on 6 February the women from the First Fleet landed. Professor C. Manning Clark has described the scene: That night the sailors asked for some rum to make merry with upon the women quitting the ships. Soon, as one observer put it, they began to be

elevated, and all that night there were scenes of debauchery and riot, which beggared description. 5 In 1798, Governor Hunter attributed the rapidly rising expenses of the Government largely to the desire for liquor by officers of the colony, and in 1802 Governor King tried to limit the increase in the liquor trade. By

1808, Governor Bligh regarded the situation as so serious that he took steps to make it illegal to trade in spirits, to land liquor without a permit or to distil rum in the colony. His actions precipitated the infamous Rum Rebellion by the New South Wales Corps which overthrew him as Governor. Bligh's departure gave only a temporary respite to the liquor interests of the colony, and on 16 February 1810 Governor Macquarie imposed the first duty on spirits in an effort to reduce 'drunkenness and

idleness'. 6 In his book The Australianization of John Bull, Joe Rich writes: ... evidence shows that heavy drinking was a serious problem in the settle­ ment's early days. One man claimed that as a boy in Hobart he had seen 'the whole colony drunk for several weeks, from the Governor downwards', and even in 1830 it was said that 'one half of those who die in the colony in the present day perish, either directly or indirectly through drunkenness' ...

A doctor arriving in 1802, was astonished to find that it was no uncommon occurrence for men to sit around a bucket of spirits and drink it with quart pots until they were unable to stir from the spot' ... Even the clergy were involved (in the liquor trade and profiteering). When

the colony's first church was being built the Reverend Mr Johnson paid the labourers partly in rum at the rate of a gallon for ten shillings, although he had bought it for four shillings and sixpence ... 7 Various writers who described the early days ofthecolonydrew attention to the fact that 'many poor settlers were ruined by the craving for liquor',

that church services were rendered impossible because of the 'number of drunken soldiers and convicts surrounding the outside of the place of public worship', and that the colony's first murder, in January 1794, was probably directly related to the theft of money to buy liquor. 8

27

Social

Acceptability

The 'masculine' traditions and myths of Australia, and the development of the 'mateship' ethic, with its stress on ability to consume large quantities of liquor, have served to reinforce these earliest sociological characteristics in Australia. Liquor has now become so much an integral part of the Australian way of life, for such a substantial proportion of the community, that we fail to recognise either the nature or the magnitude of the problem. There is even a tendency to believe that the direct relation­ ship between drinking, motor vehicle crashes and road fatalities is some­ thing of quite recent origin though the problem was identified as a major one at least as early as I 959. 9

The ;social acceptance of alcohol and, indeed, of alcohol abuse is so widespread in Australia that the Committee would not be surprised if its findings and recommendations came as a shock to the majority of the Australian community. We believe that failure to take into account the central place of alcohol in our history and mores has contributed to the

relative failure of most previous drug-control programs.

Nearly all witnesses and most published literature have drawn attention to the high level of public acceptance of alcohol use in Australia, and the extremely tolerant attitude to misuse. Dr Basil Hetzel stated: It has to be admitted that we have something of a blind spot in this country

about alcohol. It is part of being manly to be able to hold large amounts of alcohoJ.l 0 Professor F. A. Whitlock described the attitude of many people towards workmates with alcohol problems:

The tendency of the man who is drinking overmuch , and this is impairing his work and efficiency, is for him to be protected by his workmates until it is too late.11 In his book Men in Groups, Lionel Tiger made some interesting com­ ments on the sociology of alcohol:

Even in the Bowery (New York skid-row), where disaffiliated outcast males live in wa ys only now becoming understood, it has been noted that, 'There are strong indications that the heavy drinkers are more integrated and more sociable than the light. The analytical problem lies in determinin g whether socialisation causes drinking or drinking results in sociability where there is no disapproval' .. . 12 We do not understand the relation between drinking and socialisation in Australian society. This lack of basic sociological data is one of the problems requiring research and illumination.

In his annual report for 1975- 76, the Commonwealth Director-General of Health wrote:

28

How can society as a whole, and every individual, be induced to change attitudes to deeply-entrenched and widely-accepted customs? It is, perhaps, appropriate at this point to mention what might be termed a 'conspiracy of silence' concerning alcohol- the refusal by so many people to acknowledge that a problem even exists. It is seen in the attitude of many adult moralists who castigate young people for their attitudes to drugs while at the same time declining to moderate their personal over-indulgence in alcohol- a double standard which is indefensible in the eyes of the young.

Drinking Habits of the Young

Alcohol-associated morbidity and mortality are often accepted as un-alterable facts of life by professionals and laymen alike. 1 3 In the past, governments, both Federal and State, have contributed to this social attitude. Alcohol has been perceived as a source of excise revenue, and the rising levels of production and consumption of alcohol have meant substantial increases in government revenues. Measures to control rising consumption, or to restrict growing availability, have been noticeably absent from the programs of Commonwealth governments.

Drinking habits are fairly well established during the adolescent's second decade. From time to time through the inquiry, reference was made to three factors-the pressure which peer groups apply to start and maintain drinking habits, the influence of the mass media on such habits, and the establishment early in life of a relationship between alcohol and the motor car. Dr Hetzel drew our attention to these factors also and to findings about their importance:

These findings clearly point to the importance of factors in adolescent and early adult life in the establishment of drinking patterns in Austral ia. We know that this is the period for the attainment of identify (sic) for the young man-in sociological terms the adoption of a role model on which future life style is based. In Australian society, two major features of the maturing process for the young man are the opportunity to drive a motor car and to drink alcohol. These he eagerly seeks, prompted to do so by pressures of his own peer group, pressures from the mass media, and an expression of his inde­

pendence and status as an adult in a demanding and competitive society. The young adult is also more vulnerable to alcohol by virtue of his high incidence of emotional disturbances ... 14

The Committee believes that the community is generally ignorant of the extent of the alcohol problem among the young. The Sydney Morning Herald of 6 April 1974 reported that Professor W. F. Connell's book 12 to 20-Studies of City Youth revealed the following broad statistics:

The percentage of teenagers drinking alcohol once a week or more starts at 9.61 per cent for 11-12 year old boys and 5.15 per cent for 11-12 year old girls. It rises to 15.02 per cent and 8.11 per cent for 13-14 year olds; 29.42 per cent and 14.39 per cent for 15-16 year olds still at school; 46.27 per cent and 18.18 per cent for the same age group out of school; 44.83 per cent and 27.50 per cent for 17-18 year olds at school; and 68.29 per cent and 33.82 per cent for the same age group out of school.

The Commonwealth Department of Health told the Committee: Doctors Bell and Rowe, in their recently published study, 'Monitorin g Drug Use in New South Wales, 1971-1973' found that, of 3,369 Fourth Formers in 1973 , 24.2 per cent were non-users of alcohol, 75.8 per cent were currently drinking alcohol and 5.2 per cent were drinking most days .

By comparison, a Victorian study, 'Drug Use by the Young Populati on of Melbourne, 1971-1973' also looked at 2,042 secondary students over 15 years within their sample and found that 13.5 per cent were non or ex-users of alcohol, 86.5 per cent were users and 5.4 per cent were dinking most days .

Finally, the National Drug Education Program Research Project, carried out in 1973 and 1974 by Dr Irwin, in a sample of all Grades in A.C.T.

29

Extent of the Problem

secondary schools found that, in 1973, 50.2 per cent of 4,952 school children were non-users of alcohol, 48.8 per cent were users and 2.0 per cent were heavy users, using a self-rating scale. 15 Survey evidence on drinking by youth is extensive. One further example is a survey carried out by the Child Health Committee of the New South Wales Education Advisory Council. In a sample of2741 adolescents from thirty schools in metropolitan and rural New South Wales in 1974, that Committee found that 2.4 per cent of males and 0.8 per cent of females were 'problem drinkers'; that over 9 per cent of all 12 to 17 year olds claim to get 'very drunk' more than once a month and a further 2 per cent admit to regularly 'passing out' from the effects of alcohol; and finally that approximately 20 per cent of the sixteen to seventeen year

old males in the sample admitted to getting very drunk more than once a month.16

The Youth Say project reported in 1974 that the group of activities which included visiting clubs and the like was the single most preferred recreational activity for both males and females in both the fifteen to seventeen and the eighteen to twenty age groups. 17

Recruitment of the young to alcohol use is accelerating at a rate far greater than is recruitment to the use of any other drug. A special study on alcohol and health problems of people eighteen and over, published by the United States Department of Health, Education, and Welfare in

1975, concluded: It is evident that the 18-20 year-olds have the largest proportion who had experienced some problem in connection with drinking (27 per cent), .. .1 8 Given this overwhelming weight of evidence about alcohol problems among the young, the Committee was surprised and disturbed to see in The Sun newspaper published in Sydney on 21 April 1977 a report that a Chief Inspector of the Victoria Police was advocating that the legal drinking age be reduced to 16.

The study made by J. G. Rankin and P. Wilkinson in 1968 remains one of the few comprehensive surveys of the extent of the alcohol problem among Australian adults. This study led to the conclusion that 'at least five per cent of adult men and one per cent of adult women are potential or actual victims of alcohol misuse'. 19 If one relates these figures to the latest estimates of population aged twenty and over-the age range used in the survey-the conclusion would be that at least 212 000 males and 43 000 females have some problems with alcohol. When those under the age of twenty who may be at risk are added, it becomes apparent that the number of persons in Australia who potentially or actually suffer serious problems with alcohol is close to 300 000.

The survey by Rankin and Wilkinson disclosed also that 7.9 per cent of males and 1.1 per cent of females in the sample surveyed were consuming more than 80 g of alcohol per day-equivalent to eight I 0-oz glasses of beer-and that 3.3 per cent of males and 0.4 per cent of females sampled were drinking more than 120 g of alcohol per day.

30

Who Abuses Alcohol?

A survey of a northern Sydney suburb by Anne George, in 1971, revealed that 26. 6 per cent of males and 16. 7 per cent of females in the sample consumed alcohol daily or on most days of the week. 20 In a survey of a western Sydney suburb conducted in 1973, she found that 17. 4 per cent of males and 6. 2 per cent of females in the sample consumed alcohol every day or on most days. 21

The most recent survey of the adult population was conducted in Sydney in 1976 on 8 516 adults who had been through a medicheck screening. This survey revealed that 39 per cent of the males and 21 per cent of the females drank at least some alcohol every day or on most days, and that 11.3 per cent of the males and 1. 6 per cent of the females had six or more drinks per day (size unstated). 22

From further surveys, one can state some conclusions about the corre­ lation of certain other factors with high levels of alcohol consumption. There is no stereotype of the problem drinker. However, it appears that the male drinker is more at risk. The problem drinker may be found in any socio-economic stratum and be of any age. One researcher noted:

Doctors, dentists, politicians, clergymen, businessmen, shopkeepers, labourers, artisans, school teachers, social workers and journalists are a cross-section of alcoholics. 23 Further, the Committee was told that some types of employment present a greater danger of the development of drinking problems than do others. Where broken shifts are involved, as in the transport, meat and mining industries or on the waterfront, the risk is particularly high. 24 Workers engaged in the manufacture and retailing of alcohol are considered to be at risk also. 25

Rankin made the following observations on the patterns of alcoholism in Australia: The prevalence of alcoholism is highest among Australian-born, particularly those of Irish-Catholic origin and British and East European migrants; it is

lowest amongst Italians, Greeks and Jews ... The prevalence of alcoholism is also related to social class, being at least three times more common in the lowest social group, excluding vagrants, than in the highest . . . familial factors appear to be dominant in the aetiology of alcohol misuse . . . In

Australia, two patterns have been found in the childhood of alcoholic patients, namely impaired psychological and sociological development which will impede or prevent normal adolescent and adult adjustment, and a learned familial pattern of excessive drinking ...

The choice of marital partner also appears to be important in the develop­ ment and perpetuation of alcoholism in Australia . . . It has been found that men and women who are either alcoholic before marriage or ultimately become so after marriage have a sixfold increase above the normal expectancy of marrying a partner who also is, or will become, an alcoholic. About 12 per cent of alcoholic men in Australia have alcoholic wives and more than 50 per cent of alcoholic women have alcoholic husbands. In the case of women, alcoholism usually develops after marriage, at least in part as a result of the husband's alcoholism. 26

S. Encel, K. Kotowicz and H. Resler have reported that age had little effect on drinking patterns in men, except that there was a slight

31

decrease after age 60. In women, prevalence of heavy drinking tended to increase between the ages of 20 and 60, after which it diminished considerably. 2 7 These survey results are supported by one very recent summary of the available data, published by Rev. G. S. Martin, a member of the Com­ mission of Inquiry into Poverty, in the Commission's Third Main Report, entitled Social/ Medical Aspects of Po verty in Australia. 28

It will be noted, however, that there are some problems with the inter­ pretation of these raw data. Some potentially contradictory statements are made about the relationship between the levels of education and social status and of alcohol misuse. For example, Encel and his colleagues did not confirm the views of Rankin cited above. Also, it is unclear whether variations in alcohol consumption related to religious classifications reflect religious-based factors underlying socio-economic factors. 29 What is useful in the data, however, is the overwhelming weight of evidence that alcohol abuse constitutes a problem in every group in Australian society, regardless of all other factors.

Consumption Australia occupies ninth30 or tenth31 place among alcohol-consuming countries in terms of per capita consumption of absolute alcohol. Table 2.1 gives the latest consumption figures. The figures in column 4 should be considered with caution and should be related to the later discussion concerning the increase in the consumption of beer, wine and spirits respectively. The percentage increases are not directly comparable one with another.

Consumption figures in columns 1 and 2 are estimates derived by the Australian Bureau of Statistics from collected data. 32 Since 1975, there has been a minor change in the method of deriving the estimate for wine consumption. Apparent consumption is now found by adding imports to sales of wine by wine makers. 33

Table 2.1 Australian consumption of alcohol

(2)

Per Head

(I) of Total

Total, Population, 1975-76 1975-76

million Jitres litres

Beer( a) 1 903 139.8

Wine( b) 181 13 . 3

Spirits(b) . (c)16 (c)l . 2

(a) For percentage alcohol content see Table 2. 3. (b) For percentage alcohol content see Table 2. 6. . (c) Expressed as absolute alcohol, not as beverage quanttty. (d) Expressed on an absolute alcohol basis.

(3) (4)

Per Head Increase per of Adult Head of

Population Population, (18 and over) 1965-66 to 1975-76 1975-76

litres per cent

208.8 27

19.9 122

(c)l. 8 (d) 50

Source: Derived from data supplied by the Australian Bureau of Statistics and the Common­ wealth Department of Health.

32

Beer

Table 2. 2 indicates the annual changes in the consumption of beer over the last 10 years.

Table 2.2 Australian consumption of beer

Year

1965-66 . 1966-67 . 1967-68 . 1968-69 . 1969-70 . 1970-71 . 1971-72 . 1972- 73 . 1973-74 . 1974-75 . 1975-76 .

Overall increase

Consumption per Head of Total Population

Increase per Year

litres per cent

110.0 113 . 2 11 6. 8 120.0 123.7 126.7 127 . 5 131.5 141.3 142.7 139.8

2.9 3.2 2.7 3.1

2.4 0.6 3.1 7.5 1.0

- 2.0

27.0

Source: Consumption figures 1965-66 to 1974-75 from Commonwealth Department of Health Annual Report 1975-76, Table 17. Consumption figures 1975-76 from Australian Bureau of Statistics, personal communication.

The percentage increase in beer consumption is much less than that recorded for wine or spirits, and beer is losing some of its hold on the market generally. Indeed, the submission from the Australian Associated Brewers indicated a substantial decrease in beer sales following the 56 per cent increase in the excise on beer in the Budget for 1975-76. 34 Despite a

beer price-cutting war in Victoria, Mr Bingham from the Brewers indicated a 1. 8 per cent decrease in the level of beer consumption in that State for the 12 months ended June 1976, 35 while his colleague, Mr Roberts, indicated that in New South Wales, for the 12 months ended October 1976,

beer sales were down 6 per cent. 36 The Committee places on record its appreciation of the Brewers' excellent submission, which was a serious contribution to the ongoing debate about the alcohol problem in Australia. We also note that a medical advisory group of eminent medical science personnel is being established with the assistance of the brewing industry, and financed initially to a level of some $100 000 annually, to advise the industry on health matters and to make grants for medical research. 3 7

There are many myths about Australian beer, not least of which is that it is the 'strongest' in the world. This is not true, as Dr Milner

observed: l\1ost think it 'the strongest and best in the world'-it is average. 38 Table 2. 3 puts this matter in perspective and draws attention to the relationship between beer strengths in a number of countries.

33

Table 2.3 Alcohol content (proportion by weight) of beers from 18 countries

(Arranged in Descending Order of Mean)

Country

Thailand Switzerland Denmark France. Papua New Guinea Malaysia Holland West Germany Philippines . New Zealand. South Africa . Taiwan Mauritius Fiji United Kingdom Japan .

Australia United States

(a) One sample only.

Source: Australian Associated Brewers, Evidence, p . 2586.

Wine and Spirits

Range

per cent 4. 66(a) 4.19(a)

3.95-4.40 4 . 17(a)

4.04-4.29 4.17(a)

3.98-4 .05 3.70-4 .38 3 .97(a) 3.35-4 .66 3.70-4 .05 3.74-4.00

3. 83(a) 3. 82(a)

3.02- 5.68 3.65- 3.77 2.50-4.56 3.51-3.92

Mean

per cent

4. 66 4.19 4.18 4 . 17 4.1 7

4 .17 4 .02 3.97 3.97 3. 91 3.88 3.88 3.83 3.82 3.78 3. 71 3 .71 3. 68

Few changes in social behaviour have been quite as dramatic as Aust­ ralians' changing attitudes to wine. From a fairly small base with a limited clientele some years ago, the Australian wine industry has developed into a primary industry of world standard with a large and growing range of consumers. As Table 2. 4 shows, per capita consumption of wine has grown by 122 per cent over the last 10 years. This increase has been almost solely in the table wines category. Sales of fortified wines have remained relatively stable, especially in recent years.

34

Table 2.4 Australian consumption of wine

Year

1965-66 1966-67 1967-68 1968-69 1969-70 1970-71 1971-72 1972-73 1973-74 1974-75 1975-76

Overall Increase

Consumption per Head of Total Population Increase

per Year

litres per cent

6.0 6.8 7.6 8.3 8.9 8.7 9.0 9.9 11.2 12.5 13.3

13.3 11.8 9.2 7.2 -2.2

3.4 10 .0 13.1 11.6

6.4

122.0

Source: Consumption figures 1965-66 to 1974-75 from Commonwealth Department of Health Annual Report 1975-76, Table 17. Consumption figures 1975-76 from Australian Bureau of Statistics, personal communication.

Consumption of spirits also has risen, by 50 per cent over the period from 1965-66 to 1975-76, as Table 2.5 shows.

Table 2.5 Australian consumption of spirits (Expressed as Absolute Alcohol)

Year

Consumption per Head of Total Population Increase

per Year

1i tres per cent

1965-66 1966-67 1967-68 1968-69 1969-70 1970-71 1971-72 1972-73 1973-74 1974-75 1975-76

Overall Increase

0.8 0.8 1.0 1.0

1.0 1.0 1.0 1.3 1.3 1.2 1.2

Nil 25.0 Nil Nil

Nil Nil 30.0 Nil -7.7

Nil

50.0

Source: Consumption figures 1965-66 to 1974-75 from Commonwealth Department of Health Annual Report 1975-76, Table 17. Consumption figures 1975-76 from Australian Bureau of Statistics, personal communication.

The National Health and Medical Research Council, in 1975, in a report on the health problems caused by alcohol, expressed its concern about the increasing extent to which young people were turning to the consumption of spirits. 39

35

Consumption Patterns and Their Significance

While beer has an alcohol content of 2 . 5 per cent to 4. 56 per cent by weight, wine and spirits have a much higher alcohol content (shown in Table 2. 6). Any shift in the drinking patterns of the young could preface a new level of alcohol-related problems in the future. We share the concern of the NH and MRC on this matter.

Table 2.6 Alcohol content of wine and spirits

Wine- Unfortified Fortified Spirits-Brandy Whisky

Rum Gin Vodka

Cider . Perry(a)

Liqueurs .

(a) Pear cider.

Proportion by Weight

(Approximately)

per cent 10.0 and above 17 . 5 and above 36 .0 32 .0 32 .0 32 .0 32 .0 Up to 55.0

Variable up to 10 .0 Up to 8.0

Source: Australian Associated Brewers, Evidence, p. 2585 .

Rising levels of wine consumption mean that there are rising levels of intake of alcohol, especially if this is a reflection of a shift from beer to wine or spirits-a matter on which no real evidence has been offered to us . From several practical demonstrations, the Committee is aware of the problems of producing palatable non-alcoholic wines. However, we urge the wine industry to endeavour to develop a non-alcoholic wine which is acceptable to a larger proportion of the community.

Not all people are consuming the same amounts of alcohol. The con­ sumption rates of moderate and social drinkers are well below the mean figures, whereas the consumption of heavy and problem drinkers is very much greater than the figures quoted. This was emphasised in the sub­ mission from the Australian Associated Brewers, which pointed out that most Australians who drink do so without ill effects. 40

Consumption can be measured in two ways. First, one can compare the consumption of beer, of wine and of spirits in terms of litres per head . However, because of the various alcohol contents involved, use of this ranking as the sole guide would be misleading. Consumption can also be measured by amounts of ethanol (absolute alcohol) consumed. Table 2. 7 shows the amount of ethanol ingested per head from 1965- 66 to

1975-76.

36

Table 2. 7 Australian consumption of absolute alcohol

1:-stimated total consumption of ethanol in Increase

Year litres per head per year

1965-66 7.0

per cent

1966-67 7.3 4.3

1967-68 7.7 5.5

1968-69 7.9 2.6

1969-70 8.3 5.1

1970-71 8.4 1.2

1971-72 8.6 2.4

1972-73 9.1 5.8

1973-74 9.7 6.6

1974-75 9.9 2.1

1975-76 9.9 Nil

Overall increase 41.0

Source: Consumption figures 1965-66 to 1974-75 from Commonwealth Department of Health Annual Report 1975-76, Table 17. Consumption figures 1975-76 from the Australian Bureau of Statistics, personal communication.

It is possible to calculate the increase in the consumption of alcohol by Australians in the form of beer, wine and spirits, respectively, between 1965-66 and 1975-76. The amounts are shown in Table 2.8.

Table 2.8 Australian consumption of ethanol in the form of beer, wine and spirits, 1965-66 and 1975-76 (expressed in litres per head)

1965- 66 . 1975-76 .

Increase .

Beer

5.3 6.7

1.4

Source: Derived from Australian Bureau of Statistics figures.

Wine

0.9 2.0

1.1

Spirits

0 .8 1.2

0.4

It can be seen that beer has contributed most to the increased intake of absolute alcohol, wine to a lesser degree and spirits least. Tables 2. 7 and 2. 8 are based on Australian Bureau of Statistics approximations of alcohol content of 4 . 8 per cent by volume for beer,

15 per cent by volume for wine and 100 per cent by volume for spirits. To the extent that these are notional figures for each beverage, the data in the two tables represent approximations rather than actual figures of ethanol consumption.

Planners must watch the changing patterns of consumption for each type of beverage. For example, significant emerging factors might include the increasing consumption of wine with meals or the renewed interest in home wine making, as shown by the fact that in 1977 an all-time high

of 10 per cent of the boxed grapes in Melbourne was sold to individuals for this purpose.

37

Some witnesses expressed concern that drinking environments could contribute to alcohol abuse. Others voiced a general desire for the pro­ motion of drinking environments that might encourage more moderate consumption. 4 1 All these factors must be considered when strategies to reduce the overall consumption of alcohol are being developed.

In attempting to relate general community levels of alcohol consump­ tion to the number of problem drinkers, the Committee examined a statistical model for the prediction of community alcohol consumption patterns, known as the Ledermann formula. 42 The Ledermann model holds that the distribution of the numbers of drinkers who consume various amounts of alcohol can be represented mathematically in what is called a normal/logarithmic distribution and that the number of heavy drinkers in the community is in direct proportion to the average consump­ tion in the community. 43 This model is probably inadequate to describe in mathematical terms community patterns of alcohol consumption. Two witnesses criticised the statistical basis of the Ledermann curve. 44 In addition, Rev. George Martin, of the Commission of Inquiry into Poverty, drawing on evidence from Ireland analysed by B. Walsh and D. \Valsh, made the following comment:

The situation in Ireland demonstrates the fallacy of using population consumption as an index of the health and social problems of alcohol. 4s Nevertheless, there are Australian figures which show a general correl­ ation between levels of alcohol consumption and the number of heavy drinkers. A curve representing data from the famous Rankin and Wilkinson survey conducted in Melbourne shows a smooth transition from the lower levels to the higher levels of consumption as shown in

Figure 2.1.

38

24819177-4

Figure 2.1 Alcohol consumption of a sample of males over the age of 20, Melbourne, 1968

8%

40 80 120 gms/day

Consumption

Source: B. S. Hetzel, 'The Prevention and Control of Alcoholism in Australia', in Australian Journal of Alcoholism and Drug Dependence, No. 1, February 1975, p. 19.

Available empirical data also indicate a correlation between the levels of overall consumption and alcohol-related problems. An example is the situation in Ontario, depicted in Figure 2. 2.

39

Figure 2.2 Alcohol consumption and deaths from liver cirrhosis in province of Ontario, Canada, 1928-67

L C

I

I /,_,.I I '

I

(b)

Liver cirrhosis death rate(L) / _,­ ,.....__...

, .... /

I

(a) Litres of absolute alcohol consumed per capita for persons aged I 5 and older. (b) Centred two-year moving averages of deaths from liver cirrhosis per 100 000 persons aged 20 and older, corrected to allow for the differences between the Fifth and Sixth Revisions of the International List of Diseases and Causes of Death (see Popham, R. E.

(1956) Quart. J. Stud. Alcohol, 17, "70; World Health Organization (1952) Comparability of statistics on causes of death according to the Fifth and Sixth R evisions of the International List, Geneva). Source: R. E. Popham, W. Schmidt and J. de Lint (1975), 'The prevention of alcoholism:

epidemiological studies of the effect of government control measures', in J. A. Ewing (ed.), Drinking, Nelson-Hall, Chicago (in press).

Similar data have been obtained from studies of overall alcohol con­ sumption and liver cirrhosis made in Italy from 1941 to 1972. 46 Further confirmation can also be obtained from data published by the Common­ wealth Department of Health, as shown in Figure 2. 3.

40

Price and the Consumption of Alcohol

Figure 2.3 Alcohol consumption, deaths due to cirrhosis of the liver and deaths due to alcoholism and alcoholic psychosis in Australia, 1908-74(a) 10

- Alcohol consumption (b) ••- Deaths due to cirrhosis ofliver (c) - Deaths due to alcoholism and alcoholic psychosis (c) .. :'··. .. \

.......

\ (d) I ... . .-··\ .. ··· . ... ········ .. .• \. . ..... .... .........

1910 1920 1930 1940 1950 1960 1970

(a) To highlight the trends in the series over time, a three-year moving average has been applied to the original figures. (b) Consumption measured in litres of alcohol per person, based on average alcohol strengths by volume of 4. 8 per cent for beer, 15 per cent for wine. Estimated wine consumption

not available prior to 1947. (c) Deaths due to cirrhosis of the liver and alcoholism and alcoholic psychosis, per 100 000 population. (d) In 1947 wine consumption was added to total consumption figures.

Source: Commonwealth Department of Health Annual Report 1975-76, p. 2.

These examples show that a strong correlation exists between con­ sumption levels and at least some alcohol-related problems. Although it is not possible to prove that there is a causal relationship between the two, it is highly probable that a direct link exists, and the Committee believes that an overall decrease in alcohol consumption would alleviate some

alcohol-related problems. Therefore, we declare that an overall reduction in the level of alcohol consumption in Australia must be achieved.

More alcohol than ever before is being consumed per head in our com­ munity today. One reason is that it is possible to drink more for less expenditure in real terms. Table 2. 9 shows the percentage of personal consumption expenditure on alcohol over the last six years.

Table 2.9 Percentage of personal consumption expenditure devoted to alcohol

1970-71 1971-72 1972-73 1973-74 1974-75 1975-76

6.53 6.38 6.29 6.13 5.90 6.40

Source: Figures for 1970-71 to 1974-75 from the Commonwealth Department of Health Annual Report 1975-76. Figures for 1975-76 from the Australian Bureau of Statistics, personal communi­ cation.

41

Variation in the price of alcohol relative to average disposable income has been shown to correlate inversely with the level of consumption. A good example of this effect was found in Ontario, Canada, as Figure 2. 4 shows.

Figure 2.4 Alcohol consumption and relative price of beverage

alcohol in province of Ontario, Canada 1928 to 1967

2

•····.

f \ .: .\ : i

......... ..: '\ .•

1933

\ .. ...

1938

'• I•

.. · .. · \\

·\ .. ·· ...

1943 1948

..· .. ·· ..... : i

1953

••• ..... Price (P)

.............

.......... ,.· .•.•••

1958 1963

(a) Litres of absolute alcohol consumed per capita for persons aged 15 and older.

p

(b) Average price of 10 Iitres of absolute alcohol divided by personal disposable income. Source: R. E. Popham, W. Schmidt and J. de Lint (1975), 'The prevention of alcoholism: epidemiological studies of the effect of government control measures', in J. A. Ewing (ed.), Drinking, Nelson-Hall, Chicago (in press).

The graph shows that for the period around 1930 an increase in price corresponded with a decrease in consumption. Evidence that similar measures would reduce consumption in Australia is not conclusive. There have been two slight decreases in consumption following an increase in price. In August 1970, an excise of 50c per gallon was imposed on wine. As a consequence, consumption of wine decreased by 2. 2 per cent (see Table 2. 4) with no compensating increases in consumption of beer or spirits. In 1970-71, alcohol consumption increased by only 1.2 per cent, compared with an average of 4. 6 per cent in each of the previous four years (see Table 2. 7). When the excise was removed in December 1972, consumption rose. In 1975, the Government increased the excise on beer by 56 per cent, and again there was a decrease in consumption (see Table 2. 2), with only a small increase in the use of wine or spirits consistent with annual trends in consumption (see Tables 2. 4 and 2 . 5). Overall consumption of alcohol remained stable in 1975-76 (see Table 2. 7).

42

Whether these variations in alcohol consumption are temporary or sustained is uncertain. It is important to note that on neither occasion was there a significant increase in the consumption of other forms of alcoholic beverages as the demand for one of them fell. This trend in Australia is in contrast to experiences in various countries-for example, Ireland and Sweden-where the overall demand for alcohol has been demonstrably inelastic. Observation of this fact led Rev. Martin, of the Commission of Inquiry into Poverty, to reject price rises as a method of effecting a substantial reduction in overall levels of alcohol consumption. 47 In view

of the situation in Australia, the Committee does not agree with Rev. Martin on this matter. We are sufficiently impressed by the above examples showing the relationship between prices and levels of consumption to favour the regular adjustment of excise to maintain the 'real' price of alcohol. The Government should determine the appropriate percentage of personal expenditure which spending on alcohol should represent.

Any alcohol-pricing policy would have to be finely balanced. Too high a price for alcohol would create an 'economic prohibition' with the price of 'legal' alcohol high enough to promote a black market supported by suppliers who considered the risks involved worth the prices received.

Further, the Committee would not wish to advance pricing policies which would put alcoholic beverages beyond the reach of the average wage earner.

The Committee recommends:

That government imposts on all alcoholic beverages be adjusted annually so that real prices of the beverages remain constant.

We note the detailed argument, advanced by D. Faris, that regular adjustments to excise would substantially 'stabilise or reduce' the level of consumption and would represent part of an overall rational approach to alcohol pricing. 4 s ·

Pricing policies can affect the relative use of beer, wine and spirits. Largely because of the effects of government excise policies, one can buy more alcohol per dollar in fortified wine than in beer-a fact known to every skid-row alcoholic. If care were not exercised, changes in price levels and relativities could give rise to undesirable patterns of consump­ tion, and continual evaluation would be needed to counter this possibility.

In excise and sales tax, governments have two very powerful means of controlling the price of alcohol. There has always been a substantial dichotomy in government attitudes to excises on beer and on wines. No excise is at present imposed on wines. Commonwealth excise collected on beer and on spirits for the last 10 years is shown in Table 2 .10.

43

Low Alcohol Content Beer

Table 2.10 Net excise on alcoholic beverages collected in Australia

Year ended 30 June Beer Spirits

$m $m

1967 320.832 24.872

1968 338.614 26.738

1969 355.001 24.440

1970 370.067 26.535

1971 382.469 25.923

1972 398.330 27.180

1973 418.367 30.500

1974 462.400 46.037

1975 475.963 62.847

1976 693.987 66.984

Source: Australian Associated Brewers, Evidence, p. 2657.

The South Australian Brewing Co. Ltd has calculated that in 1976 the excise on absolute alcohol containedin beerwas $8.76 per litre and the excise on absolute alcohol contained in spirits was $10.21 per litre. 49 On 16 August 1977, the Senate Standing Committee on Trade and Commerce reported on the effect on the wine making and grape growing industries of variations in the tax structure. It recommended that:

the Government give a firm undertaking that no excises or sales taxes be imposed on the wine industry until the transition period for repayment of deferred tax by most of the industry has ended. We recognise, however, that the reasons for maintaining wine's tax exempt status may not be permanent and, in the future, regard may need to be had, with their changing circum­ stances, to equity between alcoholic beverages, revenue raising issues and social considerations. 50

The impact on the wine industry of previous changes in excises has been noted. The industry is concerned about tax legislation and about the possible effects of the reimposition of excise. Our Committee believes, however, that there is a substantial argument in favour of the imposition of a new tax or excise on wine. Any scheme introduced could vary accord­ ing to the amount of alcohol contained in the wine and could be phased in over a number of years to reduce the immediate impact on the wine industry.

In pursuit of our national goal of reduced per capita consumption of alcohol, we recommend:

1. That government revenue policies operate to keep at approximately the same ·level the prices of the absolute alcohol contained in beer, in wine and in spirits, bearing in mind that the Government has at its disposal various revenue devices with which it can achieve this aim.

2. That a sales tax or excise on wine be phased in over a period which will enable the wine industry to adjust appropriately.

Even though Australian beer has one of the lowest average alcohol contents, there has been considerable discussion about the likely effects on alcohol-related problems if a low alcohol beer were to be introduced

44

and proved to be commercially successful. 51 To date, the principal low­ alcohol beers-Southwark Export Pilsener (South Australian Brewing Co. Ltd, 2. 5 per cent by weight) and Carlton Light Ale (Carlton and United Breweries Ltd, 3. 2 per cent by weight)-have not enjoyed great commercial success. 52 However, there is an established, viable market for Southwark Export Pilsener. Dr Hetzel, in his evidence, cited the British experience and expressed his support for low-alcohol beer while conceding the past poor commercial record of low-alcohol beers in Australia. 53

In their evidence, the Australian Associated Brewers made several points to the Committee on this question. These included: ... the lowering of alcohol content of beer would serve no useful purpose unless the alcohol contents of all beverages of comparable price were also

lowered. 5 4

In Australia two companies have lower strength beer brands but in neither case have the brands attained more than a three per cent market share. 55 In addition, the Brewers also pointed out that with one minor exception beer had never been advertised with direct reference to its alcoholic strength, implying that they regarded this as contrary to their own Voluntary Code for Advertising of Alcoholic Drinks (see Appendix 1)

and as undesirable for the community and the industry. They believed that, with present pricing, such advertising would encourage the use of high-alcohol beers. 56 This evidence was taken by the Committee on 25 February 1977. On

14 March 1977, Cooper and Sons Ltd introduced to the market their new low-strength beer, Trak. This beer has an alcohol content of 2. 5 per cent by weight, and is promoted by the company as having a taste not significantly different from that of its regular beers. The label for Trak claims it to be 'a low alcohol beer'. 57 The company has expressed great hopes for the success of this new product, even though it sells at the same retail price as other commercially available beers.

Evidence had been put to the Committee that low alcohol beer would find it difficult to establish a market share if there were no price differ­ ential. 58 The claim of Cooper and Sons Ltd that the lowering of the alcohol content had been compensated for in terms of taste by an increase in the use of German hops was noted with interest, 59 since the claim was

often made that low alcohol beers were not palatable for the Australian drinker-a claim not fully sustained, or completely rejected, by the Committee's own sampling of a number of beers. The introduction of a low-alcohol beer will not by itself solve any

major alcohol problems, but it could be a step in the right direction. The already heavy drinker will not switch to a low-alcohol beer, but it may well find acceptance among younger and newer drinkers, whose intake of alcohol would thus be reduced. Since such a beer could appeal to mainly 'social' drinkers, it may well be that the social drinker who drives will thus reduce the chances of his causing a road crash.

In a sample studied by N. A. Broadhurst, 85 per cent reported that 'companionship is the major reason for drinking in hotels' , 60 not the

45

consumption of alcohol. In another study by K. Freedman, M. Henderson and R. Wood, a substantial proportion of the sample reported that 'it's often quite difficult to limit your drinks, because you are expected to keep up with your mates'. 61 The availability of a low-alcohol beer could allow the social drinker-especially in hotels and clubs, which account for 30 per cent of drinking62-more easily to restrict his level of alcohol intake while still not contravening the norms of 'school drinking'. Broadhurst's study also indicated that 73 per cent of beer drinkers in his sample would not object to halving the alcoholic content of beer. 63

In general terms, the Committee supports the proposition that breweries should be encouraged to research, produce and market a low-alcohol beer, and expresses its hope that, even if the impact on the market were small, this would at least make some contribution to the lowering of overall levels of consumption, with a consequent reduction in alcohol-related problems. Implementation of the recommendation below would help to achieve this objective.

Price differentials can be used to overcome much of the criticism of this type of beer. A market research survey initiated by the breweries indicated that a low-alcohol beer will not find a viable market if it is sold at the same price as regular beer. One conclusion from the survey was stated as follows:

However, at price reductions of $1.20, $2.40 per dozen, we are talking in different terms. A market could well exist at that level, but heavily dependent on the production of a product tasting the same as regular beers. 64

The Committee recommends:

That the excise imposed on beers of a low alcohol content (defined as not more than 2.5 per cent by weight) be 30 per cent less than that on other beers.

Legislation There is a considerable amount of Federal and State legislation directly related to the liquor industry; Commonwealth legislation, for example, includes the Excise Act, the Distillation Act, the Spirits Act and some sections of the Customs Act. Nearly all of this legislation can be used to influence the level and type of consumption.

State Governments are responsible for the licensing of commercial premises and derive considerable revenue from them. Table 2. II indicates the growth of State Government revenue from liquor licence fees in South Australia from 1966-67 to 1976-77. Table 2.12 shows the growth of licensed premises in the same State from 1966-67 to 1975-76. It should be borne in mind that these changes have occurred while there has been a dramatic increase in the number of outlets other than hotels. 65

46

Table 2.11 South Australia, revenue from liquor licence fees

$

1966-67 . 1 623 595

1967-68 . 2 219 634

1968-69 . 2 634 700

1969-70 . 3 092 020

1970-71 . 3 265 318

1971-72 . 3 601 418

1972-73 . 3 676 632

1973-74 . 4 186 727

1974-75 . 5 384 032

1975-76 . 7 457 367

1976-77 (estimated) . 8 900 000

Source: Australian Associated Brewers, Evidence, p. 2656.

Table 2.12 South Australia, active liquor outlets

1966- 1967- 1968- 1969- 1970- 1971- 1972- 1973- 1974- 1975-Licence 67 68 69 70 71 72 73 74 75 76

Full publican's 596 596 597 598 598 598 600 601 602 603

Limited publican's 16 24 29 37 40 44 48 55 55

Wholesale storekeeper's 26 36 38 40 41 40 42 42 45

Retail storekeeper's . 31 48 99 99 100 103 105 107 110

Storekeeper's Australian wine (now retail storekeeper's) 86 84 50 2

Wine 11 11 11 12 12 12 9 11 12 12

Distiller's storekeeper's 20 21 32 32 30 30 31 33 34 34

Vignerons 2 36 45 44 47 55 61 67 75

Clubs 42 44 54 60 73 93 133 159 177 185

Permit clubs 393 611 735 740 745 741 751 753 756

Packet 3 3 2 2 2 3 3 4 5

Restaurant 30 59 66 88 106 121 137 151 171

Cabaret . 4 3 3 3 3 3 2 2 2

Theatre . 1 1 1 1 2 3 3 4 4

Twenty litre 5 14 20 22 25 24 32 40

Reception house 3 6 4 3 5 6 6

Section 15 (Wilpena Pound) 1 1 1 1

Section 16 (ETSA) 3 4

Railway. 1

756 1263 1571 1740 1794 1846 1916 1986 2052 2108

N.B. Licences Omitted: Brewer's Australian Ale and Hotel Brokers Source: Australian Associated Brewers, Evidence, p. 2655.

Further extensive State revenue is collected-for example, in New South Wales-from poker machines, which are situated almost solely in licensed premises. In the financial year 1975-76, the yield to the New South Wales Government from this source was $82.4m.

All States provide some statutory control over the production of certain alcoholic beverages. 66 These laws generally provide for a minimum level of alcohol or proof spirit to be contained in various beverages. New South Wales requires 'beer' to contain at least 7.3 per cent by volume

of proof spirit ( 4. 17 per cent v /v of alcohol) while South Australia, Tasmania, Victoria and Western Australia require it to contain at least 2 per cent v/v of proof spirit (1.14 per cent vfv of alcohol). South

47

Australia and Tasmania require fortified wine to contain at least 17 per cent v/v of alcohol at 20°C and other wine at least 8 per cent, while Western Australia requires 17 per cent and 8 per cent vfv at 15. 56°C respectively. New South Wales, South Australia, Tasmania and Victoria require 'OP' rum to contain more than 57.12 per cent v/v of alcohol at 20°C and other spirits at least 37.03 per cent v/v, while Western Australia specifies a level separately for each category of spirits.

The National Health and Medical Research Council also has established a standard specifying minimum levels for the alcohol content of wines and spirits. There are draft standards for beer, cider and perry. 67 It is interesting to note that all these regulations refer to minimum levels of alcohol; no legal controls are imposed on maximum levels. This situation also draws attention to the fact that there are no strict controls on the home brewing of beer, and that some samples of home brew have been shown to contain alcohol levels as high as 5.6 per cent by weight-far in excess of the levels for commercial products. 68

Customs duties are imposed on beer, wine and spirits imported into Australia, and excise duties are imposed on locally produced beer and spirits. The production of beer and spirits in Australia is subject to strict controls by the Commonwealth authorities. At the Commonwealth level, control over wine making appears to exist only where fortified wine is involved-that is, wine to which wine spirit has been added. This control appears to be exercised because of a desire to keep track of all

spirits distilled. The legislation relating to the operations of brewers and distillers is complicated. The Excise Act, the Spirits Act and the Distillation Act all contain provisions, and some parts of the Customs Act also are relevant. There are numerous references to alcohol content. Customs duty on beer, wine and spirits is based on alcohol content. Excise duties are also partly based on alcohol content. 'Beer', for example, is defined as having an alcohol content of 1 . 15 per cent by volume. Below this level of alcohol content, it attracts no duty. Beer with an alcohol content above this level may be manufactured only under licence.

There are no excise duties on wine and the only controls relating to wine under Commonwealth legislation are those for fortified wine discussed above. 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 fortified 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.

48

Alcohol and Health

The Committee recommends: That the Commonwealth Department of Health and the health policy body in each State and Territory continually monitor the levels and patterns of alcohol consumption and formally advise their respective Governments, before each budget, of the health considerations to be taken into account when examining excise and other revenue from alcohol.

Dr M. Chegwidden, Director of Alcohol and Drug Dependence Services for the Health Commission of New South Wales, was quoted in The Australian of 1 August 1974 as having said: ... alcoholism now ranks as the third biggest health problem, behind heart

disease and cancer. In another ten years my guess is that alcoholism will be on top ...

The Canadian Commission of Inquiry Into the Non-Medical Use of Drugs reported: Heavy alcohol users as a group have been shown to have a higher mortality rate than persons of similar age in the general population. Studies in various

countries have found that alcoholics are more likely than non-alcoholics to die from various accidents, poisoning with other drugs, suicide, homicide and certain diseases such as pneumonia, tuberculosis, liver cirrhosis, gastro­ intestinal ulcers, heart disorders and some cancers ... 69 Apart from deaths directly related to alcoholism, the misuse of alcohol is a major factor in many other causes of death in Australia varying, for example, from 100 per cent for beriberi to 10 per cent for burns. Table 2. 13 shows estimates made by the Commonwealth Department of Health for alcohol-related deaths in Australia.

Table 2.13 Deaths attributable to alcohol in Australia

Cause of death

Tuberculosis . Beriberi . Alcoholic psychosis . Alcoholism

Cardiomyopathy Cirrhosis of the liver Diseases of the pancreas Motor vehicle traffic accidents Accidental alcohol poisoning Bums .

Accidental drowning Suicide . Homicide

Estimated percentage attributable to alcohol

30 100 100 100

15 50 15 50 100

10 20 20 33t

Source: Commonwealth Department of Health Annual Report 1975-76, Table 19.

49

The Department proceeded from this to obtain an estimate of the number of deaths attributable to alcohol, and found that they increased by 11 per cent from 1965 to 1974. Also, it found that alcohol has been a major factor in something like 3 per cent of all deaths in Australia each year and in some 30 000 deaths over the last ten years. 7 o

The extent of the problem may be better understood by reference to deaths from cirrhosis of the liver. In spite of advances in medical tech­ nology, the number of such deaths per 100 000 of the population has risen markedly.

Table 2.14 Deaths from cirrhosis of the liver in Australia

1965 1966 1967 1968 1969 1970 1971 1972 1973 1974

Deaths/rom cirrhosis of

Population the liver

'000

11 387.7 547

11 599.5 598

11 799.1 604

12 008.6 697

12 263.0 676

12 507.3 703

12 755.6 768

12959.1 805

13 131.6 927

13 338.3 1104

Deaths per 100 000 of total population

4.8 5.2 5.1 5.8 5.5 5.6 6.0 6.2 7.1 8.3

Source: Population-Australian Bureau of Statistics. Deaths-Commonwealth Department of Health Annual Report 1975-76, Table No. 7. The Department of Health statistics indicate that the death rate from cirrhosis of the liver rose from 4. 8 per 100 000 in 1965 to 8. 3 per 100 000 in 1974. A significant percentage of these deaths is due to alcohol.

Professor F. A. Whitlock stated in evidence: As Professor Gordon, Emeritus Professor of Social and Preventive Medicine in the University of Queensland, has recently observed, 'Alcoholism is one of the major health problems in the community. In importance it ranks after cardiovascular disease, cancer, psychological disorder and accidents. How­ ever, it contributes in a major way to the incidence of both the last two'. As Sundby has shown, its contribution to the aetiology of cancer is not small. It is ironic that faced by this formidable catalogue of evils brought about by a single agent, we concentrate our attention on relatively trivial problems such as marihuana and ignore the massive contribution to disease and social dis­ order caused by excessive drinking. 71 The Australian Academy of Science and the National Health and Medical Research Council have also drawn attention to various aspects of this problem in their publications entitled Diet and Coronary Heart Disease and The Health Problems of Alcohol respectively. 72

The Committee was informed that at least 10 per cent of the nation's health costs are related to alcohol. On 1975-76 estimates, this means that a sum in excess of $400m was spent on alcohol-related illness. 73

50

Further evidence was provided by a five-year research program con­ ducted at St Vincent's Hospital, Melbourne, where 1000 alcoholics who voluntarily attended the Alcoholism Clinic were examined. The most common acute conditions found were acute alcoholic liver diseases

(25. 1 per cent of all cases in the series), peripheral neuropathy (19. 0 per cent), hypertension (16. 9 per cent) and alcoholic gastritis (13. 3 per cent). The most common chronic diseases were chronic bronchitis (17. 3 per cent), cirrhosis (9 . 8 per cent), chronic brain syndrome (8. 8 per cent),

epilepsy (7 . 8 per cent) and peptic ulceration (7 . 2 per cent). Major injuries, mostly as a result of road traffic crashes, ·had been sustained at some time by 11 . 6 per cent of the patients. 74

Hospital statistics reveal that approximately 14 per cent of all patients entering mental health institutions are admitted with a diagnosis of alcoholism or alcoholic psychosis. 75 The National Health and Medical Research Council found that 'not less than 10 per cent of admissions to

public hospitals are substantially due to alcohol'. 76

The Committee was particularly interested in the effects of alcohol taken in conjunction with other drugs. In April 1977, a campaign was launched by the Pharmacy Guild of Australia and the Australian Founda­ tion on Alcoholism and Drug Dependence to direct the community's

attention to the dangers of mixing alcohol with various 'household' drugs-for example, aspirin and antihistamines-and other prescribed substances. On 19 April 1977, the Sydney Daily Telegraph, reporting on the opening of the campaign, stated:

. . . medical authorities said last night that more than 50 of the 100 most often prescribed drugs contain at least one ingredient known to react on­ favourably with alcohol. Dr Gerald Milner, in a number of papers, has reported the results of research on important aspects of the problem. Among other things he has found:

Most heavy consumers are multiple drug users; and cannabis and narcotic users, on the average, drink more than other people, and so the problems are compounded. 77

The environment for the majority of adults includes the use of alcohol and the control of complex machinery, especially the motor car. Barbiturates have been shown to add to the deleterious effects of alcohol, and a positive joint drug action increases the hazards of accidental and suicidal overdosage. 78

It can be seen clearly that, in addition to what may be called the direct effects of alcohol on health, grave risks are incurred when even small amounts of alcohol are allowed to react with other drugs, including many which are in common and frequent use in most Australian households.

The Committee does not believe that warnings of the health effects of the excessive consumption of alcoholic beverages, displayed on the packaging in which drugs are sold, would be effective in isolation. However there might be some value in a warning which indicated the

' . dangers of drinking such beverages while taking any forms of medicatiOn.

51

Alcohol and Social Behaviour

One study of criminals concluded:

... probably 50 per cent of those convicted of the more serious crimes were, at the time of the commission of their crimes, under the influence of alcohol sufficient to have had an appreciable effect on their inhibitions. 79 In a study of 644 violent assaults of a non-sexual and non-acquisitive nature 'where aggression was perpetrated for its own sake', it was found that over 98 per cent had been committed by males and that 73 per cent of the offenders and 26 per cent of the victims had been drinking prior to the offence. For occurrences between 10 p.m. and midnight, 98 per cent of the offenders had been drinking. Also, 24 per cent of the assaults had occurred in or immediately outside a public place where liquor was sold. Where alcohol was involved, 55 per cent of the offenders were under 25 years and 25 per cent were under 20. 80

A study of rape offenders in Victoria showed that 49 per cent described themselves as heavy drinkers or alcoholics and a further 40 per cent regarded themselves as 'moderate' drinkers. Overall, 71 per cent said they were accustomed to getting drunk at least once a week. 81

R. G. Birrell and J. H. W. Birrell conducted a study at the Royal Children's Hospital, Melbourne, and found that one in five maltreated children had at least one parent suffering from alcoholism. 82 The Canadian Commission of Inquiry reported:

Of all drugs used medically or non-medically, alcohol has the strongest and most consistent relationship to crime.

A Canadian study of ex-prisoners concluded that an abnormally high propor­ tion of excessive drinkers had committed crimes against the person, and a lower proportion had committed crimes against property. Excessive drinkers also had a higher proportion of sex crimes.

A significantly higher percentage of the psychiatric patients who had been in trouble with the law had drinking problems .. . Persons with alcohol problems constitute a considerable proportion of people imprisoned in Canada for serious offences. Twenty-nine per cent of the admitted male inmates with serious identified drinking problems, and 22 per cent of females admitted for serious crimes, were judged to be problem drinkers. 83

Ellen Goodman, writing in The Medical Journal of Australia, stated: However alcohol when abused presents the most startling correlation with crime and violence. It is particularly associated with homicide and suicide. 84 The Committee believes that there is probably a relationship between excessive alcohol consumption and the rising crime rate but is awaiting the presentation of more direct evidence on this matter.

Child abuse is becoming more common and the Committee awaits the presentation of further evidence which would clarify the role that alcohol plays in its incidence. Many people are calling for stern measures to be taken by the law in relation to alcohol and its contribution to crime and disorder. However, there is a need to balance any such measures with proper regard for civil

52

Alcohol and the Work Force

liberties, especially in their relation to the 95 per cent of men and 99 per cent of women who have no serious problem with alcoholism. Many of the issues of civil liberties have been argued at great length in public debates over the use of the Breathalyzer and random breath tests, just as they were at an earlier stage over the compulsory wearing of seat belts. There seems

to be general acceptance of the need for effective measures, especially relating to drinking in association with driving. Professor Neal Blewett, President of the South Australian Council for Civil Liberties, told the Committee:

I think that one would be entitled to go a long way in the case of drunken drivers. 8 5

Insofar as the libertarian takes a position on physical harm to others, then one can go a long way under the libertari an model if there is clear evidence of harm being done to other people. 86 It will be seen from our recommendations about laws in the traffic field

that we accept the view that stern steps are justified when dealing with the alcohol abuser who poses a threat to the well-being of others.

For many years, drunkenness has been treated by the law as a crime. Rev. Martin, of the Commission of Inquiry into Poverty, noted: . . . it was found that drunks represented approximately one-third of arrests made in New South Wales and about the same proportion of admissions to

the prisons in New South Wales. (In Victoria, convictions for drunkenness and disorderly conduct accounted for about half of admissions to prison. 8 7 Professor Ronald Sackville, another member of the same Commission of Inquiry, has also commented on the relationship between the misuse of alcohol and trouble with the law, and has shown the disproportionately close association between this problem and general levels of poverty and financial insecurity. 88

The Committee is aware that a significant proportion of drunkenness is 'victimless crime' and can be dealt with in a better way than by arrest. We wish to encourage efforts to intervene more effectively which are now being made in several Australian States.

A study by J. N. Santamaria at St Vincent's Hospital, Melbourne, found that fewer than 10 per cent of alcoholic men treated were skid-row cases and only 2 per cent of those attending were over the age of 64. 89 The implication is that the overwhelming majority of alcoholics are members of the Australian work force. It has been further estimated that about 4 per cent of the male work force, or at least 160 000 men, are alcoholics. 90

We have already quoted the view of one authority about the way in which alcoholics tend to be 'protected' at work. The typical fate of the employed alcoholic has been described as follows : . . . usually, over a 15-20 year period, i.e. by the age of 45, nearly 50 per cent

are likely to be unemployed. By this stage, many of the remainder, who still working, are engaged in occupations demanding less or none ?f previously acquired skills with a consequent significant reductiOn m thetr wages and their productive capacities. 91

53

It should not be thought, however, that alcoholism is simply a problem for the factory worker or the shop floor employee. It permeates all levels of the work force from the top to the bottom, and is apparent in varying degrees in private and public sectors. In some situations, it is easier to conceal than in others, and the detection of alcohol impairment at work often poses difficult problems.

Evidence presented to the Committee stated: In 1959, Maxwell in the U.S.A. (a more moderately drinking community than Australia) pointed out that alcoholics were 2-! per cent times as frequently absent from work, had 3t times as many accidents, and three times the sick­ ness payments. 92 It has been estimated that in some industries about 70 per cent of the personnel problems presented to management and to unions may be due to alcohol. 93 A conservative estimate puts industry costs due to alcohol in

1972-73 at no less than $532m 94 with some authorities citing a current figure of $1000m. 95 As with many of the alcohol-related problems studied by the Committee, the question of the alcoholic in the work force has received little attention in Australia until recently. Even as recently as 1975, the then Department of Labour and Immigration, in a report to the Organisation for Economic Co-operation and Development, entitled Manpower Policy in Australia, when dealing with matters such as 'Health and Safety at Work' and 'Quality of Life at Work' had nothing to say about any problems or programs related to alcoholism in the work force. 96

A great deal more attention is now being paid to this subject, and the Committee notes with much satisfaction the current effective and pro­ ductive co-operation between the trade union movement and employers' organisations in the development of appropriate responses to this problem. In February 1977, the Federal Minister for Health announced a further grant of $100 000 to the Australian Foundation on Alcoholism and Drug Dependence to support its work on a national scheme to combat alco­ holism in industry. 9 7

The Committee is concerned that mere short-term funding is insufficient to allow programs to develop as they must if a serious effort is to be made to overcome this major national problem. We believe that effective pro­ grams to combat alcoholism in industry will require rolling triennial funding.

Mr Ken Stone told the Committee: I submit to you that Industry is succeeding in an area where Health Auth-orities have failed. 98 The Committee was impressed by evidence outlining the efficacy of most programs dealing with alcoholism in industry. 99 They provide an excellent 'lever' for use in bringing alcohol abusers to treatment before damage to health or social well-being has become irreparable. The programs them­ selves emphasise the fact that constructive help without stigma is available to the employee if he chooses to accept it. This mode of approach serves to motivate the alcoholic to obtain treatment and to seek maximum benefit from it so that he may hold or regain his job.

54

In Mr Stone's words, six essential elements in a successful program are: (1) Company and Trade Union Policy (common to both) (2) Available treatment facilities (detoxification, counselling, therapy, etc.) (3) The knowledge to obtain early identification ( 4) Willingness of supervisors and shop stewards to use the policy and stick

to the program (5) Acceptance by the alcoholic employee of treatment (6) Long-term operation of the policy and program_Ioo

Such a program does not require any unusual investment of time, money or personnel. A policy on alcoholism is merely an addition to the existing personnel policies in most medium to large businesses. Evidence of the success of overseas programs is encouraging. The Bell Telephone Co., Chicago, conducted an evaluation of its program over a

1 0-year period. Of a total of 402 employees treated (309 men and 93 women), 80 per cent had been with the company more than 10 years. Sickness disability was strikingly reduced after treatment, as was the number of accidents, both on duty (from 57 to 11) and off duty (from 75 to 28), comparing the 5-year period before with the 5-year period

after treatment. 1 01 Results at General Motors Oshawa plant, in Canada, also support this type of program. 102 Speaking of Australian experience, Mr Stone stated: Recovery rates of persons treated through this early intervention system are

claimed to be as high (as) 80 per cent. 1 0 3 The main reason for this outstanding success rate is that these programs identify the problem drinker in the early stages when successful treatment is much more likely.

In the United States, where losses to industry through alcohol have been estimated at $US9. 35 billion in 1971, 104 over 620 companies had occupational alcoholism programs in 1975, half of these having been introduced over the previous two years. In many recent collective agree­ ments between American management and labour, programs to combat industrial alcoholism have been specifically

As noted above, alcoholism is not confined to 'industrial' occupations alone. In 1970, the United States Congress passed a comprehensive Federal Prevention and Treatment of Alcohol Abuse and Alcoholism Act which, in section 201, specifically directed its attention to Federal civilian employees-in other words, the Federal public service. The Act provided for treatment and rehabilitation for such employees and for

prevention of job discrimination against them, except in authorities related to national security-for example, the Central Intelligence Agency, the Federal Bureau of Investigation and the National Security Agency. 106 In Australia, such programs are beginning only now. Victoria already has 27 under way in both public and private sectors; but at the time of

writing this report no Commonwealth programs were in operation. The two most frequently cited programs operational in Australia are those of the Nylex Corporation Ltd and Kodak Pty Ltd. Discussing the Nylex program, Tricia Ritman made an important point: there is a need to have

involved with its management experienced people who are 'familiar with

24819/77-5

66

the illness of alcoholism, its symptoms and its effects on a person'. In addition, such people ought to have an understanding of counselling skills and be acquainted with the options and facilities available for the treatment of alcoholism in its widest possible sense. 10 7

Evaluation of these programs is still in its early stages. In June 1975, Dr W. Granger, Medical Director of Kodak, gave details of the company's program:

1. There have been 34 people involved in the programme to March 1975. Of these 34 patients 18 were per cent. Of these 34 patients

22 are total abstainers-one patient has continued to have an odd social drink and 11 have continued to drink excessively. Of the 34 patients 27 were male and 7 were female. Of the 22 abstainers 18 were male and 4 were female. Of the 11 who continued to drink excessively 9 were male and 2 female. The odd social drinker was female. 2. The financial cost to the company was less than $100 per patient for the

treatment. Replacement cost of one employee for another exceeds $500 in the average without regard to the skill deletion. 3. The saving in absentee days averages approximately 14 days per year per person for those who abstained, this , is approximately 400 dollars.

The financial results are gratifying but the results in people are tremen­ dous.108

The Victorian Public Service has been the first to move into the field for public service employees. In 1975, the State Public Service Board issued a personnel policy statement concerning the rehabilitation of problem drinkers and the prevention of alcohol-related problems within State departments and agencies. It was proposed that a rehabilitation program be initiated and maintained within each department and agency. The program was to be based on the facilities of the Alcoholics and Drug Dependent Persons Services Branch of the Department of Health, or the Government Medical Officer, and on educative information provided by the Board and the Victorian Foundation on Alcoholism and Drug Dependence.1 0 9 Such a program is welcomed and should be watched with interest to see whether it can be used as a model for similar programs in other States and at Commonwealth level.

66

The Committee recommends:

1. That the Federal Government take urgent steps to introduce into the Commonwealth Public Service an appropriate program to deal with alcohol abuse, and that all possible encouragement be given to the State Public Services to follow the direction taken in Victoria.

2. That, in view of the demonstrated value of alcohol programs in industry, adequate long-term funding be provided by Commonwealth and State Governments specifically for the purpose of promoting, monitoring, evaluating and designing such programs. 3. That the Federal Government give practical support and encourage­

ment to Australian firms and trade unions for the development and introduction of their own alcohol-abuse programs with suitably trained personnel.

Alcohol and the Australian Aboriginal

4. That Commonwealth and State Governments participate with trade unions and employers in further research into and development of appropriate alcohol-abuse programs.

The Australian Aboriginal has been one of the most tragic victims of the white man's penchant for self destruction through the misuse of alcohol. It did not take long for the Aboriginal population of Sydney to be infected by the drinking habits of early colonists. On a visit to Sydney

in 1820, the Russian seafarer and explorer Bellinghausen specificalJy remarked on the desire for liquor among the local Aboriginals and the effect which it had on their health. 110 In 1892, Richard Hill, M.L.C., wrote a pamphlet concerning the Aboriginals of New South Wales in which he described the Sydney of his younger days, 60 years before,

when there had been hundreds of Aboriginals living in the area of the settlement. His pamphlet of 1892 declared that nearly all were dead and that 'drink has been the principle (sic) cause'. 111 French visitors in 1819 noted that drunkenness among Aboriginals in Sydney was a byword. Indeed, Governor Phillip's protege, Benne1ong, became an alcoholic and died in 1813 in a drunken brawl. The Quaker Daniel Wheeler wrote

of the indigenous people in 1839: ... their debased condition is greater than can well be conceived, and such as to render every attempt to assist them fruitless: if money is handed to them it is immediately exchanged for rum, or if clothes, they are forthwith sold or exchanged for whatever will procure strong drink, such is the curse entailed upon them since their acquaintance with the British ... 112

The Committee believes that it should comment on the specific problem of alcohol in relation to Aboriginals because it involves issues which are not immediately relevant to the problems associated with the white population. Conversely, many of the statements and recommendations made in relation to the white community are not relevant to Aboriginals.

The House of Representatives Standing Committee on Aboriginal Affairs is currently investigating the problems of alcohol among Aborig­ inals in the Northern Territory. That Committee's interim report described alcohol as 'the greatest present threat' to Aboriginals in the Northern

Territory, and warned that 'unless strong immediate action is taken they could destroy themselves' .113 Recommendations on this problem were made as far back as 1974 when the Workshop on Aboriginal Medical Services presented its report. 114 There have since been the report from the House of Representatives

Standing Committee on Aboriginal Affairs entitled Aboriginal Health in the South- West of Western Australia, 115 and the various reports from the Senate Standing Committee on Social Environment and the Senate Select Committee on Aborigines and Torres Strait Islanders entitled The Environmental Conditions of Aborigines and Torres Strait Islanders and the Preservation of their Sacred Sites. 116 These reports and others,

such as that of the Western Australian Royal Commission into Aboriginal Affairs, have highlighted the special problems of alcoholism among

57

the Aboriginals, which may be at least four times the rate found in the white community. 117

We do not propose to review all the evidence presented in the earlier reports. Rather, we direct attention once again to their findings, conclus­ ions and specific recommendations, and voice our own concern that the problem of alcoholism is much more acute among Aboriginals than in the rest of the community. Unless urgent action is taken, part of our original Australian community may be wiped out by this epidemic.

Recently, the Government tabled a statement on the recommendations of the Senate Select Committee on Aborigines and Torres Strait Islanders. On the matter of alcohol and Aboriginals the statement declared: Consistent with the Government's concern over the disturbing effects of

alcohol on Aboriginal people and communities, the Minister for Aboriginal Affairs in 1976 gave a comprehensive reference on the alcohol question to the House of Representatives Standing Committee on Aborigines and Torres Strait Islanders (sic), whose interim report 'Alcohol Problems of Aboriginals: Northern Territory aspects' was tabled in late 1976. A final report is expected later this year. Careful attention will be given to the findings of the Com­ mittee. Pending receipt of the report, however, the Government already supports the decisions of Aboriginal groups in all these matters, particularly those relating to the availability of alcoho1. 118

The Committee recommends:

That the Federal Government implement the recommendations made by Committees of both Houses on alcohol and its use by the Aboriginal community, and report to the Parliament on the steps which it takes in in accordance with those recommendations.

Licensing Laws Changes in licensing laws in most States and Territories over recent years have had the effect of increasing the outlets for liquor, as is demon­ strated by the South Australian example (see Table 2 .12). There is clear evidence that many of the licensing laws are not being observed. For instance, intoxicated persons are being served in hotels and clubs119 and under-age drinking has increased.120 The Committee regards it as an anomaly that recent changes in the law in the Australian Capital Territory removed the authority of the police to determine whether drinkers on licensed premises were under age. We recommend:

That the Australian Capital Territory Police have restored to them the authority to enter licensed premises to deal with the problem of under-age drinking.

State licensing laws even have provisions which positively encourage drinking and then driving. Section 60 of the New South Wales Licensing and Liquor Act provides that liquor may be served to bona fide travellers at certain times, provided that they have travelled a certain distance to reach the licensed premises. Those who then need to return home or to continue their travels are thereby positively encouraged to drink and drive.

58

Economic Costs and Benefits of Alcohol

The Committee has also noted some calls for the reduction of legal drinking-age limits, and rejects such calls completely.

On these issues, we recommend:

1. That State and Territory licensing laws be more strictly enforced than at present.

2. That section 60 (bona fide travellers provisions) of the New South Wales Licensing and Liquor Act be repealed.

3. That State Governments defer relaxation of regulations regarding sales outlets and that the Commonwealth Government not in any way increase the availability of alcohol.

4. That the Commonwealth Department of Health examine the relation­ ship between merchandising and alcohol consumption patterns and advise on the types of sales outlets most appropriate to attainment of the desired national goals.

There has been no comprehensive empirical study ofthe economic costs and benefits of alcohol in Australia. However, Dr L. R. H. Drew has calculated that in 1972-73 direct State and Commonwealth revenue from taxes on alcohol was $547m and total personal consumption expenditure on alcoholic beverages $1 415m. On the basis of these figures, total direct economic benefit would not exceed the latter figure, although there would be many additional indirect benefits. He estimated the total cost

of alcohol to the community at $1 177m-health $100m, industry $532m, road crashes $350m and social welfare $195m. 121 Dr Drew concluded: . . . even at the economic level the costs related to alcoholic liquors are beginning to approach maximum estimated benefits. Alcohol costs increase

disproportionately to benefits, given increasing consumption and it can be anticipated that, if consumption continues to rise over the next 10 years as it has in the last ten years, then costs will far exceed benefits. 122

Dr J. H. W. Birrell, in evidence, referred to a study by Troy and Buchan who found that car crashes-a high proportion of which are directly due to alcohol-cost the Australian community about $800m. 123 He summed up:

The balance sheet, I think, would be all anti-alcohol; there is no doubt about this. On the other hand, you are dealing with people's jobs, their careers; it would certainly take a lot of coping to alter one. 124

Such a balance sheet does not portray the 'benefits' derived by the general community from the production of alcoholic beverages and employment in the liquor and allied industries. Indeed, this touches on what several commentators, for example, Faris, in Canada, 125 and Jellinek, in the

United States, 126 have termed 'economic alcoholism' or the 'economic origins of alcoholism'. Faris predicated the need for government pricing policies in Canada to reduce the overall level of alcohol consumption and remarked that, given the economic strength of the liquor industry and all

59

Advertising and the Media

allied industries (for example, transportation, farming, advertising, packaging, distributive, entertainment etc.):

The government-industrial complex is North America's largest drug pusher. Only an aroused citizenry can effect any meaningful change. 127 It is indeed difficult to make any meaningful analysis of the overall cost and benefits of alcohol consumption in Australia. C. M. Deakin, J. N. Santamaria and P. Wilkinson have shown that the social and medical costs to the community for each individual alcoholic are in the order of

$800 per year. 128 This figure alone indicates the magnitude of the amounts potentially involved. As the Committee has noted elsewhere, any sub­ stantial reduction in the overall level of consumption will make a real impact on Federal and State treasuries. Clearly, the extent to which revenue losses may be offset by savings in all other areas is worthy of much more detailed economic analysis.

The Committee recommends:

That the Commonwealth Department of Health prepare and publish a comprehensive analysis of the costs of alcohol abuse in Australian society.

When considering the question of any regulation of the advertising of alcohol, the Committee was faced not only with contradictory views about the efficacy of such a step, but also, once again, with the whole question of civil liberties discussed by us earlier.

In his evidence, Dr Hetzel supported the banning of advertising of alcohol, claiming that a ban 'would be of benefit'. 129 Similarly, Rev. Martin made his second recommendation in these terms: Advertisements for alcohol be prohibited on radio and television, particularly

those directed towards young people. 130 The Standing Committee on the Health Problems of Alcohol, one of the committees of the National Health and Medical Research Council, has also supported controls on the advertising of alcohol:

Despite the inadequacy of data on the effect of alcohol advertising it would appear that advertising needs control, or even phasing out. 131 On the other hand, the Media Council of Australia brought to the attention of the Committee an existing voluntary code of advertising practice in relation to alcoholic beverages which appears at Appendix 1, and the advertising industry has established an Australian Advertising Standards Council under the chairmanship of Sir Richard Kirby. The charter of the latter body is to:

Advise the Media Council on codes and ethics for advertising; Bring breaches of advertising standards to the attention of the various code committees of the Media Council; and Generaliy to assist in maintaining and improving the standards and ethics of advertising. 132

The Federation of Australian Commercial Television Stations, in submissions to both the Committee of Inquiry into Broadcasting and the

60

Australian Broadcasting Tribunal, has reported the operation of various codes of voluntary self regulation in advertising, and has noted that a code of alcohol advertising has now been registered with the Trade Practices Commission. 133 The Committee itself viewed all advertisments made for television in 1977 by Tooth and Co. Ltd, Tooheys Ltd, the Cascade Brewery Co. Ltd, and Carlton and United Breweries Ltd, all of which complied with the voluntary .code of self regulation placed before us.

In terms of hard evidence about the effect of any such prohibition of advertising, the only study which the Committee could find was that of R. G. Smart and R. E. Cutler, conducted after advertising was banned for 14 months from September 1971 to October 1972 inclusive in the Canadian province of British Columbia. After studying sales data for

the years 1962 to 1972, they concluded: The data presented lent little support for the view that the B.C. advertising ban reduced alcohol consumption. Both the yearly and monthly analyses of beer, wine or liquor consumption show no substantial effect of the ban.134 Similar lack of effect has been reported in many places following the ban on cigarette advertising. 135

Nevertheless, the Committee is concerned that, given the high level of exposure of people-especially the young-to mass media advertising, estimated by one detailed survey at 3 hours 40 minutes per night for most young secondary students, 136 the pressures of advertising will augment pressures by peer groups to push young people into drinking.

Alcohol is effectively promoted also through entertainment. particularly films and television series. It is not unusual to see the principal male character consuming large amounts of alcohol on screen, often solely for the purpose of getting drunk. Because most films are imported from

other countries, Australian authorities have little control over film content. However, in the United States the National Association of Broadcasters has established a set of standards for television programs. The standard relating to alcohol reads:

The use of liquor and the depiction of smoking in program content shall be de-emphasized. When shown, they should be consistent with plot and character development. 13 7 The question of advertising alcoholic strengths is a complex matter. Dr Gerald Milner has suggested:

Labelling would help overcome the astounding ignorance of Australians about their beloved beer ... Labelling would give impetus to moves to favour the production, advertising and distribution of true 'light lagers' (maximum 3 per cent alcohol), the purchase of which should be encouraged, compared to other stronger beverages,

by Government action on excise, duty and prices generally.138 However the Australian Associated Brewers noted in their submission that Germany and the United States had specifically legislated against such labelling of beer;139 that in the United Kingdom a beer had been advertised on the basis of its having been made 'stronger' by comparison with other beers;140 and that in the Netherlands, after

61

such labelling was introduced in 1964, there had been a swing to the consumption of the stronger beers, leading to a discontinuation of the labelling practice. 141

As noted earlier, the new beer marketed by Cooper and Sons Ltd is specifically labelled as 'a low alcohol beer'. The Australian Associated Brewers opposed labelling with a statement of alcoholic strength on the ground that such labelling would promote the stronger beers. 142

In evidence, Dr F. H. Buchanan made some comments about the effectiveness of anti-drinking educational campaigns:

The ones that do seem to be effective are statements by people-Olympic athletes and champions in sport. They are never done. Sir Donald Bradman­ he is another generation now-when he was at the peak of his career used to say quite openly that he did not drink, that he was a teetotaller. That kind of statement is effective. 143 In sad contrast to this, we now see the use of leading sportsmen-for instance, members of the Australian Test Cricket Team-in the promotion and advertising of alcohol. It is perhaps a pity that sportsmen and sports­ women lend their prestige to the promotion of products which, when used to excess, are so demonstrably harmful to so many Australians. The Committee is disturbed by the use of sexual imagery and the highlighting of sporting heroes in alcohol advertising.

We recommend:

1. That the Commonwealth Government ban the advertising of alcoholic beverages, whether by way of corporate advertising or by exhibiting of the brand name of such beverages in a planned fashion, on radio and television and in areas under direct Commonwealth control, such as in the Territories and at airports.

62

2. That, until a total ban has been implemented, the question of substantial compliance with the voluntary code for the advertising of alcoholic beverages by brewers, distillers, wine makers and all retailers of alcbolic beverages be reviewed annually.

3. That State Governments and local government authorities be encouraged to ban the advertising of alcoholic beverages.

4. That the Federal Minister for Environment, Housing and Community Development, and the State Ministers responsible for youth, sport and recreation, appeal to sportsmen and sportswomen throughout Australia not to lend their names and prestige to the promotion of alcoholic beverages. 5. That the Commonwealth Government make any grants to sporting and

cultural bodies conditional on their not accepting money from manu­ facturers and retailers of alcoholic beverages and investigate the possibility of indemnifying such bodies for loss of revenue, at least in the short term. 6. That the Commonwealth Government consider refusing tax deductibility

for expenses incurred in the promotion of alcoholic beverages.

Treatment Services Treatment of alcohol-associated problems is usually carried out either in general hospitals or by mental health services, community support agencies

and voluntary organisations. At present, a wide variety of treatment methods are being used. The most common are psychotherapy, behaviour therapy, counselling (on alcohol and alternatives to it), confrontation and the use of disulfiram (Antabuse) and other drug therapy.

There is a general lack of research on the effectiveness of these methods. Research done has often been subjective and inconclusive. Dr Milner believes that in order to overcome these deficiencies it is necessary to define client variables carefully so as to ensure that valid comparisons can be made; to define goals of management and procedure for management carefully; to record current behaviour; and to ensure follow-up, noting changes in behaviour and statements, particularly in terms of management

goals.144 Most of the treatment for alcoholics is carried out at the institutional level, but many people working in the field are dissatisfied with this emphasis. The South Australian Government told the Committee:

Most practitioners in the field of alcohol and drug abuse problems seem to be dissatisfied with the institutional and individual approaches that have been built up over the last thirty years.

Often the client feels fobbed off in this process and labelled as an alcoholic when in fact he or she does not accept the labels. Somewhat reluctantly, clients then present themselves to clinically based services where they feel cowered by a highly professionalized ethos associated

with the clinic. The treatment then proceeds, usually with insufficient regard to the clients family, environment and cultural background, and finally con­ cludes unsuccessfully. The end result is to make the client a little more sceptical of (and a great deal craftier with) the helping professions. In the light of this, it is argued that more successful results would be achieved

by helping the alcoholic in non-specialist community-based health and welfare facilities with counselling and programmes that are grounded realistically in the family and the environment.145 One well known community based program which has an apparently impressive record of success is that of Alcoholics Anonymous. This

organisation conducts 'open meetings' which relatives and friends are encouraged to attend and 'closed meetings' for alcoholics only. Pedr Davis states: An estimated 60 per cent of newcomers walk out of their first AA meeting

filled with the wonder of it all, quite convinced they have taken their last drink. Usually they then go into the honeymoon period and run into problems of adjustment and tension which they may, or may not, conquer. However , roughly half of those attending a dozen or more AA meetings achieve sobriety for at least twelve months. Perhaps one quarter remain sober fo r the rest of

their lives. 146 This is considered to be a high rate of success in the treatment of

alcoholism. Dr Milner has put forward a community program for alcoholics. He proposed a regional service led by a community consultant and a community counsellor, with secretarial assistance. The function of this

63

Driving, Road Crashes and Alcohol

team could be to co-ordinate existing facilities in the region and to prevent duplication of services. Referrals of drinkers could be made by family members, church and social workers, doctors etc., 'not for specific treat­ ment but in order (to) secure the most effective organisation and deploy­ ment of local resources to cover the individual's special problems and needs' .147 Dr Milner has stated that it is essential that adequate provision for evaluation of the service be made.

A pilot program based on this approach has been established in Geelong ; but as it has been operational for only a short time its effectiveness can be judged only with difficulty at this stage. If the Geelong project proves effective, similar centres could be established in other regions.

The relationship between alcohol and the road toll is staggering. Year by year, road crashes with their death, injury and property damage continue to mount at an alarming rate. Programs of public education and driver education have been undertaken at all levels, in schools and in the media, by all governments and by numerous groups in the community, but have been sporadic and unco-ordinated and seem to be minimally effective.

Table 2. 1 5 gives the number of the deaths on the roads each year.

Table 2.15 Road deaths in Australia

1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976

Source: Australian Bureau of Statistics.

3 164 3 242 3 166 3 382 3 502 3 798 3 590 3 422 3 679 3 572 3 694 3 583

Table 2. 16 gives statistics for blood alcohol level (BAL) recorded in the report on an examination of post-mortem alcohol levels of 1601 people involved in fatal road crashes in Brisbane between 1955 and 1971.

64

Table 2.16 Blood alcohol levels in 1601 accident fatalities in Brisbane (July 1955-June 1971)

Ped- Car Car Motor

Total estrians drivers passengers Others cyclists

Blood alcohol/eve/ (mg/100 ml) (1601) (617) (447) (331) (94) (112)

per cent per cent per cent per cent per c.ent per cent

Percentage with levels of 50 mg/1 00 ml or greater (11 SI) 36 . 8 32.0 52 . 1 32.9 34.0 15.1

Percenta ge with levels of 100 mg/100 ml or greater (22 SI) 31.8 30 . 3 44 .9 24.7 28.7 12.5

Percentage with levels of 200 mg/100 ml or greater (43 SI) 13.9 15.9 18.8 7.8 10 . 6 5.3

Percentage with levels of 300 mg/100 ml or greater (65 SI) 2.0 3.7 1.3 1.2 0.9

Source: J. I. Tonge, 'Post Mortem Blood Alcohol Levels in Road Accident Victims', in National Road Safety Symposium (Canberra, March 1972), p. 204.

Using this and several other studies, I. R. Johnson concluded that almost 1200, or one in three, of the persons killed in road accidents in Australia in 1975 had a BAL above 50 mg/100 ml (11 SI). 148 The Com­ monwealth Department of Health has estimated that alcohol is a major cause of 50 per cent of road fatalities. 149 Johnson calculated from the available Australian data that in non-fatal casualty accidents about

one-quarter of injured pedestrians and between one-fifth and one-third of injured drivers have elevated blood alcohollevels. 150 A survey of Victorian hospitals conducted during April and May 1977 found that more than 500 drivers involved in road crashes had blood alcohol levels exceeding 50 mg/100 ml (11 SI). Table 2 . 17 shows BALs for

251 drunken drivers treated in May 1977.

Table 2.17 Blood alcohol levels of drunken drivers treated in Victorian hospitals during May 1977

BAL

> 50 mg/100 ml > 100 mg/100 ml > 150 mg/100 ml

> 200 mg/100 ml > 250 mg/100 ml > 300 mg/100 ml > 350 mg/100 ml

Number

251 190 127 68

32 10 3

Source: Survey conducted by the Road Trauma Committee of the Royal Australasian College of Surgeons, quoted in The Age, 21 June 1977.

It is difficult to estimate the number of drivers in the general population who drive with an elevated blood alcohol level. J. A. Duncan conducted surveys of 3500 drivers in Canberra in 1971 and 1972. He found that 6 per cent to 7 per cent of drivers had BALs of 30 mg/100 ml (6 Sl) or

65

greater and about 1 per cent had BALs of 80 mg/100 ml (17 SI) or greater in the period from I 0 a.m. to 2 a.m. 151 Statistics from Darwin courts reveal that 8 per cent of the adult male population had been charged with drink-driving in 1975.152

The argument was put to the Committee that alcohol would not neces­ sarily have caused road crashes involving fatally injured drivers who had more than the legal limit of alcohol in their blood, and that other factors such as faulty brakes, bad roads or poor lighting may have been respon­ sible.153 We reject this argument. We have examined various studies on alcohol and driving capacity. One such study showed that increasing blood alcohol levels resulted in progressive impairment of driving per­ formance. Even at a BAL of 50 mg/100 ml (11 SI), performance was impaired, particularly among less skilled drivers. 154

Table 2. 18 shows the probability of being involved in a motor vehicle crash at various blood alcohol levels.

Table 2.18 Probability of involvement in a road crash, related to blood alcohol level (BAL)

Estimated crash probabilities, based on risk at zero BAL

1

1

1-2. 4

6- 8. 25- 50 ':>: 100

BAL

gm/100 ml

zero 0 .04 0.05 0.08 0.10 0.15 0.20

Sf units millimoles/

mg/100 ml litre

zero zero

40 9

50 11

80 17

100 22

150 33

200 43

Source: A. R. Harcourt, submission to the Senate Standing Committee on Social Welfare.

There have been surveys which indicate that a number of persons charged with drunken driving are habitual offenders and that many of them have alcohol problems. These recalcitrant drivers constitute a special class of offenders. They remain virtually immune from the effects of most legal and preventive measures which are successful in other segments of the driving population-a fact which has been noted in Australia, by researchers like Santamaria, 155 and confirmed by overseas experiences such as those in Sweden reported by H. Klette156 and R. Borkenstein. 15 7 The separate nature of the group with whom we are concerned was clearly identified by the Expert Group on Road Safety which, in a report to the Minister for Shipping and Transport in September 1972, stated:

66

THE EFFECTS OF PUNISHMENT Psychological research shows that the effectiveness of punishment in altering behaviour is usually increased when the punishment is accompanied by an educational process which directs attention to the desired behaviour. Punishment is relatively ineffective when detection is only intermittent. It is maximally effective, however, when it immediately follows the undesirable behaviour.

PUNISHMENT AND PARTICULAR GROUPS OF ROAD USERS Road users fall into three groups. First, there are those who are simply unable to conform to the law. Many excessive drinkers fall into this category. They are resistant to the threat of punishment and to punishment itself. People involved · in an atypically high number of accidents, often incorrectly labelled 'accident­ prone', are also in this group. The second group comprises those who, although capable of safe road

behaviour, deliberately and consistently flout the law by driving while intoxi­ cated or by speeding. Drivers with unsatisfactory traffic records tend towards unlawful and antisocial behaviour in many other areas of their daily lives. This group probably cannot be deterred by punishment alone, since its

deviant behaviour represents conformity with its own social norms. The third group comprises the majority of road users who occasionally engage in unsafe behaviour through carelessness, inexperience or some momentary failing. Although not an homogeneous group, their behaviour is most likely determined by a fairly realistic assessment of the probability of being apprehended and punished. Enforcement of punitive measures would have the greatest effect on this group. 158

Some studies have found that over 30 per cent of those who have been convicted of drink-driving offences are re-convicted for further drink­ driving or other offences. 159

Diversionary Programs Overseas evidence on the success of diversionary programs has been encouraging. 160 T. G. Duffy, in a paper presented to the Seventh Inter­ national Conference on Alcohol, Drugs and Traffic Safety, noted

that the program conducted in El Cajon, California, had been useful in all aspects of the reduction of alcohol abuse and that it could be shown to be a substantial money-saver for various municipal and State authorities. 161

A diversionary scheme was introduced in New South Wales in March 1976. This scheme offers the program only to those drivers who are charged with having a BAL above 150 mg/100 ml (33 SI) or who have a previous drink-driving conviction. After the defendant has pleaded guilty and

elected to enter the program, his case is adjourned for an eight-week period during which time he attends a central assessment centre and is directed to a suitable diversionary program. There are three alternative programs, based on education, counselling or behaviour modification,

respectively. Throughout the adjournment period, the defendant is placed under the supervision of a probation officer, who files a final report to the magistrate on the defendant's participation in the program. 162 Evaluation of this program is not fully completed; an inconclusive interim report was presented in May 1977. 163

The Australian Capital Territory Legislative Assembly passed, and the Commonwealth Parliament has allowed, a Motor Traffic (Alcohol and Drugs) Ordinance 1977, which provides for diversionary programs for persons with drug-related problems.

67

The Committee applauds the introduction of pilot programs. We are anxious to see evaluation of their effectiveness before recommending the extension of such programs on a more general basis. The Committee recommends:

1. That, if diversionary programs are shown to be effective, they be introduced in all States and Territories. 2. That provision for the evaluation of effectiveness be incorporated in any diversionary programs introduced.

Breathalyzers and Random Breath Tests There has been a great deal of discussion about Breathalyzers and random breath tests, both from the point of view of effectiveness and from the civil liberties perspective. One witness reported that more than 80 per cent of the drivers who are subjected to Breathalyzer tests are in fact charged. 164 There is evidence that these tests are often more likely to be administered to certain classes of drivers-especially the young-because of their conspicuousness and police attitudes towards them. 165

The available evidence does not enable us to make a definite judgment about the effectiveness of Breathalyzers in reducing the road toll. The increased number of convictions resulting from their use may have a deterrent effect. The test of the Breathalyzer's effectiveness will be its ultimate contribution to the reduction of drink-driving offences and of the road toll.

Legislation was introduced in Victoria on 1 July 1976 to provide for random breath tests, but to date the Committee is unaware of any evidence to enable their efficacy to be evaluated fully. Mr R. Tomasic, citing evidence from both Britain and Australia, came out very strongly against such measures, 166 and the Australian Law Reform Commission, in a report entitled Alcohol, Drugs and Driving, concluded that random breath tests are not justified at this time. 16 7

At this stage, we have not sufficient evidence to show that random testing would decrease the drink-driving problem. However, we recom­ mend:

That, if evaluation shows random breath tests to have positive effects on driver behaviour, they be introduced in all States and Territories. The Committee feels that, in the meantime, the Breathalyzer could be used to optimal effect if police patrolled those areas where drinking combined with driving is most likely to take place; that is, outside hotels, clubs and premises where private parties are being held. While the proposal to patrol private parties may be criticised by civil liberties groups, it must be remembered that about 70 per cent of drinkers are not drinking in hotels and clubs, 168 and that civil liberties, as Professor Blewett re­ minded us, do not extend to the right to injure or endanger others. 16 9 The police not only should apprehend those who have contravened the

68

law by driving while under the influence, but also should issue warnings to persons who appear to be so affected but have not yet taken control of a vehicle. The Committee recommends:

That police extend Breathalyzer testing in the vicinity of all places where people drive after drinking.

Blood Tests There have been suggestions that blood tests be automatically adminis­ tered to all victims and persons involved in road crashes. The Australian Law Reform Commission has supported the use of screening tests in

the Australian Capital Territory and has discussed the various alternatives available. 170 G. A. Ryan and others have reported on the material which became available to various medical and other authorities after the introduction in Victoria in Aprill974 oflegislation to allow blood samples

to be taken from all persons aged 15 years or over after involvement in a road crash.l 71 Although the Australian Law Reform Commission was 'not persuaded that universal blood samples should be required of persons admitted to hospital following motor vehicle accidents', 172 the Committee believes that this procedure provides valuable data on the extent of the drink­ driving problem. We therefore recommend:

1. That the suggestions of the Australian Law Reform Commission regarding screening tests of drivers be adopted. 2. That blood samples be taken from all persons over a specified age who are involved in serious road crashes.

Licences Licence revocation is one ·of the most powerful legal sanctions, but automatic disqualification provisions may tend to make the enforcement authorities somewhat reluctant to search out offenders whose livelihoods would be impaired by the use of this sanction. Moreover, it is likely to be effectual with the rational rather than the recalcitrant offender.

In some States, special provisions in the law allow qualified driving licences to be issued to people who have been convicted of drink-driving offences. 173 Usually these licences restrict the holder to use of a vehicle during certain hours only, or for certain purposes only such as travelling

to and from work. Both Tomasic and the Australian Law Reform Com­ mission have spoken favourably of the effects of this procedure. 174 The Committee notes that the Law Reform Commission, among others, urges that the training of learner drivers should include specific information concerning the effects of alcohol and drugs on driving, and that questions on these matters should be asked as part of the driving test given to applicants for licences. 175

We recommend: 1. That the option to issue qualified licences to convicted drink-drivers be introduced in all States and Territories.

69

2. That learner drivers be provided with information about the effects of alcohol and other drugs on driving, that questions on such effects form part of the licence test, and that literature on the interaction of alcohol and drugs with driving be sent with notices of licence renewals.

Education

Dr R. Spielman advised the Committee that although there is no standard safe alcohol limit for everyone, there is widespread ignorance of the general relation between amount drunk and degree of driving impair­ ment.l76 A survey by Freedman, Henderson and Wood also found this to be true. They concluded:

There is clearly a wide gap existing between what are the established facts on the relationship between alcohol and driving impairment and what the general public believe. This knowledge gap needs to be bridged. The increase in public awareness of the facts of alcohol and driving impairment will not result in a dramatic drop in the incidence of alcohol-involved crashes in the community, with a mass rush to behave in accordance with the law. What it will do is to bring about a growth in social pressures to curb irresponsible drinking and driving. A better informed public will be more likely to provide social controls on drinking and driving that will reinforce existing legal controls. In the long term this should result in a change in customary behaviour relating to drinking and driving in the community. 17 7

Education has been suggested as an important means to reduce the drinking-driving problem. Basic information on bow much alcohol is likely to impair driving, and the dangers of driving while drunk, should be widely disseminated. One witness suggested that information on sobering up should also be publicised :

This is one important aspect of the problem which is seriously misunderstood by the majority of the lay public. The body is capable of destroying alcohol at only a very slow rate, about 2 glasses of beer or equivalent per hour. It is completely fallacious and highly dangerous to assume that at the end of a drinking session a short period of abstinence and the drinking of coffee will significantly lower the blood alcohol concentration. As an example, an

individual in whom the blood alcohol level has reached 0.1 g. per cent will require 5 hours before his body can clear itself completely of alcohol. The individual who spends 3-4 hours drinking at a party until after midnight and reaches say a blood alcohol level of 0. 16 g. per cent will require 10 hours to

become free from alcohol and, in fact, may still be seriously under the influence of alcohol when he drives to work the next morning. 1 7 8 In 1973 the New South Wales Government sponsored a program of two drink-driving campaigns which were conducted by Dr J. M. Hender­ son. The first was intended solely to increase public awareness. It had three stated objectives :

70

1. To increase awareness of the relationship between drinking and driving and serious traffic crashes. 2. To increase awareness of the Breathalyzer legislation and the penalties contained in it. 3. To increase awareness of the amount of alcohol required to break the

Jaw.17Y

24819!77-6

A before-and-after survey revealed that 'there was a measurable increase in knowledge in the areas defined by these objectives•.Iso The second part of the program, which became known as the 'slob campaign', was designed to bring about a change in public attitudes

towards:

(a) A person who drinks about 6 middies of beer in an hour and then drives, and (b) A person who tries to persuade someone to have an extra drink before driving. 181 A before-and-after survey revealed that there were probably significant changes of attitude, 182 though it is not clear for how long the beneficial effect was maintained. Henderson noted a drop in the average blood

alcohol level (content) of convicted drivers: An indirect indicator of behavioural change is that a slight, but statistically significant drop in the average BAC of convicted drivers was recorded, with the campaign being the most likely explanation for this effect. 183

The Committee recommends:

That, except for pilot programs, Commonwealth and State Governments give financial assistance only to educational programs which identify the dangers of drink-driving and which have been demonstrated to produce the desired behavioural changes.

Mechanical Deterrents

Strategies designed to reduce the road toll can be directed towards modifying driver behaviour or towards making the environment safer. Behavioural approaches are attractive, but so far unproven. Only environ­ mental modification-for example, seat belt legislation-has reduced the road toll to date. We note that the Victorian legislature was the first to introduce seat belt legislation, which has now received wide approval

throughout the world. There are several devices which will prevent a drunk driver from starting his car. One such device is the Phystester. When the ignition is switched on, a series of five digits appears on a miniature display panel for a few seconds, The driver must then punch the same sequence of

digits on a push-button keyboard before the car will start. If he does not succeed in three tries with different digits each time, the car will not start for half an hour or longer. 1 84 Another device requires the driver to use the steering wheel to keep a pointer, which is randomly moving about, within two parallel lines for about 30 seconds; otherwise the car will

not start.l 85 The problem associated with these devices is that factors other than alcohol impairment-for example, arthritis-may prevent a driver from successfully performing such tests. However, a Japanese-designed device

which fits on the steering wheel will overcome this problem. If any alcohol is detected, the ignition will not function. 186 On 11 February 1977, The Advertiser of Adelaide reported that another Japanese-designed device, which operates in a manner similar to a Breathalyzer, will prevent a car

71

A National Strategy on Alcohol

from being started before the driver has exhaled into a sensor. If a pre­ determined level of alcohol is registered, the ignition cannot be made to function. All of these devices . are still in the prototype stage and will not be ready for marketing for some time. The Committee recommends:

That Commonwealth and State Governments support the researching and development of mechanical devices to deter drink-driving and, when perfected, require that they be fitted to the vehicles of recalcitrant drivers, at their own expense, as a prerequisite to any renewal of their driving licences.

Proposed Sub-committee on Drugs and Driving

The Committee feels that the drink-driving problem is so serious that it warrants a national response. At present, the States experiment with various counter-measures. That they do so in isolation from one another is unsatisfactory. There must be an organised sharing of ideas, techniques and experiences and a development of co-operation between the States.

In order to achieve this, the Committee recommends:

That a Sub-committee on Drugs and Driving be established within the National Standing Control Committee on Drugs of Dependence, with at least the following functions-( a) To formulate and state a national policy relating to alcohol, other

drugs and driving. (b) To monitor and assess the drink-driving problem and problems associated with driving and other drugs. (c) To monitor and assess existing drink-driving counter-measures. (d) To examine proposals to counteract the drink-driving problem and

problems associated with driving and other drugs. (e) To formulate guidelines for the implementation of viable proposals, each of which should have an evaluation component built in. (f) To report its findings, and to recommend lines of action, to Common­

wealth and State Governments.

The Committee also recommends: _, That the National Standing Control Committee on Drugs of Dependence

be required to report publicly every two years on the activities and progress of the Sub-committee on Drugs and Driving.

A national control policy for overall drug use, including abuse, is discussed in Chapter 1.

72

The Committee recommends: That the Commonwealth Government develop and announce a specific policy on alcohol and alcohol abuse, which should include a clear state­ ment of the Government's intention to bring about an overall reduction in the level of alcohol consumption in the community.

We believe that a reasonable national goal would be to aim for a relative stabilisation of levels of consumption within the next five years, followed by a 1 per cent annual reduction in the levels of overall consumption in the next ten years.

The Committee believes that, in promoting such a policy, the Common­ wealth Government should look for the closest co-operation with all other governments, the trade unions, industry groups, employee groups and specialised voluntary and medical agencies within Australia. We make no specific recommendations about the nature of such a co-operative

and consultative program, but emphasise that support for it must be adequate and must come from the highest levels of government. The Committee urges that the development of a national strategy begin immediately. Every day of delay adds to the national problem in terms of lost resources, lost production, lost capacity and, above all,

lost lives.

References 1

World Health Organisation, Expert Committee on Drug Dependence, Problems and Programmes Related to Alcohol and Drug Dependence in 33 Countries (Geneva, 1974), p. 5.

2 J. G. Rankin & P. Wilkinson, 'Alcohol and Tobacco Consumption', in J. Krupinski & A. Stoller (edd.), The Health of a Metropolis (Victoria, 1971), p. 61. 3 World Health Organisation, Expert Committee on Drug Dependence, Twentieth Report (Technical Report Series, No. 551) (Geneva, 1974), p. 61. 4 K. Bruun, G. Edwards, M. Lumio, K. Makela, L. Pan, R. E. Popham, R. Room, W.

Schmidt, 0. Skog, P. Sulkunen & E. Osterberg, Alcohol Control Policies in Public Health Perspective (The Finnish Foundation for Alcohol Studies, Finland, 1975), vol. 25, p. 28. 5 C. M. H. Clark, A History of Australia (Melbourne, 1962), vol. 1, p. 88. 6 Clark, pp. 214ff. 7 J. Rich, The Australianization of John Bull (Hong Kong, 1974), p. 27.

8 Rich, pp. 27ff. 9 G. C. Drew, W. P. Colquhoun & H. A. Long, Effects of Small Doses of Alcohol on a Skill Resembling Driving (London, 1959). 10 Evidence, p. 1828. 11 Evidence, p. 1919. 12 L. Tiger, Men in Groups (London, 1969), pp. 123-4. 1 3 Commonwealth Department of Health, Annual Report of the Director-General of Health

1975-76 (Canberra, 1976), p. 4. 14 Evidence, p. 1797. 15 Evidence, p. 1632. 1 6 Garry Egger, Rob. Parker & Peter Trebilco, Adolescents and Alcohol in New South Wales

(Report to the Child Health Committee of the New South Wales Health Education Advisory Council) (New South Wales, 1976), p. 42. 17 Youth Say Project, The Recreational Priorities of Australian Young People (Canberra,

1975), pp. 16ff. 18 United States Department of Health, Education, and Welfare, 'Alcohol and Health', quoted in Australian Journal of Alcoholism and Drug Dependence, vol. 3, No.4, November 1976, p. 139.

1o Rankin & Wilkinson, p. 67. 2o A. George, 'Survey of Drug Use in a Sydney Suburb', in The Medical Journal of Australia,

29 July 1972, p. 233. 2 1 A. George, '1973 Survey of Drug Use in a Western Suburb of Sydney' (New South Wales

Health Commission), p. 7. 22 I. Reynolds, J. Harnas, H. Gallagher & D. Bryden, 'Drinking and Drug Taking Patterns

of 8,516 Adults in Sydney', in The Medical Journal of Australia, 20 November 1976, p. 782. 23 P. Davis, Australians and Alcoholism (Sydney, 1976), p. 18.

24 Evidence, p. 2163.

2 5 J. G. Rankin, 'The Size and Nature of the Misuse of Alcohol and Drugs in Australia',

in L. G. Kiloh & D. S. Bell (edd.), 29th International Congress on Alcoholism and Drug Dependence (Melbourne, 1971), p. 13. 2 6 Rankin, pp. 13-14.

27 S. Encel, K. Kotowicz & H. Resler, 'Drinking Patterns in Sydney, Australia', in Quarterly

Journal of Studies on Alcohol, Supplement 6, 1972, p. 1.

73

28 Rev. G. S. Martin, Social/Medical Aspects of Poverty in Australia (Third Main Report of the Commission of Inquiry into Poverty) (Canberra, 1976), pp. 107ff. 28 A. F. Davies & S. Encel, Australian Society: A Sociological Introduction (Melbourne, 1965), pp. 42ff. 30 Evidence, p. 2128. at Evidence, p. 2599. 32 Australian Bureau of Statistics, Apparent Consumption of Foodstuffs and Nutrients 1973- 4

(Ref. No. 10.10), p. 25. 33 Australian Bureau of Statistics, personal communication. 3 4 Evidence, p. 2612. 35 Evidence, p. 2715. 36 Evidence, p. 2716.

37 Evidence, p. 2691.

3 8 Evidence, p. 2733. 39 National Health and Medical Research Council, Report of the Standing Committee on the Health Problems of Alcohol (Canberra, 1975). 40 Evidence, p. 2577. 41 Evidence, p. 827.

4 2 Evidence, p. 346. 43 G. H. Miller & N. Agnew, 'The Ledermann Model of Alcohol Consumption: Description, Implications and Assessment', in Quarterly Journal of Studies on Alcohol, vol. 35, No. 3 (1974), p. 877.

44 Evidence, p. 2714, pp. 346ff. 45 Martin, p. 106. 46 G. Bonfiglio & A. Martinotti, 'Alcohol and Drug Dependence in Italy', in Australian Journal of Alcoholism and Drug Dependence, vol. 3, No. 3, August 1976, p. 72. 47 Martin, p. 121. 48 Evidence, pp. 1813-16. 49 Evidence, p. 2659. 50 Senate Standing Committee on Trade and Commerce, Tax and the Wine and Grape

Industries (Canberra, 1977), p. 79. 51 A. R. Harcourt, submission to the Senate Standing Committee on Social Welfare. 52 Evidence, pp. 2600ff. 53 Evidence, p. 1843. 54 Evidence, p. 2598. 5 5 Evidence, p. 2600. 56 Evidence, p. 2600. 57 Cooper and Sons Ltd, personal communication. 58 Evidence, p. 2694. 59 Cooper and Sons Ltd, personal communication. 60 N. A. Broadhurst, 'A South Australian Survey on Attitudes to Cigarettes and Beer', in

Australian Journal of Alcoholism and Drug Dependence, vol. 3, No. 1, February 1976, p. 26. 61 K. Freedman, J. M. Henderson & R. Wood, Drinking and Driving in Sydney: A Community Survey of Behaviour and Attitudes (Traffic Accident Research Unit, Department of Motor

Transport, New South Wales, 1973), p. 10. 62 Evidence, p. 2707. 63 Broadhurst, p. 26. 64 Frank Small and Associates, 'Survey into the Potential for Low-Alcohol Beer' (survey

commissioned by The Australian Associated Brewers) (Melbourne). 65 Evidence, p. 2697. 66 New South Wales, Pure Food Act; South Australia, Regulations under the Food and Drug Act; Tasmania, Public Health (Food and Drug Standards) Regulations; Victoria,

Food and Drug Standards Regulations; Western Australia, Food and Drug Regulations; Queensland, Food and Drug Regulations. 67 National Health and Medical Research Council, 'National Health and Medical Research

Council Standard for Wine' (November 1974) & 'National Health and Medical Research Council Standard for Spirits and Liqueurs' (April 1975); & National Health and Medical Research Council Food Standards Committee, 'Draft Standard for Beer' (May 1976) & 'Draft Standard for Cider and Perry' (September 1976). 68 Evidence, p. 2593. 69 Commission of Inquiry Into the Non-Medical Use of Drugs, Final Report (Ottawa,

1973), p. 401. 7 ° Commonwealth Department of Health, p. 161. 71

Evidence, p. 1885. 72 National Health and Medical Research Council, Standing Committee on the Health Problems of Alcohol, The Health Problems of Alcohol (Canberra, 1975); & Australian Academy of Science, Working Group on Diet and Coronary Heart Disease, Diet and

Coronary Heart Disease (Report No. 18) (Netley, South Australia, March 1975). 73 L. R. H. Drew, 'Health Costs of Alcohol: The Role of Psychiatrists in Instituting Change' (Commonwealth Department of Health, Canberra), p. I.

74

74 P. Wilkinson, A. Kornaczewski, J. G. Rankin & J. N. Santamaria, 'Physical Disease in Alcoholism: Initial Survey of 1,000 Patients', in The Medical Journal of Australia, 5 June 1971, p. 1217. 76

National Health and Medical Research Council, Standing Committee on the Health Problems of Alcohol, p. 5. 76 National Health and Medical Research Council, Standing Committee on the Health

Problems of Alcohol, p. 6. 77 G. Milner, 'Marihuana, Narcotics and our Community' (paper delivered to the Rotary International Annual Conference, Albury/Wodonga) (March 1976), p. 2. 78

G. Milner, 'Interaction Between Barbiturates, Alcohol and Some Psychotropic Drugs', in The Medical Journal of Australia, 13 June 1970, p. 1204. 79 Quoted in National Health and Medical Research Council, Standing Committee on the

Health Problems of Alcohol, p. 7. 80 E. Y. Ots, 'The Relationship between Alcohol and Violent Crime' (Chief Secretary's Department, Victoria): quoted in National Health and Medical Research Council, Standing Committee on the Health Problems of Alcohol, p. 7. 81 E. J. Hodgens, I. H. McFadyen, R. J. Failla & F. M. Daly, 'The Offence of Rape in

Victoria', in The Australian and New Zealand Journal of Criminology, vol. 5, p. 225; quoted in National Health and Medical Research Council, Standing Committee on the Health Problems of Alcohol, p. 7. 82 R. G. Birrell & J. H. W. Birrell, in The Medical Journal of Australia, vol. 2, p. 1023;

quoted in National Health and Medical Research Council, Standing Committee on the Health Problems of Alcohol, p. 7. 83 Commission of Inquiry Into the Non-Medical Use of Drugs, pp. 402-4. 84 E. Goodman, 'Drugs and the Law', in The Medical Journal of Australia, 9 April 1977,

p. 546. 8 5 Evidence, p. 1322.

86 Evidence, p. 1324. 87 Martin, p. 113. 88 R. Sackville, Law and Poverty in Australia (Second Main Report of the Commission of Inquiry into Poverty) (Canberra, 1976).

89 J. N. Santamaria (ed.), Symposium: Alcohol and Drug Dependence-Th e Role of Industry and Commerce (1972 Summer School of Studies on Alcohol and Drugs, Melbourne, 1972), p. 11.

90 L. R. H. Drew, Personal Responsibility and Alcohol Problems (Commonwealth Depart-ment of Health, Canberra, 1976), p. 2. 81 Santamaria, p. 11. 92 Evidence, p. 1799. 93 G. C. Wilson, 'The Role of Small, Medium and Large Industry in the Management of

the Alcoholic', in Alcoholism in Industry, Proceedings of the First National Management/ Union Alcoholism Cor.ferer.ce (Canberra, 8-9 November 1974), p. 21. 94 Drew, Personal Responsibility, p. 6. 95 Evidence, p. 2236. 96 Commonwealth Department of Labour and Immigration, Manpower Policy in Australia

(Canberra, 1975). 97 Commonwealth Record 2:5 (7-13 February 1977), p. 121. 98 Evidence, p. 2140. 99 Evidence, pp. 1805, 2156, 2135. 1oo Evidence, p. 2133. 101 Evidence, p. 1805. 1o2 Evidence, pp. 2156-7. 103 Evidence, p. 2135. 1 0 4 Evidence, p. 2236. 105 Evidence, p. 2245. 106 Evidence, p. 2245. 107 Evidence, p. 2137. 108 Evidence, pp. 2138-9. 1oe Evidence, p. 2230. 11o Clark, pp. 347ff. 111 J. N. Lickiss, 'Health Problems of Urban Aborigines: with Special Reference to the

Aboriginal People of Sydney', in Social Science and Medicine, vol. 9, p. 313. 112 Lickiss, p. 314. 113 House of Representatives Standing Committee on Aboriginal Affairs, Alcohol Prob?ems of Aboriginals: Northern Territory Aspects (Interim Report) (Canberra, 1976), p. XI. 114 Commonwealth Department of Health, Workshop on Aboriginal Medical S ervices (Can­

berra, 1974), pp. 63-4. 115 House of Representatives Standing Committee on Aboriginal Affairs, Aboriginal and Related Matters in the South- West of Western Australia (Canberra, 1976), pp. XI-XVI. 116 Senate Select Committee on Aborigines and Torres Strait Islanders, The Environmental

Conditions of Aborigines and Torres Strait Islanders and the Preservation c.f their Sacred Sites (Canberra, 1976), pp. 117-24. 117 Senate Select Committee on Aborigines and Torres Strait Islanders, P· 121.

75

118 Senate, Parliamentary Debates, 3 June 1977, p. 2044. 119 Evidence, pp. 827ft'. 120 Evidence, p. 891. 1 21 Drew, Personal Responsibility, p. 6. 122 Drew, Personal Responsibility, p. 7. 123 Evidence, p. 465. 1 24 Evidence, p. 465. 125 Evidence, p. 1809. 12s Evidence, p . 1823. 127 Evidence, p. 1824. .

128 C. M. Deakin, J. N. Santamaria & P. Wilkinson, 'The Cost of Alcoholism to the Com-munity', in The Medical Journal of Australia, 30 June 1973 , p. 13 05. 129 Evidence, p. 1845. 130 Martin, p. 126. 1a1 National Health and Medical Research Council, Standing Committee on the Health

Problems of Alcohol, p. 20. 132 Media Council of Australia, submission to the Senate Standing Committee on Social Welfare (1976), p. 2. 133 Federation of Australian Commercial Television Stations, S elf Regulation by Australian

Commercial Television (1977), p. 8. 134 R. G. Smart & R. E. Cutler, 'The Alcohol Advertising Ban in British Columbia: Problems and Effects on Beverage Consumption', in British Journal of Addiction , vol. 71 (1 976), p . 20.

135 Evidence, p . 2827. 136 R. J . Powell, 'Television Viewing by Young Secondary Students' (Australian Broad­

casting Commission, 1973), p. 4. 137 National Association of Broadcasters, The Television Code (18th edn, New York, 19 75),

p. 4.

138 Evidence, p . 2733. 139 Evidence, p . 2605. 140 Evidence, p. 2605. 141 Evidence, p. 2606. 142 Evidence, pp. 2505-6. 143 Evidence, p. 1990. 1"" G. Milner, New Management Programs and their Evaluation in the Alcohol and Drug

Field (National Alcohol and Drug Dependence Multidisciplinary Institute, Canberra, 1975), p. 40. 145 Evidence, p. 1342. 146 Davis, p. 96. 147 G. Milner, Working Paper on Phased Development of Regional Services for Alcohol

Problems (Department of Health, Victoria). 148 I. R. Johnson, Alcohol and Road Accidents-A Review of the Problem (National Alcohol and Drug Dependence Multidisciplinary Institute, Canberra, 1976), p . 19. 149 Commonwealth Department of Health, Annual Report, p. 161. 150 Johnson, p. 19. 151 J. A. Duncan, Drinking Driving by Canberra Motorists: Report on a Survey of the Effect

of the Introduction of the Breathalyzer Legislation (Canberra, 1976), p. 5. 152 Chief Magistrate's Office, Northern Territory, private communication. 153 Evidence, p. 2622. 154 S. H. Lovibond & K. Bird, 'Danger Level-The Warwick Farm Project', in L. G. Kiloh

& D. S. Bell (edd.), 29th International Congress on Alcoholism and Drug Dependence (Melbourne, 1971), p. 305. 155 J. N. Santamaria, Guidelines on the Rehabilitation of Drinking Drivers (paper presented at the Seventh International Conference on Alcohol, Drugs and Traffic Safety, Melbourne,

1977).

1 56 H. Klette, Politics and Drunken Driving-the Swedish Experience (paper presented at the Seventh International Conference on Alcohol, Drugs and Traffic Safety, Melbourne, 1977). 1 57 R. Borkenstein, An Overview of the Problems of Alcohol, Drugs and Traffic Safety

(paper presented at the Seventh International Conference on Alcohol, Drugs and Traffic Safety, Melbourne, 1977). 158 The Expert Group on Road Safety, Road Accident Situation in Australia (Report to the Minister for Shipping and Transport, Canberra, 1973), p. 31. 159 Evidence, p. 495. 160 Evidence, pp. 563ft'. 1 6 1 T. G. Duffy, 'TheEl Cajon Municipal Court's Antabuse Counselling Program', in S eventh

International Conference on Alcohol, Drugs and Traffic Safety, Abstracts (Melbourne, 1977), p. 74. 162 E. J. Walker, The Sydney Drink Driver Scheme: A Court Referral Program for High Risk Drinking Drivers (Central Court of Petty Sessions, 1977), pp. 2-5. 163 Walker. 164 Evidence, p. 934.

76

165 Evidence, p. 595. 166 Evidence, p. 554. 167 Australian Law Reform Commission, Alcohol, Drugs and Driving (Report No. 4) (Canberra, 1976), p. 111. 168 Evidence, pp. 2697, 2707. 169 Evidence, p. 1322. 170 Australian Law Reform Commission, p. 126. 171 G. A. Ryan, 'Blood Alcohol and Road Trauma Survey', in The .Medical Journal of

Australia, 24 July 1976, p. 129. 172 Australian Law Reform Commission, p. 130. 173 Australian Law Reform Commission, Ch. 13; Evidence, p. 612. 174 Australian Law Reform Commission, Ch. 13; Evidence, p. 612. 175 Australian Law Reform Commission, Ch. 13. 176 Personal communication. 177 Freedman, Henderson & Wood, Drinking and Driving in Sydney, p. 24. 178 Evidence, p. 1489. 179 K. Freedman, J. M. Henderson & R. Wood, Drink-Driving Propaganda in Sydney,

Australia: Evaluation of First Stage, Information Campaign (Traffic Accident Research Unit, Department of Motor Transport, NSW, June 1975), abstract. 18° Freedman, Henderson & Wood, Drink-Driving Propaganda, abstract. 181 J. M. Henderson, 'Attitudes to Drinking and Driving in Australia', in Seventh Internationa

Conference on Alcohol, Drugs and Traffic Safety, Abstracts (Melbourne, 1977), p. 12. 182 Henderson, p. 13. 183 Henderson, p. 13. 184 A. E. Raymond, A Review of Alcohol in Relation to Road Safety (Canberra, 1973), p. 50. 185 Dr I. Johnson, Victorian Department of Transport, personal communication. 186 Raymond, p. 51.

77

cHAPTER 3 Tobacco

Smoking is dangerous to health.

Tobacco, particularly in the form of cigarettes, continues to contribute each year to the deaths of approximately 8000 Australians from heart disease and about 3500 from lung cancer. 1 Smoking is one of the main avoidable health hazards in modern society; yet Australians continue

to smoke 2800 million cigarettes each month. 2 The dangers of smoking have been widely publicised. So much has been written about them, and there have been so many health-oriented programs, that the general public cannot be ignorant of the fact that smoking is a major health hazard. Yet Australia's death rate from diseases related to cigarette smoking continues with little positive outcry or action by the community or govern­ ments to change these circumstances.

Adults, possessed of the facts and the maturity to make decisions about their own life styles and health, may choose to continue to smoke and put their health at risk. The Committee notes that there is a great difference between their situation and that of young and impressionable children who, with neither the information nor the maturity to make such far­ reaching decisions, are either pressured into smoking by their peers or seduced into smoking by attractive and high-powered advertising. Once the facts are presented to an adult, any choice must be his; no government can make that choice for him. However, there are grounds for govern­ ments to take steps to prevent children from endangering their own health. The difference between adult and adolescent decisions is important, and it is so seen by the Committee.

There is no declared national policy which identifies a national goal of diminished per capita use of tobacco. The declaration of such a policy is a necessary and vital first step towards a national program. The Com­ mittee recommends:

That Commonwealth and State Governments determine as national policy a commitment to a decrease in per capita consumption of tobacco.

Smoking has been accepted by the authorities as dangerous to health. In 1962, the Royal College of Physicians, in London, issued the first of its three major reports confirming the health dangers of smoking. In 1964, the United States Surgeon General issued his famous report. These initial findings have since been repeated and substantiated.

79

The History of Smoking and Tobacco

Governments overseas have recognised the health threat of tobacco and have taken a variety of counter-measures. All Australian Govern­ ments, Federal and State, have recognised this threat. They have moved to provide for the labelling of tobacco products so as to indicate their dangerous nature, and have started on the path of prohibiting the adver­ tising of tobacco. It appears that the fact of tobacco's being dangerous is no longer subject to question in responsible quarters. The Committee rejects the assertions of the tobacco industry that there is no proven relationship between tobacco smoking and ill health. 3

The number of deaths, the morbidity and the misery caused by smoking are very substantial. It is not only that smoking causes death; it causes many deaths. Cigarette smoking is still as important a cause of death as were the great epidemic diseases of the past. 4

The use of tobacco dates from remote antiquity. Until recently, it was thought that tobacco smoking was exclusively South American in origin, with the first reports of tobacco use being given in 1497 by a friar accom­ panying Columbus' second expedition to the Americas. But recent examination of some Egyptian mummies suggests that tobacco chewing may have been practised in ancient Egypt. Tobacco use spread to Europe from the New World, however, when a Spanish physician at the Court

of Philip II first encouraged its smoking. From Spain, it was spread to France by the French Ambassador, Jean Nicot, from whose name the classification Nicotiana and the word 'nicotine' derive. In 1565, Raleigh introduced the plant to England where James I, horrified at its use, published a pamphlet entitled 'A Counterblast to Tobacco' and attempted, by stringent laws, heavy punishment and even threats of excommunication, to prevent its use-like modern attempts at prohibition, all to no avail. By the time of the Great Plague, tobacco was thought to be a useful prophylactic and children were encouraged in its use, while for the first time the Government started to derive substantial revenues from excise on tobacco, at the same time prohibiting its cultivation in Britain. In the Georgian period, snuff taking displaced smoking as the most common form of tobacco consumption; by the start of the nineteenth century, this role had passed to cigars. Cigarettes were introduced by soldiers returning from the Crimea and in 1842 the first Pure Tobacco Act was introduced to control the quality of tobacco products. It was not until the First World War that cigarettes accounted for over half the total consumption of tobacco products. Tobacco continued to be a lucrative revenue source, and until recent years ranked second only to income tax as a source of revenue for the British Government.

In Australia, several tobaccos grow wild (Solanum auriculatum and Nicotiana glauca) but are of no commercial value because they contain no nicotine. In Arnhem Land, tobacco has long been chewed or smoked by the Aboriginals, and tobacco chewing is also common in parts of

Central Australia. The development of the Australian tobacco industry is discussed later in this chapter.

80

Extent of the Problem

Who Uses Tobacco?

The extent of the problem can be gauged from survey information. A survey by J. G. Rankin and P. Wilkinson in 1969 indicated that 56 per cen( of males and 35 per cent of females over the age of 25 were smoking. Almost all the tobacco consumed was in the form of cigarettes. 5

Dr N.J. Gray, using what he described as a large, representative sample of 6354 persons, found in 1974 that 41 per cent of males and 29 per cent of females aged 16 and over smoked cigarettes. Gray compared his survey results with the findings of a Roy Morgan Gallup Poll conducted in

1969, and concluded that, although per capita consumption had shown only minor variations, there had been important changes in the smoking patterns of various age groups. Smoking had increased among people in their 20s and reduced among people aged 30 and above. Over one-third

of the males and one-quarter of the females who had ever smoked had stopped. 6 The number of male ex-smokers found in this survey is almost the same as was found in another conducted in Sydney in 1975, which found that 32 per cent of males and 15 per cent of females had stopped

smoking. 7 These figures may reflect the current trend for more women to start smoking and for men to give it up.

There have been several surveys on patterns of tobacco consumption by adolescents. One conducted in nine Canberra high schools in 1973 and 1974 revealed that 29.3 per cent of boys and 23.9 per cent of girls smoked tobacco, and that 55 per cent of the total sample had used tobacco

at least once. 8 These figures are supported by the findings of an earlier survey which showed that 22 per cent of young people in Canberra smoked. 9

A Sydney survey found that in the years from 1971 to 1973 the pro­ portion of users remained steady at about 40 per cent and was approx­ imately the same for males as for females. 10 In another Sydney survey, 6591 children aged 12 to 13 years, and 4879 aged 8 to 9, were examined

annually from 1971 to 1975. An increase in smoking was recorded over the period. The proportion who smoked one or more cigarettes per week increased from 14 per cent to 22.5 per cent of boys and from 4.6 per cent to 19 .I per cent of girls. 11 A survey of Melbourne youth con­ ducted in 1972 revealed that about 47 per cent of secondary school children smoked. 12

These surveys, together with others by Anne George, 13 D. Carrington­ Smith 14 and the Commonwealth Department of Health, 14a indicate that about 40 per cent of the Australian population smoke cigarettes. A useful summary of the surveys is provided by P. Healy. 15

A significant national survey of 1276 Australian doctors-111 8 males and 158 females-was conducted in 1974. Their smoking habits and any changes therein, their opinions of the health risks associated with smoking, and the advice they gave to their patients about smoking were noted.

Only 14 per cent smoked cigarettes and, of all who were ex-smokers, 72 per cent had given up smoking more than five years before-the

81

majority for health reasons. Most expressed a strong belief that smoking and ill health were associated and 63 per cent encouraged their patients to stop smoking. 16 Tables 3 . 1 and 3. 2 depict the situation.

Table 3.1 Proportion of Australian doctors who smoke cigarettes, by age

Number of doctors

Age group (years) Total Smokers

Under 25 1 0

25 to 29 41 2 (5 per cent)

30 to 39 292 39 (13 per cent)

40 to 49 425 61 (14 per cent)

50 to 59 295 54 (18 per cent)

60 and over 214 24(11 percent)

Not established 8 1

Total . 1276 181 (14 per cent)

Source: N.J. Gray, D. J. Hill and D. R. Evans, 'Attitudes and Smoking Habits of Australian Doctors', in The Medical Journal of Australia, 29 November 1975, p. 823.

Table 3.2 Response af Australian doctors to the question: 'How strongly do you believe that cigarette smoking causes the following diseases?'(a)

Proportion of doctors

Coronary heart Lung Chronic

Belief held disease cancer bronchitis Emphysema

per cent per cent per cent per cent

Definitely the major cause 7 55 39 28

One of the causes 87 43 58 61

Have no opinion 3 1 2 6

Unlikely to be a cause 2 1 3

Is not a cause 1 1

(a) Non-responses to this question were not tabulated, and did not exceed 1 per cent. Source : N . J. Gray, D. J. Hill and D. R. Evans, 'Attitudes and Smoking Habits of Australian Doctors', in The Medical Journal of Australia, 29 November 1975, p. 823.

Clearly, doctors feel that their health will be endangered if they smoke. Table 3 . 3 gives details of consumption rates by age and sex from Rankin and Wilkinson's 1969 survey.

Table 3.3 Consumption rates of smokers by age and sex A. Proportion of Males in Designated Consumption Brackets, by Age Group

Cigarettes smoked per day

Never smoked Stopped 1-14 15-24 25+

82

Age group

0-14 15-24 25-34 35-44 45-54 55-64

per cent per cent per cent per cent per cent per cent per cent

98.8 55.8 30.8 29.9 20 .8 23.7 16.8

0.6 1.9 12.5 9.3 21.9 16.1 34.8

0.6 21.2 17.8 17.8 19.8 12.9 28 .4

16 .9 26.9 22.4 14.6 25.8 13.7

5.0 12.0 20.6 22.9 21.5 6.3

Table 3.4

Number of cigarettes per da;v(b)

1-19

20-24

25+

B. Proportion of Females in Designated Consumption Brackets, by Age Group

Age group

Cigarettes smoked per day 0-14 15-24 25- 34 35-44 45-54 55-64 65+

Never smoked 100 62 .0 55.9 37.8 49.5 51.4 76.5

Stopped 2.1 6.8 7.5 8.4 13 .5 10.1

1-14 19. 7 19.2 19.8 11.2 15.3 8.0

15-24 14.9 13.0 22 .6 17.8 11.7 4.7

25+ 1.3 5.1 12.3 13.1 8.1 0.7

Source: J. G. Rankin and P. Wilkinson, 'Alcohol and Tobacco Consumption', in J. Krupinski and A. Stoller (edd.), The Health of a M etropolis, pp. 66-7.

An Australia-wide survey of 3316 male and 3037 female respondents in June and July 1974 found consumption of cigarettes for various age groups, as seen in Table 3 .4.

Consumption of cigarettes by age and sex(a)

Proportion of sample

16 to 29 30 to 39 40 to 49 50 to 59

Sex Total years years years years 60+ years

per cent per cent per cent per cent per cent per cent

Males. 40 47 38 31 37 44

Females 60 62 62 54 54 64

Males. 31 32 30 32 24 32

Females 22 23 21 21 25 21

Males. 22 15 25 31 33 15

Females 14 12 14 19 17 7

(a) Data relate to 1358 male and 888 female smokers found in an Australia-wide survey in June and July 1974. (b) Figures for respondents not stating daily consumption are omitted (7 per cent males, 4 per cent females). Source: N . J. Gray and D. J. Hill, 'Patterns of Tobacco Smoking in Australia', in The Medical Journal of Australia, 29 November 1975, p. 820.

The pattern has been for more males than females to smoke cigarettes, and for males to smoke more cigarettes per day. Table 3. 5 gives more details from this survey of smoking habits by age and sex for the 3316 males and 3037 female respondents.

83

Table 3.5 Smoking habits by age and sex in people aged over 15 years

Proportion of sample

16to 20to 25 to 30to 35to 40to 45 to 50 to 55 to 60to

Smoking 19 24 29 34 39 44 49 54 59 69 70+

category Sex Total years years years years years years years years years years years

per per per per per per per per per per per per

cent cent cent cent cent cent cent cent cent cent cent cent

Smoke cigar- Male 41 36 49 44 46 44 39 43 43 35 32 28

ettes Female 29 29 38 37 30 29 27 33 37 25 16 10

Smoke cigars Male 4 1 3 5 6 4 6 4 3 5 4 3

and/or pipes Female Ex-smoker Male 22 11 12 14 15 19 21 24 28 32 37 44

Female 10 9 9 8 10 16 9 9 7 11 11 9

Never smoked Male 33 52 35 37 32 33 33 29 25 27 26 24

regularly Female 60 60 52 55 59 54 63 58 55 63 72 79

Source : N. J. Gray and D. J. Hill, 'Patterns of Tobacco Smoking in Australia', in The Medical Journal of Australia, 29 November 1975, p. 820.

Gray told the Committee in evidence that from this he concluded: 1. Smoking rates among people over 55 years are substantially below the national average smoking rates and among people aged 20-35 are sub­ stantially above the national average. 2. There is a very large number of ex-smokers in people over 45 years or

more. It is impressive that over one-quarter of the male population which is now aged 45 years or more has now become ex-smokers. Information not shown on this table, but obtained from the same survey, indicates that two-thirds of this group gave up smoking five years or more ago. 17 The Committee has noted some interesting and potentially disturbing features about the changing patterns of cigarette consumption as between men and women in other countries. There is a considerable body of evidence to suggest that most of the decline in cigarette smoking has taken place among men, and that by contrast the rate of smoking among women has either risen or remained static. The British Tobacco Research Council has reported that in Britain the number of women smoking manufactured cigarettes increased from 37 per cent to 43 per cent between

1952 and 1975, whereas the number of men smoking manufactured cigarettes fell from 59 per cent to 46 per cent over the same period. 18 In a study of the effects of the Norwegian Tobacco Act, Dr Kjcll Bjartveit reported that while the level of smoking among males had significantly reduced from June to December 1975-respectively two months before

and five months after the introduction of legislation prohibiting all tobacco advertising-there had been no significant reduction in the level of smoking among females, which had increased steadily since 1973. 19 Irwin's study of Canberra school children showed that 'unlike alcohol where it appears that the process of establishing drinking behaviour is rather extended, in the use of tobacco, it appears that the establishing of smoking behaviour is much more precise'. By form 3-that is, year 9-boys' habits are well established and by form 4 girls' habits are estab­ lished. 2° Contrary to assertions by the tobacco manufacturers, 20a the

84

decision to smoke is not only one for adults. By early adolescence, adult patterns of smoking have already been established.

A significant number of young people smoke tobacco. This was explained to the Committee in the following way. Older people see and understand death; they have had personal experiences related to death, discomfort, morbidity and misery, whereas younger people have a lesser acquaintance with these experiences; death is not real to them. Consequently, warnings that cigarettes may cause illness or death have little impact on the young. 21 The illness or death is not seen as relating to them.

However, the most important factor leading to young people smoking is peer group pressure. The Committee was told that in most schools a smoking group and a non-smoking group exist, each brought together by its own range of common-interest activity. The leader of the group is very important to the members, and other children often copy his example. 22

Parental example, also, often leads children to develop a smoking habit. This influence is apparent at an early age. The Royal College of Physicians of London, early in 1977, reported:

Some children begin to smoke at 5 years of age, and it has been found that about one third of adult regular smokers began before they were 9. About 80 per cent of children who smoke regularly continue to do so when they grow up. The earlier in life a person starts to smoke regularly, the greater is the risk of early death. 23

A smoking parent has twice the chance of having a smoking child; a smoking older brother has twice the chance of having a smoking younger brother. 24 Another factor which has a direct bearing on children taking up smoking is the very professional and appealing tobacco advertisements to · which they are exposed. This aspect will be discussed more fully later in this

chapter. Older people appear to have stopped smoking because of the combined effects of smoking-related illnesses, health education and press publicity. It seems that the motivation to give up cigarettes increases with age.

Gray and Hill also analysed the social data from the 1974 survey and found some significant statistical variations in socio-economic levels, education, nationality and demography. There was a slightly higher proportion of cigarette smokers among metropolitan respondents

(37 per cent) than among non-metropolitan respondents (33 per cent), chiefly because more non-metropolitan respondents (48 per cent) than metropolitan respondents (44 per cent) had never smoked. More metro­ politan smokers (54 per cent) than non-metropolitan smokers (48 per

cent) consumed at least twenty cigarettes per day. Respondents born in Australia reported a lower percentage of cigarette smoking (34 per cent) than did those who were British born (43 per cent) or were born elsewhere (39 per cent). Australian-born and British-born

respondents had a similar daily consumption of cigarettes.

85

High education was associated with reduced smoking rates. Only 30 per cent of respondents who had done some or all of a tertiary course were cigarette smokers, compared with 37 per cent of the remainder. With relation to income levels, the survey showed:

Except for very low income earners (less than $4000 per annum), among whom 32 per cent were current cigarette smokers, income was inversely related to cigarette smoking. Among those with annual incomes of $4000 to $5999, the current cigarette smoking rate was 39 per cent, for those with

$6000 to $7999 it was 35 per cent, and for those with $8000 and over it was 34 per cent. 25

Health Nicotine has been described as perhaps the most addictive of the licit drugs. The Committee was told that at least half the smokers smoked for the nicotine 26-a finding confirmed by the recent report of the Royal College of Physicians. 27 It acts as a stimulant in small doses but becomes a depressant in larger doses. It is important to recognise that smoking is a form of drug dependence, but one with especially insidious character­ istics. The Royal College of Physicians described the smoking habit as follows:

Tobacco smoking is a form of drug dependence different from but no less strong than that of other addictive drugs. It is seldom a take-it-or-leave-it activity practised in moderation on special occasions. Only 2 per cent of cigarette smokers limit themselves to intermittent or occasional smoking. The majority are regular and dependent smokers who seldom go more than an hour or two without a cigarette. Most people who drink alcohol or take sleeping pills are able to do so in moderation or on special occasions and can tolerate periods without them. It is only a small minority who have drinking problems or who become alcoholics or addicts. Furthermore, dependence on alcohol or barbiturates usually occurs in settings of psychological or social difficulty. With cigarette smoking the situation is altogether different. The most stable and well-adjusted person will, if he smokes at all, almost inevitably become dependent on the habit. One large-scale study showed that of those teenagers who smoked more than a single cigarette only 15 per cent avoided becoming regular dependent smokers. 28

The College also commented: Most of the recent slow down in the rate of improvement of life expectancy and half the difference in life expectancy between men and women can be attributed to the fatal effects of smoking. 29 Cigarettes are a danger to health.

Classic epidemiological studies have demonstrated the dangers of smoking. Major reports have been presented by the World Health Organ­ isation, the United States Surgeon General, and the Royal College of Physicians, of London. 30 Many studies have contributed to their con­ clusions. There is no need for this Committee to canvass reasons so well based. Smoking is a causatiye factor in the following conditions (see Table 3.6):

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Cancer of the lung Cancer of other respiratory sites Chronic bronchitis and emphysema Non-syphilitic aortic aneurysm

24819/ 77-7

Ischaemic heart disease Laryngeal cancer Cancer of the oesophagus Respiratory (pulmonary) tuberculosis Pulmonary · heart disease Hernia

Retarded intra-uterine growth Peptic ulcer Cancer of the bladder Pneumonia Arteriosclerosis

Cerebral thrombosis. Consequences associated with smoking are (see Table 3. 6): Cancer of the pancreas Hypertension

Cancer of the rectum Suicide Cirrhosis of the liver, alcoholism Poisoning. Doctors have been the first to recognise how reaJ are the health dangers of smoking, and as a consequence they have substantially altered their habits. The Commonwealth Department of Health made available to the Committee a recent report by Sir Richard Doll and R. Peto, who studied the smoking habits of 34 000 male British doctors for the period from

1951 to 1971. Changes to smoking habits and certified causes of all 10 072 deaths recorded in the study were noted. The average number of cigarettes smoked per day had decreased from 9.1 in 1951 to 3.6 in 1971. In 1951,

17 per cent of male British doctors did not smoke; 30a in 1958; 44 per cent did not; and by 1966, just over 50 per cent did not smoke. No figure is available for 1971. 31 Table 3. 6 shows that mortality increased progressively from light, to moderate, to heavy smokers of cigarettes for twenty-one of twenty-two causes of death related to smoking.

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Table 3.6 Deaths per 100 000 men standardised for age, by cause of death, method of smoking, and number of cigarettes smoked per day when last asked (extracted from a sample of British doctors) and excluding ex-smokers.

Annual death rate per 100 000 men, standardised for age

Current smokers

Pipe and Mixed Cigarettes only, no. jday Non- Cigarettes or cigars (cigarettes

Cause of death smokers only only and others) 1- 14 15- 24 25

Closely associated causes

Cancer of lung . 10 140 58 82 78 127 251

Cancer of oesophagus 3 14 11 27 11 12 21

Cancer of other respiratory sites . 1 13 9 10 5 7 33

Respiratory tuberculosis 3 15 3 8 9 10 30

Chronic bronchitis and emphysema 3 74 28 34 51 78 l 14

Pulmonary heart disease 0 10 9 14 6 9 25

Aortic aneurysm (non-syphilitic) . 5 33 18 23 17 38 52

Hernia 0 5 4 0 3 4 11

Jschaemic heart disease

Ischaemic heart disease 413 669 425 528 608 652 792

Other associated causes

Cancer of rectum 6 16 10 17 11 11 33

Cancer of pancreas 14 22 12 16 19 20 29

Cancer of bladder 9 19 14 13 20 20 13

Pneumonia 54 73 38 59 56 84 105

Myocardial degeneration 67 139 101 103 136 116 202

Hypertension 37 50 34 30 33 59 65

Arteriosclerosis . 21 29 17 17 21 25 68

Cerebral thrombosis 86 115 99 104 94 134 137

Cirrhosis of liver, alcoholism 7 21 9 13 11 14 44

Peptic ulcer 8 20 10 13 9 30 27

Suicide 21 33 32 28 22 30 53

Poisoning 9 19 11 11 14 17 28

Parkinsonism

Parkinsonism 14 6 4 4 9 2 6

Unrelated causes

All other causes 518 616 473 434 615 573 697

All causes l 317 2154 I 434 1 591 1 857 2 066 2

(Number of deaths) (940) (3 343) (1 527) (1 148) (1 209) (1 137) (997)

Source: Sir Richard Doll and R. Peto, 'Mortality in Relation to Smoking: 20 years' Observations on Male British Doctors', in The British Medical Journal, 25 December 1976, p. 1529.

88

One distinctive feature of this study was the opportunity to follow up a population many members of which actually gave up smoking during the study period. The report notes:

As a result lung cancer grew relatively less common as the study progressed, but other cancers did not, thus illustrating in an unusual way the causal nature of the association between smoking and lung cancer. a1a

Table 3.7

Cancers of the lung, oesophagus, and other respiratory sites, chronic bron­ chitis and emphysema, and pulmonary heart disease have been known to be associated with smoking for many years, and there is a mass of evidence to indicate that the association is mostly causal, without, of course, implying that smoking is the only cause. 32 A major conclusion of the study was that, above the age of thirty-five years, smoking actually caused mortality between one-quarter and one­ half greater than total mortality in non-smokers. 33

A Danish study of lung cancer and smoking revealed that since 1960 female lung cancer rates (correlated with increases in smoking) had in­ creased more rapidly than the rates for males and that this trend was most apparent in younger women. 34 A detailed Canadian study confirmed these findings, reporting striking increases in female lung cancer rates and calling for more anti-smoking effort to be directed at younger women. 35 The Committee has already noted some evidence in Australia which confirms this world-wide trend.

We consider this trend disturbing, particularly because of the implica­ tions which it has for younger women who smoke when they are pregnant -a matter discussed later in this chapter. We are also concerned because of the significant influence which mothers tend to have on their children, especially at an age when young children may be forming attitudes favourable to development of the smoking habit.

Some researchers have attempted to quantify the years of life lost by smokers. The amount by which life is shortened at various ages, according to the number of cigarettes smoked, was calculated for American men by E. C. Hammond in 1968. Table 3. 7 shows that a man of 30 who smoked an average of 10 to 19 cigarettes per day could expect to lose 5-!- years of life.

Life expectancy of American men at various ages, and 'years of life lost' by cigarette smokers

Present age

Cigarettes per day Life expectation 25 30 35 40 45 50 55 60 65

0 Years expected . 48.6 43.9 39.2 34.5 30.0 25.6 21.4 17.6 14.1

1- 9 Years expected 44.0 39.3 34.7 30.2 25.9 21.8 17.9 14.5 11.3

Years lost(a) 4.6 4.6 4.5 4.3 4.1 3.8 3.5 3.1 2.8

10- 19 Years expected 43.1 33.8 29.3 25.0 21.0 17.4 14 . 1 11.2

Years lost(a) 5.5 5.5 5.4 5.2 5.0 4.6 4.0 3.5 2.9

20- 39 Years expected 42.4 37.8 33.2 28.7 24.4 20.5 17.0 13.7 11.0

Years lost(a) 6.2 6.1 6.0 5.8 5.6 5.1 4.4 3.9 3.1

(a) The decrease in the number of years of life lost by cigarette smokers as they get older (which may suggest that their outlook improves as they continue to smoke) is, of course, due to the shortening expectation of life. The percentage reduction of expectation of life gets greater with advancing age. Thus the smoker of 10 to 19 cigarettes per day has an expectation reduced by 11 per cent when he is 25 , but by 21 per cent when he is 65 . Source: Royal College of Physicians, Smoking and Health Now (1971), p. 29.

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Low-Tar, Low-Nicotine Cigarettes

The Committee was informed that the death risk from cigarette smoking could be reversed quite rapidly. With lung cancer, the risk is halved in the first 2 to 3 years, and reduces to that of a non-smoker after I 0 to 15 years. The risk of heart disease reduces even more rapidly. 36

The Australian Cigarette Manufacturers presented a comprehensive submission which denied any causal relationship between smoking and ill health and also expressed doubts about whether cessation of smoking led to any improvement of health. The manufacturers claimed that the case against smoking had been built on statistics which remained un­ supported by conclusive experimental study. They said that further co-operative research into the nature and causation of any relationship between smoking and disease was needed. 37

The Acting Director-General of Health for the Commonwealth, in rebuttal, stated that the manufacturers' submission was in places self contradictory or misleading and that its conclusions were generally invalid . The Commonwealth Department of Health, in its submission, offered statistical evidence from many countries which it claimed showed un­ doubted association between cigarette smoking and disease. It further submitted that if all research into the smoking problem were repeated to confirm the findings already obtained, action against smoking would be deferred and many more smokers would die in the interim. 3 8

We have studied the evidence for and against the case that tobacco is causally related to a number of illnesses. On balance, the Committee rejects the Australian Cigarette Manufacturers' main conclusions. It supports the view of the Commonwealth Department of Health, the United States Surgeon General, the Royal College of Physicians and the World Health Organisation that there is an undoubted association between smoking and a wide range of significant diseases.

A purely statistical relationship is not of itself a cause for criticism. Numerous important associations which have been recognised on the basis of statistics have led to major medical advances in many other fields. For example, John Snow removed the handle of the Broad Street pump because he associated the drinking of the water with cholera.

Semmelweiss noted an association between puerperal fever and lack of personal hygiene in medical attendants. The association between alcohol and road crashes rests on a statistical basis. Going further, one might observe that the discoveries of Snow and Semmelweiss were made empiri­ cally on the basis of a statistical association, understanding of which was

not extended until the later development of the science of bacteriology.

The Committee was told that individuals who smoke cigarettes with a lower content of tar (also referred to in evidence as total particulate matter39) have a lower death rate from lung cancer. 40 A tar-testing program was introduced by the Anti-Cancer Council of Victoria in

1969 and continued until the publication in March 1976 of the first analysis results. Table 3. 8 shows the changes in the tar content of A ust­ ralian cigarettes since 1969.

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Table 3.8 Australian tar testing, number of brands in each tar range

Total brands

Date Up to 12 mg 13-18 mg 19-24 mg Above 24 mg tested

October 1969 2 (4 . I per cent) 14 (26. 6 per cent) 26 (53 . 0 per cent) 7 (14. 3 per cent) 49

April1971 6 (10.7 per cent) 36 (64. 3 per cent) 12 (21 . 4 per cent) 2 (3. 6 per cent) 56

December 1972 10 (18.8 per cent) 41 (77 .4 percent) 2 (3. 8 per cent) Nil 53

September 1974 11 (18.0 per cent) 44 (72.1 per cent) 6 (9 . 8 per cent) Nil 61

March 1976 17 (28. 33 per cent) 40 (66 . 67 per cent) 3 (5. 0 per cent) Nil 60

Source: N.J. Gray, E vidence, p . 2176.

The conclusions drawn from this table by the Anti-Cancer Council of Victoria were: 1. There are no longer any high tar (over 24 mgm) cigarettes available on the market in Australia.

2. In March, 1976 over one-quarter of all brands were in the low-tar bracket (under 12 mgm); hence the range of cigarettes available on the market falls within the sort of limits the Anti-Cancer Council would have been recommending to government five years ago as being both practical and sensible had legislation been considered as a means of forcing the tobacco

industry to lower tar. In practice, the tobacco industry has responded to market pressure for lower-tar cigarettes and the result is satisfactory, at least in terms of the spectrum of brands available to the smoking public.41 Without market-share figures, the Committee can draw no definite conclusions about whether the tar and nicotine intakes of Australian smokers have altered.

Appendix 2 lists the most recent figures for tar and nicotine content of Australian cigarettes. They show a general correlation between levels of tar and nicotine. The appendix is included to aid smokers to regulate their intake of tar. It has been suggested by anti-smoking campaigners that total tar intake should be kept to less than 150 mg per day.

Figure 3 . I shows a very important change in lung cancer death rates among males aged between 55 and 64 years: the rising trend has been reversed since 1970. But there is no evidence which would enable this trend to be attributed to any particular factor.

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Figure 3.1 Male lung cancer death rates in Australia

Age specific death rates 5.0 75-79 Year age group

4.5

4.0

3.5

3.0

....

2.5

"' .c 2.0

1.5

1.0

0.5

50 55 60 65 70 73

Year

Source : Th e Lancet, 31 May 1975, p. 1252.

70-74

65-69

There are studies which establish the increased risk of using tobacco with high tar and nicotine content. One study traced the cigarette-smoking habits of 1 000 000 men and women over 40 years of age for twelve years. Cigarette smokers were classified by the amount of tar and nicotine delivered by the brand they usually smoked at the start of two six-year periods. Respondents were matched in groups for age; race; number of cigarettes per day; age at which cigarette smoking began ; place of residence; history of occupational exposure to dust, fumes, gases, chemicals, x-rays or radioactive materials; education; history of lung cancer; and history of heart disease. This was done separately for men and women. Each group was then divided into high, medium and low tar/nicotine sub-groups. The study found significant differences between mortality ratios for all deaths, for lung cancer deaths and for deaths from coronary heart d.isease, as between smokers of high tar/nicotine cigarettes and smokers of low tar/nicotine cigarettes.

A further matched group analysis for coronary heart disease was carried out to hold constant factors such as a history of stroke, diabetes or high blood pressure; exercise; occupation; obesity; and consumption of alcohol, coffee, tea and aspirin. The analysis confirmed the earlier conclusion. The study also showed that the hourly consumption of many (twenty to thirty-nine) low tar/nicotine cigarettes resulted in a higher mortality ratio than consumption of fewer (one to nineteen) with a high tar/nicotine content. In all three categories (all deaths, lung cancer

92

Pipe and Cigar Smoking

deaths and deaths from coronary heart disease) smokers of low tar I nicotine cigarettes had significantly higher mortality ratios than did non-smokers. 42 However, it must not be thought that tars alone are associated with disease, since nicotine, carboxyhaemoglobin or other factors may well be associated with some other diseases.

Therefore, it seems reasonable to conclude that, for those who continue to smoke cigarettes, to switch from high tar/nicotine cigarettes to low tar/nicotine cigarettes is to take a small step in the right direction­ provided that the number of cigarettes smoked does not increase.

The Committee recommends: That tar and nicotine contents be stated on cigarette packets.

The most beneficial course would be for people not to smoke at all, but there wiJI always be some who wish to use tobacco. Tobacco smoking is a habit acquired in adolescence or earlier, and in spite of all warnings many thousands of young Australians do, and will, decide to smoke. The threat to their health would be reduced if high tar/nicotine cigarettes

were removed from the market. Therefore, the Committee recommends: That the Commonwealth Department of Health establish upper limits for tar and nicotine contents, and progressively reduce permitted levels until all cigarettes with tar and nicotine contents in excess of the estab­ lished upper limits are banned.

Scant evidence on pipe and cigar smoking was received by the Committee. Table 3.5 indicates that in the Australia-wide survey of 1974 cited above the percentages of pipe and cigar smokers were so small that definite conclusions could not be formed. 43 Table 3.6 shows that, among male

British doctors, mortality rates for those who smoked only pipes and cigars were almost always intermediate between the rates for non-smokers and those for cigarette smokers. The findings of a World Health Organisation Expert Committee indicate that pipe and cigar smokers who do not usually inhale are exposed to lower health risks than are cigarette smokers who do inhale. 44 However, pipe smoking carries its own risk of cancer of the larynx and oral cavity. It may seem advisable for those who are unable to stop smoking cigarettes to change to smoking pipes or cigars. Cigarette smokers who do so in the hope of reducing the dangers to health will fail to reduce the risks if they continue to inhale.

There is growing concern among non-smokers to ensure the protection of their right to breathe air unpolluted by cigarette smoke. In all Australian States, the problem of smoking in public transport, restaurants, hospitals and elsewhere is being studied and action is being taken. For example, New South Wales has prohibited smoking on urban and inter-urban public transport for a period of trial and evaluation; Victoria has intro­ duced a general prohibition of smoking on public transport, and other

States have made similar moves.

93

One study showed that regular exposure to a smoky environment may be hazardous to non-smokers. They were classed as passive smokers. Passive smokers inhale diluted gases from the mainstream smoke, as well as the sidestream smoke which drifts off the cigarette tip. Sidestream smoke has been shown to contain twice as much nicotine content, twice as much tar content, three times as much pyrene and phenols, three times as much benzopyrene and five times as much carbon monoxide as the mainstream smoke inhaled by the smoker. 45

Evidence has indicated that, in confined atmospheres, passive smoking leads to absorption of carbon monoxide into the bloodstream of non­ smokers, where it forms the compound carboxyhaemoglobin. Such passive smokers generally show above-average levels of this compound. 46 One recent study showed that policemen on traffic duty, while having significantly higher blood levels owing to high exposure to traffic fumes, generally had carboxyhaemoglobin levels within normal limits, these being dependent on their smoking habits. 4 7 The Committee was told that some smokers have carboxyhaemoglobin levels as high as 12 per cent. 48

The most common effects experienced by non-smokers as a result of passive exposure include eye irritation, nasal symptoms, coughing and wheezing. 49 Smokers should realise the discomfort-and at times distress-which their habit causes other people, and as a matter of courtesy regulate their smoking so as not to inconvenience anyone.

More serious consequences were shown to exist for children of 'smoking families'. One survey of 1119 subjects recorded 33 per cent more respiratory disease in young children of'heavy smoking families' (20 or more cigarettes per day) than in children of non-smoking families. 50 A similar survey examined the incidence of pneumonia and bronchitis in 2205 young children over the first three years of life. Their respiratory symptoms and the parents' smoking habits were checked annually. In the first year of life, the incidence of pneumonia and bronchitis was lowest where both parents were non-smokers and highest where both smoked. Over the age of one year, the association was not consistent. However, within the first year of life, when both parents smoked, there was double the risk of a child having an attack of pneumonia or bronchitis. 51 A 1974 Israeli study of 10 672 mothers showed 38 per cent more hospital admis­ sions for bronchitis and pneumonia for the children of mothers who smoked than for the children of non-smoking mothers. 52

The foetus of the tobacco-smoking mother also is a passive smoker, and there is evidence that the mother's use of tobacco is potentially harmful to the foetus. One finding is that smoking during pregnancy leads to a reduction in birth weight by 180 gm to 250 gm or as much as 10 per cent. 53 There is also higher perinatal and foetal wastage. The Committee believes that the dangers of smoking in pregnancy should be made known as part of pre-natal care.

94

The report published by the Royal College of Physicians early in 1977 stated:

The babies of women who smoke during pregnancy weigh, on average, 200 g (t lb) less than those of mothers who do not. In Britain it was found that babies weighing less than 2500 g (5-l lb) at birth were nearly twice as common . among mothers who smoked than among those who did not. This - is due to delayed growth rather than shorter pregnancies and the effect is

found particularly in those who continue to smoke after the fourth month of pregnancy. Nicotine and CO in the mother's blood can enter the baby's circulation and may interfere with its nutrition. They cause fetal malformations in animals

but similar effects have not been observed in humans. Still-birth and death in the first week of life occur nearly 30 per cent more often in the babies of mothers who smoke regularly after the fourth month of pregnancy. This harmful effect of smoking is greater when the baby is at

increased risk for other reasons. 54

Cigarette smoking during pregnancy has a harmful effect on the baby ... . This report considers that the evidence for ill effects of smoking cigarettes, to both mother and baby, is such that a woman should not smoke during pregnancy because of the possible harm that the baby might suffer. 55

The tobacco manufacturers, in evidence, claimed that J. Yerushalmy's study refuted the reports of problems for the foetus. 56 We note the evidence but we reject the conclusions and accept the clear rebuttal of Yerushalmy's argument by the Commonwealth Department of

Health. 57 There is a risk both to the foetus and to the newly born infant.

The Committee recognises that there are civil rights to be considered for both smokers and non-smokers, but endorses the recommendations of the 81st session of the National Health and Medical Research Council (NH and MRC), which was held in Canberra in October 1975. The Council recommended that, in order to preserve the right of the non­ smoker to avoid harmful effects from passive inhalation of tobacco smoke, responsible authorities in Australia should take action:

(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; (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; and (e) To give special attention to the protection of infants from contact with

persons who are smoking.

The 82nd session of the Council, held in Canberra in October 1976, reaffirmed the above recommendations but added 'such as restaurants, cafes and bars' to (d). The Committee commends the recommendations of the National Health and Medical Research Council on the rights of

non-smokers.

95

Advertising and the Media

We recommend:

That the recommendations on the rights of non-smokers made by the National Health and Medical Research Council at its 8lst and 82nd sessions be implemented immediately in areas under direct Commonwealth control; and that State Governments and local government authorities be urged to implement these recommendations also.

Advertising of tobacco is believed to be one factor initiating smoking, as we noted earlier. The manufacturers deny this and assert that advertising is directed at maintaining brand loyalty. To this end, the tobacco industry has probably spent close to $100m on advertising in the last six

years whereas total Commonwealth expenditure on anti-smoking cam­ paigns over the same period has been $1. 5m. 58

Advertising is designed to exploit the desire of most people to feel more sophisticated. The tobacco manufacturers assert that the decision to smoke is an adult determination, but our evidence indicates that smoking habits are well established by the age of 15. The 12 to 15 year old easily accepts the implication that taking up smoking will make him feel and appear mature and sophisticated. It has been asserted that a counter­ advertising campaign is essential; that there is a need to base the strong, successful, tough image on the non-smoker instead of the smoker. 59 However, the Committee is aware that effective counter-advertising may be difficult to identify and project.

It is useful to examine controls on tobacco advertising overseas for comparison.

Britain

Radio and television advertising has been prohibited for some years while excises on tobacco have increased dramatically. On 19 April 1977, The Australian Financial Review reported that, since 1973, sales had fallen by 5 per cent in numbers of cigarettes and lO per cent in weight of

tobacco, and that there was considerable evidence of declining use among young people, especially those under 26. Whether this is related to the advertising ban or to the increased cost of cigarettes is unclear. The newspaper reported also that the British Government had announced tough anti-smoking measures which included:

96

1. A stronger health warning on cigarette packets.

2. An immediate ban on poster, press and cinema advertising of high­ tar (over 29 mg) cigarette brands.

3. An end to all advertising of medium to high tar brands by December 1978.

4. Approaches to organisations controlling public places to ask them to restrict or ban smoking.

5. A proposal to the European Economic Community for a Europe­ wide punitive tax on high-tar cigarettes.

6. Discussions with manufacturers about regulating sponsorship of sport by the tobacco companies which Mr Ennals, the Secretary of State for Social Services, described as evading the spirit of the 11 year old television advertising ban.

The Committee noted with interest another method used to give health warnings to British smokers. This involved the insertion inside the cigarette packet itself of a small card carrying a warning. In some of the brands produced by Imperial Tobacco Ltd and John Player and Sons, the enclosed card states that the cigarettes are composed mainly of a tobacco substitute, NSM, which is identified as the trade mark of New Smoking Materials Ltd and which has been developed to convert natural plant material into a form which might help to reduce the risks which medical authorities have associated with cigarette smoking. The card also contains the following statement:

ADVICE BY H.M. GOVERNMENT If you do smoke cigarettes Leave a long stub. Remove from mouth between puffs. Inhale less. Take fewer puffs.

The Committee has received no evidence which would enable it to draw any firm conclusions about this practice, but the government warning on the card draws attention to some of the specifically harmful methods of smoking that need to be reduced or altered. We also note that the promotion of NSM as natural plant material is very much in line with the approach taken by the Reynolds company in the United States in promoting its new Real brand of cigarettes.

Norway The Norwegian Tobacco Act of 1973 placed a total ban on all cigarette advertising, introduced varying health warnings on tobacco packages and prohibited the sale of tobacco products to people under 16. Its effects, which are discussed below, have so far been most encouraging in reducing smoking levels, particularly among young people.

Sweden

The Swedish labelling system which took effect in January 1977 provides an interesting variation from the usual pattern of health warnings. The printed message on the packet may be any one of 16 approved texts which deal with differing aspects of the health problem, and thus not only convey more anti-smoking education, but also put the customer in the position of not knowing in advance what health warning the authorities will give him each day. It is yet too early for evidence on the effects of

this system to have been presented.

97

United States By the Public Health Cigarette Smoking Act of 1969, radio and tele­ vision advertising was prohibited, along with the sale of cigarettes not labelled:

Warning-The Surgeon General has determined that Cigarette Smoking is Dangerous to your Health. In addition, this Act requires the Secretary for Health, Education, and Welfare to make annual reports to Congress about current information on the health consequences of smoking and to make such recommend­ ations for legislative action as he may deem appropriate. It also provides for the Federal Trade Commission to report annually on the effectiveness of cigarette labelling, on current practices and methods of cigarette advertising and promotion, and on recommendations for legislation . It is interesting to note, in the light of this Committee's call for a clear statement of government goals, that the United States Act contains, in section 2, a 'Declaration of Policy' which, in part, declares that the policy of Congress is to ensure that the public is adequately informed that cigarette smoking may be hazardous to health.

Australia Amendments to the Broadcasting and Television Act banned radio and television advertising from 1 September 1976. The Commonwealth and all States have provided for cigarette packets to carry a warning of health dangers, though other tobacco products are not so labelled. There are restrictions on what may be otherwise printed on cigarette packets in some States, though it appears that a mere statement of the tar content of any particular brand would not be an offence. Despite discussions about the extension of the advertising ban to other media, no action has resulted.

The effects of having a federal system of government are important in respect of advertising. In the unitary countries such as Norway, Sweden and Britain, the national governments can ban advertising in all forms of the media. In countries such as the United States or Australia, the federal government can deal only with radio and television, except in Territories.

A ban for all forms of the media would require legi slation in all States. To date, the Australian States have shown no evidence of concern that they are not playing their part in counteracting the harmful effects of tobacco.

A code of advertising adopted by the tobacco industry and the Medi a Council of Australia for the advertising of cigarettes has now been registered with the Trade Practices Commission. This code may be found at Appendix 3.

From time to time, doubts have been raised about the efficacy of bans on tobacco advertising, but the material available to the Committee persuades us that such restrictions can be effective if the bans are complete and are not subverted in various ways. Dr Bjartveit, in the study mentioned

98

earlier, analysed the effect of the Norwegian ban and reported that, in its first year, per capita consumption of cigarettes and tobacco fell by 2 . 7 per cent. However, he commented: Nobody had expected that the Norwegians would change their smoking habits

overnight ... To my mind, the restrictions will essentially have an influence upon young people who have not yet acquired the habit. 60 Some Australian evidence exists also. On 13 November 1976, The Aust­ ralian reported that the ban on cigarette advertising had accelarated a decline in sales. A spokesman for Allied Manufacturing and Trading Industries Ltd (AMA TIL) was quoted as having said:

Sales have been adversely affected.

Television is by far the best medium to bring a new cigarette to the public's notice. Now it is no longer available I cannot see companies taking the gamble and producing as many new cigarettes as before. Furthermore, the first new brand of cigarette launched on the market after the start of the ban (Philip Morris Ltd's brand, Merit, launched in South Australia) proved to be a 'dismal failure'.

It is not to be supposed, however, that bans on radio and television alone can be fully effective. Indeed, there is American evidence to show that at least one tobacco company believes that, given enough money, it can still have a profound influence on the market without radio and tele­

vision advertising. On 17 May 1977, The Australian Financial Review reported that the Reynolds tobacco company was planning to spend $40m in six months on the biggest product launch in history to promote a new cigarette brand, Real.

Television and radio advertising is now supposedly lost to the tobacco industry in Australia. However, as a tactic, tobacco manufacturers have responded by sponsoring sporting and cultural organisations and events to compensate for lost promotional opportunities. They have bought the right to advertise at grounds where sporting events are televised, and to use sporting organisations and events as a vehicle for advertising. Most television broadcasts of sporting functions continue to show back­ ground 'corporate' advertising bearing the name of the sponsor whose sole product is cigarettes.

While sales figures may not be related solely to sports sponsorship, John Blizard, an independent researcher and former consultant to the Commonwealth Scientific and Industrial Research Organization, bas suggested, in a submission to the Australian Broadcasting Tribunal, that brand growth and sports sponsorship are indeed closely related.

Particular concern has been expressed at the close association of tobacco with sport. There is no doubt that this association is a promotional activity, just as there is not doubt that there has been coincidental benefit to sport. The association has implications beyond circumvention of the ban on television advertising. Sport is associated with physical fitness and any association of tobacco smoking with sport is unfortunate.

99

Industry subterfuge has rendered the ban on television advertisi ng of tobacco relatively ineffective. It is apparent that the spirit of the law is not being observed and that Parliament needs to review current legislation relating to tobacco advertising on television. It is also evident that many of the continuing problems of dealing with tobacco promotion are State and local responsibilities: State Parliaments and local government authorities should investigate avenues of action open to them.

We recommend:

1. That the Commonwealth Government ban tbe advertising of tobacco products, whether by way of corporate advertising or by exhibiting of tbe brand name of such products in a planned fashion, on radio and television and in areas under direct Commonwealth control, such as

in tbe Territories and at airports.

2. That, until a total ban bas been implemented, tbe question of substantial compliance with the voluntary code for the advertising of cigarettes by manufacturers and retailers be reviewed annually.

3. That State Governments and local government authorities be encouraged to ban the advertising of tobacco products.

4. That the Federal Minister for Environment, Housing and Community Development, and tbe State Ministers reponsible for youth, sport and recreation, appeal to sportsmen and sportswomen throughout Australia not to lend their names and prestige to the promotion of tobacco products.

5. That the Commonwealth Government make any grants to sporting and cultural bodies conditional on their not accepting money from manufacturers and retailers of tobacco products and investigate the possibility of indemnifying such bodies for loss of revenue, at least in the short term.

6. That the Commonwealth Government consider refusing tax deduct­ ibility for expenses incurred in the promotion of tobacco products.

Sales to Minors Another aspect of concern to the Committee is the sale of cigarettes and other tobacco products to children. Currently, all States and the Australian Capital Territory have laws prohibiting the sale of cigarettes and tobacco to anyone under sixteen years of age. The penalties vary but the maximum fine is only $20. Tobacco is at least as harmful to health as is alcohol. Yet, by comparison with the stringent prohibition of the sale of alcohol to minors, the restrictions on the sale of tobacco to minors are weak and apparently are not enforced. The law must indicate disapproval of recruitment of the young to tobacco use, and the Committee recommends:

That laws which make the sale of tobacco products to minors illegal be strictly enforced, and that tbe penalties prescribed be increased.

100

Education There is very little evaluative data on anti-smoking education, but the evidence that does exist suggests that care should be taken with this type of program. Irwin, in a study of first-form secondary students in Canberra, evaluated three basic educational approaches: teacher-led, group-led and individual programs. The groups receiving these three programs were compared with a control group which received no special educational approach.

Among girls, the group-led approach produced a rate of recruitment to smoking significantly lower than that of the control group. There were no significant differences between the control groups and the students in the teacher-led and individual programs. The rate of recruitment to smoking was higher among students in the individual study

program than among the control group, but the difference was not significant. Boys receiving the three educational programs did not differ significantly from those in the control group in terms of limitation of the rate of recruitment to smoking.

The study also found that education about tobacco smoking significantly increased general drug use for girls involved in the individual approach and for boys involved in the teacher-led approach. There were no other significant differences between the control group and students receiving the educational programs. 61

Overall, the results suggest that some types of anti-smoking education are having no effect or, even worse, may be increasing the use of tobacco and other drugs. These preliminary findings stress the need for proper evaluation of all educational programs.

Campaigns warning about the effects of smoking may be successful in changing attitudes to smoking but not in changing behaviour. A survey made for the American Cancer Society in 1970 showed that various anti­ smoking campaigns conducted after 1964 had been enormously effective

in moulding the attitudes of young people to cigarettes. However, the firm conviction that smoking causes harm to health had very little effect on teenage smoking habits. Two further American surveys suggest that during the years from 1968 to 1970 the proportion of teenagers recruited to cigarette smoking actually increased. 62

In each of the financial years from 1972-73 to 1974-7 5, the Australian Government gave $500 000 per annum for anti-smoking education. Some of these funds were spent in a campaign which utilised posters and slogans against smoking. No full-scale evaluation of this campaign was conducted

and the Committee is unable to comment on its effectiveness. In June 1975, the Commonwealth grants ceased and there is now very little anti-smoking information being disseminated. As part of the anti-smoking campaign, the Commonwealth Department

of Health printed, and made freely available to the public, cardboard signs requesting smokers not to smoke in the vicinity. The Committee commends this initiative and hopes that the program will continue. We feel that this is one effective way of enabling non-smokers to express their

wishes. Education is discussed further in Chapter 8.

101

Excise and Subsidy Tobacco, like alcohol, was really an importation of the white settlers and arrived with them. Governor Macquarie experimented with a crop at

Emu Plains in 1818 and tobacco was grown in the Hunter Valley in the 1820s. Jn the 1880s, there was a major expansion of the tobacco industry because of the shortage of leaf resulting from the American Civil War, and in 1888-89 production reached a peak of seven million pounds. In the first decade of this century, the focus of the industry shifted to Queensland ,

which offered the advantages of a more suitable climate and freedom from blue mould. By 1916-17, that State produced 61 per cent of the total Australian crop. Tariff Board inquiries in 1926-27 and 1931-32 set guide­ lines for the development of the local industry, and a preferential duty was introduced in 1935 and raised in 1938. In 1936, customs duties were adjusted for products in which a specified amount of Australian leaf had been blended. Originally 2t per cent for cigarettes and 13 per cent for cut tobacco, the rates of duty now stand at 50 per cent for both. 63

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 Com­ monwealth 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 manu­ facturers, 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 Aust­ ralian 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. The Committee observes that the Government on the one hand pro­ claims its belief that smoking is a danger to national health, and on the other hand refuses financial support to anti-smoking campaigns and encourages the tobacco industry both by a specific subsidy and by general subsidies to primary industry. We believe that the Government should be progressively withdrawing its support from the tobacco industry in consonance with a general commitment to reduce the overall level of tobacco consumption.

In 1975, the Commonwealth Government increased excise on tobacco products. This effectively raised the price of an average packet of cigarettes by 25 per cent between September 1975 and September 1976. The Chair­ man of AMATIL said at the company's annual general meeting in 1976 that the increase in price had caused the consumption of cigarettes to

102

decrease by about 10 per cent. The Treasury, however, claimed that clearances of cigarettes for the nine months ended March 1976 were down only 2.8 per cent compared with the corresponding period in the previous financial year. Both sources acknowledged a decline in consumption.

The Committee recommends:

1. That the Commonwealth Government declare as policy its intention to decrease the consumption of tobacco at the rate of 2 per cent a year for the five financial years commencing with 1978-79.

2. That excise policy be one tool used to reduce the consumption of tobacco.

3. That the Commonwealth Government end its annual financial con­ tribution to the Tobacco Industry Trust Account.

4. That State Governments cease their contributions to tobacco-growing research.

5. That the Commonwealth Government gradually move towards ending all specific and general subsidies to the tobacco industry within the next ten years while ensuring adequate structural readjustment arrange­ ments for tobacco producers.

6. That the Commonwealth Government ensure that the burden of any readjustment falls in the first instance on imported leaf.

Conclusions It is now established that smoking is dangerous to health. The only argument which may be purposefully pursued is about the means of reducing the impact of tobacco on health. The Committee is encouraged by the fact that older male Australians are giving up smoking, but is disturbed that women are smoking more and that anti-smoking programs aimed at the young have not been successful.

Adult smokers should have the right to smoke if others are not affected, but recruitment of the young to tobacco smoking should be discour­ aged. While common sense might suggest a strategy based on education, evidence indicated that the techniques being used at present are not effective.

Non-smokers, at every age and in both sexes, represent a majority. They also have a right to breathe unpolluted air. As a small step in the right direction, low-tar, low-nicotine cigarettes should be encouraged for those who are unable to modify or cease their tobacco-smoking habit.

The Committee recognises that smoking is an entrenched custom and major change is needed to alter the position of tobacco use in Aust­ ralian life. Information alone has not reduced, and will not reduce, tobacco smoking.

There is an overwhelming weight of evidence that tobacco use causes ill health. Perhaps 10 per cent of all deaths are attributable to it. The

24819/77--8 103

Committee expresses disappointment that the Australian Cigarette Manu­ facturers still do not acknowledge that there is any evidence that tobacco use is a causal factor in ill health.

The Australian public understands that smoking is dangerous to health. What is now required is that the Commonwealth Government develop effective strategies to reduce tobacco consumption in Australia and to decrease recruitment of the young to the tobacco-smoking habit.

References 1 Evidence, p. 2187; Commonwealth Department of Health, Annual Report of the Director-General of Health 1975-76 (Canberra, 1976), p. 152. 2 Evidence, p. 2939. 3

Evidence, p. 2903. " The Royal College of Physicians of London, Smoking or Health (Third Report) (London, 1977), summary. J. G. Rankin & P. Wilkinson, 'Alcohol and Tobacco Consumption', in J. Krupinski &

A. Stoller (edd.), The Health of a Metropolis (Victoria, 1971), pp. 65-6. 6

N. J. Gray & D. J. Hill, 'Patterns of Tobacco Smoking in Australia', in The Medical Journal of Australia, 29 November 1975, pp. 819-24. I. Reynolds, J. Harnas, H. Gallagher & D. Bryden, 'Drinking and Drug Taking Patterns of 8,516 Adults in Sydney', in The Medical Journal of Australia, 20 November 1976, p. 784. 8 R. P. Irwin, Drug Education Programs and the Adolescent in the Drug Phenomena Problem

(Canberra, 1976), pp. 2.10, 2.11. 9 B. L. Hennessy & W. J. Bruen, 'Youth in Canberra-Results and Implications of a Mental Health Survey', in Australian and New Zealand Journal of Psychiatry, vol. 7 (1973), p. 56. 10 D. S. Bell, R. A. Champion & A. J. E. Rowe, Monitoring Drug Use in New South Wales

1971-1973 (Health Commission of New South Wales, Report, No. 75 /22) (Sydney, November 1975), p. 40. 11 S. R. Leeder, J. K. Peat & A. J. Woolcock, 'Cigarette Smoking in Sydney Schoolchildren Aged 12 to 13 Years: 1971 to 1975', in The Medical Journal of Australia, 5 March 1977,

p. 325. 12 J. Krupinski & A. Stoller (edd.), Drug Use by the Young Population of Melbourne (Mental Health Authority, Victoria, Special Publications No. 4) (Melbourne, 1973), p. 25. 13 A. George, 'Survey of Drug Use in a Sydney Suburb', in The Medical Journal of Australia,

29 July 1972, p. 207. 14 D. Carrington-Smith, Survey of Drug Use Amongst 500 Women in Hobart, Tasmania (Health Education Council, Health Services Department, Hobart, 1974). ua Commonwealth Department of Health, Survey on Smoking (August 1972). 15 P. Healy, 'Use of Psychotropic Drugs in Australia', in Informed Opinion (Health Com­

mission of New South Wales, No. 14, July 1975). 16 D. W. Rankin, N. J. Gray, D. J. Hill & D. R. Evans, 'Attitudes and Smoking Habits of Australian Doctors', in The Medical Journal of Australia, 29 November 1975, p. 822. 17 El•idence, p. 2176. 18

P. N. Lee (ed.), Statistics of Smoking in the United Kingdom (Tobacco Research Council , Research Paper No. 1) (7th edn, 2 March 1977). 19 K. Bjartveit, The Norwegian Tobacco Act (paper presented at a conference on Smoking

and the Media, Action on Smoking and Health, London, 11 October 1976), p. 12. 20 Irwin, pp. 2.13, 2.14, 2.15. 20 a Evidence, p. 2904. 21 Evidence, p. 2197. 22 Evidence, p. 2197. 23 The Royal College of Physicians of London, summary. 24 Evidence, p. 2197. 2

5 Gray & Hill, p. 820. 26 Evidence, p. 2202. 27 The Royal College of Physicians of London, summary. 28

The Royal College of Physicians of London, p. 98. 29 The Royal College of Physicians of London, summary. 3 0 World Health Organisation, Expert Committee on Smoking and Its Effects on Health,

Smoking and Its Effects on Health (World Health Organisation Technical Report Series, No. 568) (Geneva, 1975); United States Department of Health, Education, and Welfare, The Health Consequences of Smoking (annual publication) (Washington, DC); The Royal College of Physicians of London, Smoking or Health. 3 0

a Sir Richard Doll & R. Peto, 'Mortality in Relation to Smoking: 20 Years' Observations on Male British Doctors', in British Medical Journal, 25 December 1976, p. 1526. 31 Commonwealth Department of Health, letter dated 12 May 1977.

104

3l a Doll & Peto, p. 1525. 3 2

Doll & Peto, p. 1533. 33 Doll & Peto, p. 1535. 34 0. M. Jensen, 'Lung Cancer and Smoking in Danish Women', in International Journal

of Cancer, vol. 15, No.6, 15 June 1975. 3 6 A. B. Miller, 'Recent Trends in Lung Cancer Mortality in Canada', in Canadian Medical Association Journal, vol. 116, No. 1, 1977, p. 28. 3 6 Evidence, p. 2203. 37 Evidence, pp. 2788-2835. 38 Evidence, pp. 2967-78. 39 Evidence, p. 2905.

-ao Evidence, p. 2177. 41 Evidence, p. 2176. 42 E. C. Hammond, L. Garfinkel, H. Seidman & E. A. Lew,' "Tar" and Nicotine Content of Cigarette Smoke in Relation to Death Rates', in Environmental Research, vol. 12

(1976), pp. 263-74. 43 Gray & Hill, p. 820. 44 World Health Organisation, Expert Committee on Smoking and Its Effects on Health, p. 23.

45 G. Noonan, 'Passive Smoking in Enclosed Public Places', in The Medical Journal of Australia, 10 July 1976, p. 68. 46 Noonan, p. 69. 4 7 J . A. Bisby & K. H. Ouw, 'Absorption of Lead and Carbon Monoxide in Sydney Traffic

Policemen', in The Medical Journal of Australia, 26 March 1977, p . 437. 4 8 Evidence, p. 2181. 4 9 Noonan, p. 68. 50 Special article, 'Dangers for Children in Smoking Families', in Community Medicine, vol.

128 (1972), p. 32; cited in Noonan, p. 68. 51 J. R. T. Colley, W. W. Holland & R. C . Corkhill, 'Influence of Passive Smoking and Parental Phlegm on Pneumonia and Bronchitis in Early Childhood', in The Lancet, vol. 2 (1974), p. 1031; cited in Noonan, pp. 68-9. 52 Editorial, 'Tobacco Smoke and the Non-smoker', in The Lancer, vol. 1 (1974), p. 1201;

cited in Noonan, p. 69. 53 Evidence, pp. 2943, 2971. 5 4 The Royal College of Physicians of London, summary. 5 5 The Royal College of Physicians of London, p. 96.

56 Evidence, p. 2943. 5 7

Evidence, p. 2972. 5 8 Evidence, p. 2921. 5 9 Evidence, pp. 2207-8. 60 Bjartveit, p. 13. 6 1 Irwin, pp. 3.21, 3.24. . .

6 2 Edward M. Brecher & the Editors of Consumer Reports, Licit and Illicit Drugs (Boston,

1972), p. 236. G3 Australian Tobacco Board, Tenth Annual Report (for the year ended 31 December 1975)

(Canberra, 1976), p. 36.

105

cHAPTER 4 Analgesics

Extent of

Analgesic Abuse

• Some people admit to taking more than fifty compound analgesics each day. • Most compound analgesics are habituating. • Women use analgesics daily twice as much as men. • Women present with kidney disease five to six times more commonly

than men do. • Compound analgesics lead to kidney infection. • Compound analgesics cause 20 per cent of kidney failure. • Analgesics can cause stomach haemorrhage. • Single analgesics are safer.

Analgesics are pain-relievers or pain-killers and they are used in single or compound tablet, powder or mixture form for the relief of mild to moderate pain. The term 'analgesic' is used for substances such as aspirin, phenacetin, paracetamol and codeine, and for preparations containing any or all of these substances, with or without the stimulant caffeine. Preparations containing one analgesic will be referred to in this chapter as 'single analgesics'; preparations containing several of the substances mentioned above will be referred to as 'compound analgesics'. 'APC' is an expression now used for preparations of aspirin, paracetamol and caffeine. 'Bex' is the trade name of the only compound of this type. Other compound analgesics have slightly different ingredients, an example being Vincent's which contains aspirin, salicylamide and caffeine. The Committee was repeatedly informed that whenever a compound analgesic is used habitually or for reasons other than the temporary relief of a minor ailment or a mild pain, abuse occurs and, if unchecked, may lead eventually to kidney disease, gastro-intestinal haemorrhage, kidney failure and death.

In spite of publicity on the dangers of analgesic abuse and the withdrawal of phenacetin from all prescription drugs covered by the pharmaceutical benefits list, there has been no reduction in 1he extent of illness resulting from excessive analgesic consumption in the last six years.

Evidence indicates that the over-use of analgesics has not changed since the report of the Senate Select Committee on Drug Trafficking and Drug Abuse in 1971. It was hoped that implementation of the recom­ mendations of that report would have led to the potential dangers of drugs of the aspirin type, and their various compounds, becoming more widely known to the community and, after a time, to a reduced incidence

107

of analgesic-related renal disease in Australia. However, among patients presenting for dialysis programs, the proportion with analgesic neph­ ropathy has steadily risen from 11 per cent in 1969 to 20 per cent in 1975 and 1976. 1 The development of serious kidney disease may be a lengthy process and six years may be too short a time for the trend to be reversed.

Evidence supplied to the Committee indicates that there are 727 patients currently on dialysis throughout Australia and that 20 per cent of these have end-stage kidney failure due to uncontrolled abuse of analgesics which are freely available over the counter. 2 The cost of providing dialysis and transplantation alone for analgesic-induced disease in Australia is about

$1m per year. 3 One survey defined analgesic abuse as the regular daily consumption of two doses of analgesic for ten years, or an equivalent aggregate dose 'of about 2 kg of aspirin and of a similar quantity of phenacetin', where that drug is included in the formulation. 4 The Committee was told that the pattern of daily use revealed by patients had altered over the last fifteen or sixteen years. Whereas, previously, patients admitted daily consumption of twenty to fifty tablets or powders and occasionally, even one hundred, rarely does anyone now admit to that order of intake. 5

A prospective autopsy survey was carried out in Brisbane over a year commencing on 8 February 1971, and the incidence of early, intermediate and advanced analgesic nephropathy was determined. Of 1587 autopsies that year from two hospitals and the Institute of Forensic Pathology, in seventeen instances death was identified as due to analgesic nephropathy. In a comparative series of 381 autopsies performed over a six-month period in Christchurch, New Zealand, death was due to the same cause in three instances. The incidence of unsuspected analgesic nephropathy was much higher in Brisbane than in Christchurch, and in both cities the incidence was much higher in females than in males. 6

Use of minor analgesics by students in seven of the nineteen high schools in Canberra was studied in 1973. All students in forms one to si x who attended on the days of the surveys were included. A follow-up survey was conducted in 1974. The rate of use by each sex differed markedly. By sixth form · (now year twelve) the rate of use by girls was double that by boys. Between the surveys, minor analgesic use by boys declined, but the pattern for girls was erratic, with some increase. These surveys showed that the pattern of use for each sex was already established before high school. 7 The Committee recognises, however, that minor analgesics have a legitimate role, which would include relief of occasional pre­ menstrual and menstrual discomfort.

The latest data made available to the Committee by the Australian Kidney Foundation cover the period from 1·July 1971 to 30 April 1976. During that time, 2050 patients under the age of sixty presented to Australian renal units with end-stage renal failure. The primary diagnosis is known for the 1681 patients who were on dialysis. For 317, or 18 per cent, it was analgesic nephropathy. This represents five cases per million of total population each year throughout Australia. 8 The figu res for individual States during the same period are given in Table 4. I.

108

Table 4.1 Analgesic nephropathy 1 July 1971 to 30 Apri11976

Queensland New South Wales and Australian Capital Territory Victoria Tasmania

South Australia . Western Australia

Australia .

Source: Australian Kidney Foundation.

Total patients with analgesic nephropathy

63

198 22 0

25 12

317

No. of patients per year with end-stage

Proportion of disease due end-stage to analgesics , disease due per million

to analgesics total population

per cent 30 6.7

25 8.4

5 1.3

0 0.0

17 4.3

12 2.3

18 5.0

The figures for end-stage renal failure have been used because fairly precise data are available, whereas the incidence of non-terminal analgesic nephropathy can only be speculated on. However, during 1976, 159 patients presented at Sydney Hospital with non-terminal renal disease caused by analgesics. The average number of cases of end-stage renal disease treated there each year is twelve. For every case of end-stage disease at this hospital, there are more than ten of non-terminal renal failure. 9

The Australian Kidney Foundation data approximately c'orrelate with figures for the incidence of daily use of analgesics in each State (see Tables 4. 2 and 4. 3). It appears that there is daily use in Queensland by around 10 per cent to 16 per cent of the population, in New South Wales by about 10 per cent and in Victoria by only about 4 per cent. The daily use figures in turn are reflected by per capita sales; for example, per capita sales in Queensland are higher than those in New South Wales, which are higher than sales per head in Victoria (see Table 4. 7).

109

Table 4.2 Surveys of analgesic consumption, Australian country towns (Healthy Populations)

Town

Mareeba, Qld, 1965

Biloela, Qld, 1967 .

A Northern Rivers Town, N.S.W., 1965 Heyfield, Vic., 1970 Queenscliff, Vic., 1970

Busselton, W.A., 1975

Aboriginals, Bourke, N.S.W., 1975

Reference

Cvjetanovic & Menkens, Dept. Soc. Med., Univ. Qld Purnell & Burry, Med. J.

Aust. 2, 389 Bain & Unwin, Dept. Soc. Med., Univ. Qld Krupinski et a/ Christie et a/, Med. J. Aust.,

2, 527

Cullen & Woodings, Med. J. Aust., 2, 211 Kamien, Med. J. Aust., 1, 261

Daily analgesic consumption

F M Major analgesic taken

per cent per cent "---y----1

16 APC powders

15 11 Phenacetin-containing (95 per cent) "---y----1

10

6 3

3-4 3-4 Compound aspirin, 30 per cent

Paracetamol, 30 per cent Aspirin, 30 per cent

1-2 1-2

45 26 Bex or Vincent's

Source: J. H. Stewart, Evidence, p. 2545.

Table 4.3 Surveys of analgesic consumption, Australian capital cities (Healthy Populations)

City

Brisbane, 1970

Brisbane, 1973

Brisbane and Sydney, 1968 Sydney, 1972

Sydney, 1972 Sydney, 1973

Sydney, 1973

Sydney, 1976

Canberra, 1973

Melbourne, 1973

Hobart, 1971

Reference

Abrahams et a/, Med. J.

Aust., 2, 397 Ferguson, Med. J. Aust., 1, 1271 Davies & Kelley, Unisearch,

Univ. N.S.W. Gillies et a!, Med. J. Aust., 1, 974 George, Med. J. Aust., 1, 207 George, N.S.W. Health

Co nun. Ferguson, Med. J. Aust., 1, 1271 Reynolds eta!, Med. J. Aust.,

2, 782 Hennessy eta/, Med. J. Aust., 1, 721 Ferguson, Med. J. Aust., 1,

1271 Carrington-Smith, Health Services Dept.

Source: J. H. Stewart, Evidence, p. 2546.

110

Daily analgesic consumption

F M Major analgesic taken

per cent per cent 16 10

10

11

15 8

4 4

5 2

22

9 3

7 3

4

4

Bex or Vincent's (65 per cent)

Sale and

Distribution of Analgesics

The reasons for these consumption differences have not previously been identified. However, there has been speculation that the locations of the manufacturers of the common brands of analgesics have been significant in the geographic pattern of abuse. 10 Information presented later in this chapter will demonstrate an association between high levels of consumption and vigorous promotion.

Reckitts Pharmaceutical Division made available to the Committee data from established industry market research sources for 1973 and advised that market information on food stores only, obtained in late 1976, indicated no significant changes. Appendix 4 shows the percentages

of national sales volume for 1973 by outlets and percentages of market shares for proprietary analgesics.

Table 4.4 Proprietary oral analgesics Proportion of National Sales Volume by Outlets

Chemist Food

Type shops stores

per cent per cent

Powders (packets of twelve) 5.1 55.0

Tablets (boxes of twenty-four) . 54.4 27.7

(a) Estimated volume through clubs, hotels, garages, milk bars etc.

Proportion of total

Other national

outlets( a) sales

per cent per cent

39.9 50.2

17.9 49.8

Source: Reckitts Pharmaceutical Division, a division of R. & C. Products Pty Ltd.

Table 4. 4 is taken from Appendix 4 and shows that 50. 2 per cent of all proprietary oral analgesiCs sold are powders. Altogether 94. 9 per cent of these powders are bought from food stores and 'other' outlets and only 5.1 per cent from pharmacies. Conversely, most tablets (54.4 per cent) are bought from pharmacies.

111

Table 4.5 Proprietary oral analgesics, sales related to State population (National Chemist and Food Stores; Other Outlets not included)

Proportion Proportion Proportion Proportion of national of national of total of national sales, sales, national

State population tablets powders sales

per cent per cent per cent per cent

Queensland (inc 1 uding Northern Territory) . 15.0 17.2 34.5 24.5

New South Wales (including Australian Capital Territory) 37.2 38.0 52.8 44.2

Victoria 27.5 25.1 5.3 16.7

Tasmania 3.1 2.8 0.6 2.0

South Australia 9.2 9.8 4.0 7.3

Western Australia 8.0 7.1 2.8 5.3

100 100 100 100

Source: Reckitts Pharmaceutical Division, a division of R. & C. Products Pty Ltd.

Table 4. 5 is derived from Table B in Appendix 4. It shows that whereas tablet sales clearly reflect the percentage of national population in each State, the sale of powders is very much a phenomenon of Queens­ land and New South Wales. The sales figures for these two States, which include those for the Northern Territory and the Australian Capital Territory respectively, account for 87.3 per cent of the chemist and food shop sales of all proprietary analgesic powders but relate to only 52. 2 per cent of Australia's population. The excess powder consumption in New South Wales and Queensland could even be understated to a signifi­ cant degree. It can be seen from Table 4. 4 that 39. 9 per cent of powders are sold in 'other' outlets not included in Table 4. 5.

Figures from pharmacy and food store sales suggest (see Table C in Appendix 4) that aspirin-a single analgesic-is the analgesic most used in Victoria, Tasmania and Western Australia whereas, in Queensland and New South Wales, Vincent's is most commonly used, with Bex next most commonly used. Vincent's APC is in fact the analgesic most used in Australia. One can only speculate whether the brand preference for compound analgesics would be different if 'other' sales outlets such as factories, garages etc. were taken into account.

112

Table 4.6 Proprietary oral analgesics, consumption in Australian States (Expressed in Arbitrary Units per head of population)

Queensland (including Northern Territory) New South Wales (includil)g Australian Capital Territory) . Victoria Tasmania

South Australia Western Australia

Tablets

64.2

55.8 52.2 55.4 60 .0

50.4

(a) Detailed data and method of calculation are shown in Appendix 5.

Powders

99.1

63.0 8.5 9.1 19.4 15.9

Table 4. 6 shows a very striking pattern of per capita analgesic con­ sumption (in arbitrary units) by State, and clearly indicates that residents of New South Wales and Queensland, in particular, generally use more analgesics than do people in other States. Use of powders, particularly Bex and Vincent's, is vastly greater in these two States, ranging from three to eleven times as high as in other States. This table suggests that in Queensland and New South Wales, Bex and Vincent's powders are not merely substitutes for other analgesics but largely represent extra con­

sumption in excess of Australia's known overall level of analgesics use, which is high by world standards.

Table 4. 7 Correlation between sales of analgesics per head of population and incidence of end­ stage renal failure in Australia (Victorian figure, as the lowest, used as the base figure).

Relative incidence by population

End-stage Total Analgesic

renal analgesic powder

State failure( a) Bex(b) Vincent' s( b) sales( c) sales( b)

Queensland (including Northern Territory) . 5.2 3 16.1 2.7 11.7

New South Wales (including Australian Capital Territory) . 6.4 2.2 9.6 2.0 7.4

South Australia 3.3 1.8 1.7 1.3 2.3

Western Australia 1.8 1.6 1.5 1.1 1.9

Victoria . 1 1 1 1 1

Tasmania 1.1 2.6 1.1 1.1

(a) Calculated from Table 4.1. (b) Calculated from Table Bin Appendix 5. (c) Calculated from Table B in Appendix 4 (proportion of national sales over proportion of national population). Source: Reckitts Pharmaceutical Division, a division ofR. & C. Products Pty Ltd; and the Australian Kidney Foundation.

Table 4. 7 demonstrates the correlation between per capita sales of all analgesics, analgesic powders, particular brands of analgesics and the incidence of end-stage renal failure in Australia. In each case, the Victorian figure, being the lowest, was used as the base figure. The magnitude of the

analgesic problem in Queensland and New South Wales is clearly shown.

113

In respect of analgesic powder sales, the figure for a Queenslander is 11.7 times, and that for a resident of New South Wales is 7.4 times, the figure for a Victorian. The incidence of end-stage renal failure (ESRF) due to analgesic nephropathy has been ranked in the same way. There is not a strict correlation between ESRF and powder sales. For every case of ESRF in Victoria there are 6. 4 cases in New South Wales and 5. 2 in Queensland. This leaves an unexplained difference between the incidence of ESRF and powder sales in Queensland and New South Wales. Bex sales ranked in a similar manner show a closer correlation to ESRF.

As hospital statistics are a function of diagnostic practice which varies from State to State, the true incidence of analgesic nephropathy can be established only by community surveys. Since large numbers of people with analgesic nephropathy are not identified and receiving treatment, hospital figures are not necessarily representative and certainly under­ estimate the real incidence of the disease.

Dr J. H. Stewart made available to the Committee material from a thesis submitted to the University of Sydney by Dr P. D. Niall. Of 585 patients accepted for end-stage renal failure programs in New South Wales between 1965 and March 1972, 185, or 32 per cent, gave a history of analgesic abuse. Of these 185 patients, 84 took Bex, 32 took Vincent's and 30 took both powders; only 14 took Veganin, Disprin and Aspro; and 25 took unnamed brands. This consumption pattern is depicted in Figure 4. I. Other data showed that nearly two-thirds of abusers took four or more doses per day. Seventy per cent of abusers had a history of 5 years or more of abuse and 22 per cent of 15 years or more; and the average duration of abuse was 9 years. The longer the duration of abuse the higher was the dosage rate. Three-quarters of abusers began the habit under the age of 35 years. 11

The figures above probably represent current usage. However, the Committee is aware of patients' poor recall of past brand preference and habits. We have no information on whether brand preference is age related and would like to have such data before interpreting the figures

produced by Dr Niall.

114

Figure 4.1 Brand of analgesic consumed by 185 end-stage renal failure patients in New South Wales, 1965-72

80

60

">

d

c..

40 c-0

0

z

20

t-

-

Bex Vincent's Bex and Vincent's Other

Combined

Source: P. D. Niall, An Investigation of Chronic Renal Failure, Dialysis and Renal Trans­ plantation in Regard to Epidemiology and Utilisation of Resources (unpublished thesis, University of Sydney).

While there may appear to be a difference between market survey figures and the pattern shown in Figure 4. I, the market survey data did not include garages, factories or milk bars, which, on anecdotal grounds, we are led to believe contribute significantly to the sale of Bex powders. Table 4. 4 shows that these outlets account for 39. 9 per cent of powder sales in Australia.

Additionally, as previously noted, there are logical fallacies in using hospital figures for end-stage renal failure as an accurate reflection of the community incidence of analgesic nephropathy.

Who Abuses The Committee was told that there are people who can be identified as Analgesics? being 'at risk'. Women present with analgesic nephropathy five to six times more commonly than men, and twice as many women as men use analgesics daily. 12 People who have gout seem to develop renal papillary

necrosis from analgesics more readily than other people taking a similar dosage, and can be identified as being at risk. 13 Evidence indicates that the vast majority of the women who develop analgesic nephropathy are from lower socio-economic groups. They

115

have problems such as a large family, isolation, marital difficulties and serious economic hardship. And they take large quantities of analgesic mixtures and compounds, which are relatively cheap, as a prop to assist them to cope with family stress and intolerable social situations. 14

Three grounds were commonly given for regular analgesic consump­ tion-recurrent headache, the belief that powders improve performance at work or give a sense of well-being, and relief of chronic musculo­ skeletal pain. 15 It seems that abusers take the first dose 'to get started in the morning' and dosage is repeated regularly throughout the day. 16

A report on the incidence of analgesic nephropathy in the Hunter region of New South Wales was made in February 1976. The character­ istics of 286 patients at Royal Newcastle Hospital identified as suffering from analgesic nephropathy were analysed. Some of the main findings were:

1. Female patients presenting for treatment outnumbered male patients by more than 6 to 1, whereas there is evidence that amongst analgesic abusers in the community women outnumber men by only 2 to 1. 2. For both males and females, almost two-thirds of patients first present

between the ages of 40 and 60. Few patients were under 30 years old or older than 70. 3. There appears to be no significant relationship between marital status and incidence of analgesic nephropathy. 4. It was significant that of the female patients resident in the Newcastle

Region, only 12 per cent were working at the time of their first admission to RNH. Most were housewives. 5. Analgesic nephropathy appears to be a peculiarly Australian (or British) ailment, with a higher proportion of patients Australian born than would

be expected. 6. The lower socio-economic groups in Newcastle have much higher incidence of analgesic nephropathy than the top socio-economic group.1 7 It seems that in the Hunter region the typical analgesics abuser is a woman,

bound to the house and probably from a lower socio-economic group. Stewart described the characteristics of individual abusers of analgesics in these terms : Some explanation for individual patients' starting the analgesic habit has

been provided by observations that many habitues had a parent or other close relative who was also addicted to powders, while others were introduced to the practice at work. There is also a high prevalence of neurosis or other psychiatric disease, domestic disharmony and non-analgesic drug dependency in the habitues themselves, and their close relatives.

But psychiatric abnormalities cannot account for the demographic pattern of analgesic abuse, particularly the female preponderance and the uneven distribution among the states of Australia. The answer may be found through an understanding of how people who are in most respects normal, are intro­ duced to the drugs and persuaded to take enough to initiate addiction. 18 Thus there is a picture of the typical abuser of analgesics and a pattern of analgesic abuse. However, why the abuser turns to analgesics instead of other means of relief is not clear.

Much of the available evidence suggests that there is a relationship between the abuse of analgesics and the abuser's social situation. As was recognised in discussion of the proposed national strategy in Chapter I,

116

Health Effects of Analgesic Abuse

if compound analgesics become unavailable or difficult to get, something else will probably be substituted. Stewart said: ... because the underlying problem of analgesic dependency is behavioural and environmental in origin rather than medical, the physician must combine

forces with the social engineer to devise a definitive solution for this condi­ tion.19

Evidence was given that intakes of approximately twenty doses of anal­ gesics per day were associated with the development of illness due to analgesic over-use. 20 This is well above the threshold level described earlier in this chapter. Normally, it takes a long time for kidney failure to occur, but there are signs that could warn people that their kidneys are being affected. Such people, for example, become particularly prone to kidney infections. 21

The 'analgesic syndrome' includes anaemia, recurrent headaches, psychological instability and peptic ulceration in addition to kidney disease. Recurrent headache may be the result, as well as the cause, of compound analgesic ingestion, but most patients give recurrent headache as the reason for taking regular doses of analgesics. However, since caffeine withdrawal may cause headache, caffeine habituation could be responsible for perpetuating both the headache and the over-use of analgesics. 22 In fact, in most cases headaches dis appeared when the habitual use of analgesics stopped. 23

Almost all patients who develop kidney trouble as a result of this form of abuse take mixtures or compounds, not single analgesics such as Aspro, Disprin and Panadol, which are seldom addictive. However, it appears that patients who take aspirin over long periods for rheumatoid arthritis may suffer some kidney damage. 2 4 Single drugs may be used in large doses for long periods usually under medical supervision in the treatment

of rheumatoid and osteo-arthritis, generally without serious renal damage. 25 There was a small proportion of patients (2 per cent to 3 per cent) with renal papillary necrosis who admitted to taking one analgesic alone, usually aspirin. 25a One expert witness stated:

No rheumatologist would deny that certain compound analgesics are poten­ tially nephrotoxic, but until it can be shown that aspirin alone, in maximum prescribed doses, causes human papillary necrosis, nephrologists have no case against the use of this drug as primary treatment for rheumatoid arthritis. 26

The Committee has been told that, with the majority of analgesic preparations, it is only when caffeine or other stimulants or additional analgesic agents are added that the habituating potential is present and analgesic abuse occurs. 2 7 In this situation analgesics are generally taken without medical guidance and for conditions that do not warrant use of the type or amount of drug consumed. 2 8 APC preparations marketed in Australia contain caffeine. Abuse of these products may result in renal papillary necrosis, followed by renal failure and then a need for renal dialysis or transplant. Professor Denis N. Wade stated:

I know of no convincing pharmacological evidence demonstrating that caffeine potentiates or otherwise contributes to the action of minor analgesics.

117

I therefore see no reason why caffeine should be contained in combined formulations of analgesics, particularly as it is reasonable to assume that the caffeine contributes to the habit of excessive consumption of combined anal­ gesics. These considerations are entirely separate from the question of the combination of caffeine with ergotamine specifically for the treatment of migraine. In this case, there is some evidence that caffeine facilitates the absorption of the ergotamine and I believe this to be an · entirely justified

combination. 29

Beckers Pty Ltd informed the Committee that it always advises against the use of compound preparations for other than the relief of minor and temporary pain or mild fever, recommends that use be limited to a maximum of three doses in any one day, and warns that prolonged use should be avoided and a physician consulted. We note that this advice has failed to discourage habitual consumption of compound analgesics.

The Committee was told that about 90 per cent of patients, when faced with the necessity for giving up analgesics, manage to do so without trouble. 30 We were also informed that most patients with serious kidney failure would improve immediately and would recover almost completely when the intake of compound analgesics stopped. 31

It was at one time believed that phenacetin was the nephrotoxic com­ ponent of powders and tablets, but the Committee was informed that there is now no evidence to substantiate the view that phenacetin alone is to blame for kidney lesions. 32 On the other hand, a recently reported study suggests that phenacetin used in compound with aspirin should be severely restricted. 33 Professor Wade said:

It is my opinion that phenacetin and paracetamol should be regarded as very similar compounds and that they should be available as single substances for short term use, particularly for patients who are intolerant to aspirin or who are allergic to aspirin. However, I have very strong feelings that the com­ bination of either phenacetin or paracetamol with caffeine is a particularly inappropriate drug formulation to have readily available for general use. 34

In 1967, phenacetin in Vincent's was replaced with salicylamide. A. F. Burry, R. A. Axelsen and P. Trolove studied 726 autopsies done in two Brisbane hospitals in 1971 and compared the results with their own similar study of 507 autopsies done at the Princess Alexandra Hospital, Brisbane, in 1964. The comparison showed a decline in deaths caused by analgesic nephropathy from nineteen in 1964 to sixteen in 1971, which was believed to have been due to a real decline in the general incidence of this disease as a result of the changed formulation of Vincent's. 35

Niall found that of 185 patients with end-stage renal failure associated with analgesic abuse, who presented for treatment in New South Wales between 1965 and 1972, eighty-four took Bex (see Figure 4.1) which at that time still contained phenacetin. In 1975, phenacetin in Bex was replaced with paracetamol. A. F. Burry and J. Hopkins conducted a survey of 322 autopsies of adults some months later to test the effects of this measure. The results showed no reduction in the incidence of advanced or early forms of analgesic nephropathy from levels noted in 1971-72. 36

118

Evidence of the role that phenacetin plays in analgesic nephropathy is inconclusive and it could be several years before the effects of its with­ drawal are known. The Committee notes that the public may not be aware that, even with the change from phenacetin to paracetamol and salicylamide, compound analgesics are still dangerous when taken to excess.

Availability At present, APC-type analgesics are sold without restriction by self­ service stores, confectioners, and tobacconists as well as by pharmacists. It was submitted to the Committee that those analgesic preparations containing more than one analgesic agent, or an analgesic and a stimulant,

should be available only on prescription. 3 7 This would end any need to advertise compound analgesics to the general public.

24819!77-9

In rebuttal, it was stated that, if compound analgesics were supplied on prescription only, hardship would be imposed on the majority of consumers who use these products sensibly. 38 Contrary evidence stated, however, that, for headaches, colds and influenza, aspirin alone or para­ cetamol alone was as effective as the compound agents. 39

It was also proposed that, since the analgesic habit is largely the result of successful advertising, we should prohibit all advertising of compound preparations but permit their sale from pharmacies without prescription provided the purchaser was attended personally by a registered pharma­ cist. 40 Pharmacists are already accepted in the community as a ready

source of information on treatment of minor ailments, and could provide information on the desirability or availability of compound analgesics for minor illness. The Committee notes that this view closely accords with the reservations

made by Senator Georges in the Senate Select Committee's report in 1971: The Minor Analgesics ... Their sale, together with all pharmaceuticals should be the responsibility of pharmacists, through recognised outlets. Advertising ... My conclusion is that a ban be placed on all TV and radio advertising of all pharmaceuticals, including minor analgesics, tobacco and alcohol and that the co-operation of States be invited to limit all other forms of advertising not under Commonwealth control. 41

The pharmacist could have the additional responsibility of referring for medical advice those purchasers who appeared to have an addiction to analgesics. There are, however, a number of problems with the above proposal. Firstly, it is not easy to tell, from appearance only, whether a person is abusing analgesics. Secondly, even if this were possible, an abuser could easily go to a number of pharmacies to build up a supply of analgesics. Thirdly, with the modern trend in retail pharmacies to larger, even self­ service type stores, individual attention from the pharmacist is not always immediately available.

It was also suggested that vigilance would be needed to prevent abuse of the single, non-prescription analgesics and that acute serious toxicity

119

might be avoided by packaging all analgesic tablets individually in foil or strip packs and by limiting the numbers sold at any one time to less than the potentially lethal dose. 42 The Commonwealth Department of Health has provided the following information about the potentially lethal oral doses of aspirin and paracetamol for adults and children:

Aspirin- Adult: 20-30 g (about 60-90 tablets, 40-60 powders). Child: 1-6 g (about 3-18 tablets, 2-12 powders).

Paracetamol-Adult: 25-30 g (about 50-60 tablets, 100-120 powders). Child: minimal lethal dose of 3 g for children of 18 months to 2 years with a body weight of

15 kg.

The National Health and Medical Research Council (NH and MRC), at its 76th session in 1973, recommended that a warning be prominently displayed on the container of every analgesic preparation sold whether with or without prescription:

CAUTION: This preparation is for the relief of minor and temporary ailments and should be used strictly as directed. Prolonged use without medical super­ vision could be harmful. In April 1977, the NH and MRC adopted the following re­ commendations:

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 substance; packed in units containing not more than twenty-five tablets or twelve powders; supplied in strip packs or in containers with suitable child-resistant closures.

That aspirin, paracetamol, salicylamide and their derivatives, when com­ bined with not more than one per cent of codeine, packed in units containing not more than twenty-five tablets or twelve powders and supplied in strip packs or child-resistant closures, be scheduled S2.

That a mixture of any two or more of aspirin, caffeine, paracetamoJ, salicylamide and their derivatives should be scheduled S4. Substances in Schedule 2 may be sold only by chemists or licensed poisons dealers. Substances in Schedule 4 may be supplied only on a doctor's prescription. 43

The Committee believes that the above recommendations would cause the general public little hardship, because single analgesics are just as effective in dealing with minor pain and would be freely available over the counter.

We recommend: 1. That the proposals for restrictions on the sale of compound analgesics adopted by the National Health and Medical Research Council at its 83rd session, in April 1977, be implemented by Commonwealth and

State Governments.

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2. That all analgesics, whether sold with or without prescription, carry the following warning on the container:

CAUTION: This preparation is for the relief of minor and temporary ailments and should be used strictly as directed. Prolonged use without medical supervision could be harmful.

3. That all non-prescription analgesics in pack sizes containing more than twenty-five tablets or twelve powders be available only from pharmacies.

4. That the Commonwealth Department of Health monitor consumer usage of and attitudes towards proprietary medicines to measure the effects of various intervention strategies.

Advertising Compared with other countries Australia has a very high rate of anal­ gesic nephropathy. For example, in Australia, 5 per cent to 15 per cent of autopsies performed in public hospitals show the presence of analgesic kidney disease compared with only about 0.2 per cent in the United States and the United Kingdom. The reasons for the difference are not yet fully understood but one reason put to the Committee was that

advertising is more intensive here than in the United States and the United Kingdom. 44 The inference is that if mixtures and compounds are widely advertised they will become more widely available to the public. From 1969 to 1972, $2m per year was spent on analgesic advertising throughout Australia. As against this, the total budget of the Australian Kidney Foundation is less than $200 000 per year, most of which is spent on research rather than on education, with little being available for counter-advertising. 45

Banning the advertising of compound analgesics would not alone reduce over-use by susceptible people or by those who have developed some form of addiction. Such people would still seek these products whether or not advertising was banned or distribution restricted.

The Committee notes current proposals for the introduction throughout Australia, during 1977, of a new voluntary censorship code for the advertising of therapeutic goods on radio and television and in news­ papers and magazines. This code has been accepted by drug manu­ facturers and retailers, the media and the advertising industry. 46 Never­

theless we are of the opinion that skilful and persuasive advertising can be a factor leading susceptible persons into impulse buying and over-use of analgesic preparations, and that restriction of distribution outlets could reduce the problem.

Arguments were put to the Committee emphasising that the majority of consumers used analgesics carefully and wisely and in accordance with directions; it was only a small minority of people who tended to over-use or abuse such products. 47 Beckers Pty Ltd claimed that its radio and television commercials were few and that none extended beyond ten seconds visual or thirty-five words audio-proof, the company suggested, that its promotional inducement was not aimed at greater consumption.

121

The company also claimed that its policy had always been 'aligned with the welfare of the community' with no attempt to 'distort the real need in favour of the profit motive'. 48

Table 4.8 Metropolitan analgesic advertising in 1974, percentage of total expenditure for each capital city

Sydney. Melbourne Adelaide Brisbane Perth Hobart. Women's magazines General magazines .

Main single

analgesics­ As pro and Disprin

28 27 5

8

6

2

21 3

100

Main

compound analgesics­ Rex and Vincent's

47 16 5

21 4

1

2

4

100

Source: Reckitts Pharmaceutical Division, a division of R. & C. Products Pty Ltd.

Table 4.8, which was derived from information on advertising costs supplied by Reckitts Pharmaceutical Division, gives approximate per­ centages of total metropolitan advertising expenditure in each capital city. In New South Wales and Queensland, expenditure on the advertising of compound analgesics is proportionally much greater than expenditure on the advertising of single analgesics. Analgesic nephropathy is highest in New South Wales and Queensland. Although it is not possible to show a causal relationship with advertising, the Committee believes that advertising has the aim of increasing sales and in this lies the main objection to unrestricted advertising of preparations which are dangerous and which can be replaced by safer products.

If the Commonwealth and State Governments accept the recom­ mendation of the National Health and Medical Research Council that compound analgesics be supplied only on a doctor's prescription, ad­ vertising of these compounds to the general public will be automatically

banned. The Committee believes that advertising of these substances should still be banned if some States decide on less restricted availability of compound analgesics.

Education In the 1960s, attempts were made to alert the public to the dangers of excessive analgesic intake. These efforts were mainly in the form of statements by individual doctors and health agencies. The Australian Kidney Foundation was formed in the late 1960s and contributed to the education of the public by issuing pamphlets, by presenting lectures to clubs and organisations and by informing the media whenever possible.

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Views of Earlier Senate Committees

It appears that these efforts have been successful in conveying information to the public. Referring to patients with analgesic nephropathy, one witness said: ... there are very few patients who deny that they knew that they were poten­

tially doing themselves harm ... I think the message has got across. 49 Notwithstanding that the message may be getting across, recent surveys mentioned earlier in this chapter show that there has not been a discernible decrease in analgesic abuse in Australia. It could be concluded that dissemination of information alone is of limited success in controlling excessive consumption. Nevertheless, the Committee believes that warnings about the dangers of analgesics should continue. It is essential that excessive users know the risks they are taking, even if they do not respond to advice.

The Committee was told that the Australian Kidney Foundation spends most of its budget on research rather than on education but is continuing to campaign against analgesic abuse by issuing pamphlets and conducting interviews. The Proprietary Association of Australia indicated that it proposed a type of consumer-education program directed towards curbing or controlling over-use of analgesics. The program has not yet commenced and its value cannot be assessed.

A concerted effort must be made to reach the community at large and to convince people that self medication leading to the use of excessive quantities of analgesic preparations results in permanent damage to health and, for some, in death. We believe that many educational programs used in the past have been ineffective or counter-productive. A suggested approach to education is discussed in Chapter 8.

Some specific recommendations made by the Senate Select Committee on Drug Trafficking and Drug Abuse in 1971 50, together with comments on those recommendations made in February 1975 by the Senate Standing Committee on Health and Welfare 51 were:

1971 Recommendation: Awareness. Society should be made fully aware by education of the risks run by a lack of caution and knowledge in self-medication or excessive con­ sumption of drugs.

1975 Comment: The Standing Committee stated that the need for drug education programs was evident and that such programs must be researched and assessed to ensure that their aims were not frustrated.

1971 Recommendation: Kidney disease and minor analgesics. Every encouragement should be given to the pursuit and extension of research into kidney disease in Australia and to the relationship between kidney disease and the misuse of minor analgesics.

1975 Comment: The Standing Committee believed that the high incidence of certain kidney disease in Australia warranted continued emphasis on research

123

allocations beyond 1975. It also endorsed the action by the then Minister for Health in asking his Department for a report on the feasibility of making all compound analgesics available only on pre­ scription. This Committee records its concern that more positive action has not yet been taken to implement the goals enunciated in the earlier reports.

Summary There is a relationship between the excessive use of compound analgesics and the occurrence of analgesic nephropathy. However, there is still doubt about which particular agent or agents may cause renal failure. Women present with analgesic nephropathy five to six times more commonly than men do. The typical abuser is a middle-aged woman in a lower socio-economic group who has significant personal and family problems and who takes large quantities of analgesic mixtures and com­ pounds in order to cope with family, social and economic stresses.

The apparent incidence of analgesic nephropathy shows marked variations between States and between Australia and other countries. The Committee has established an association between high levels of consumption of analgesics and vigorous promotion. Information on advertising costs suggests that in New South Wales and Queensland expenditure on the advertising of compound analgesics is proportionally higher than in other States and also proportionally greater than for single analgesics. The incidence of analgesic nephropathy is highest in these two States.

Most powders-94.9 per cent-are bought from food stores and 'other' outlets and only 5.1 per cent from pharmacies. Conversely, most tablets-54.4 per cent-are bought from pharmacies. Aspirin-a single analgesic­ is the preparation most used in Victoria, Tasmania and Western Australia, whereas compound analgesics are dominant in Queensland and New South Wales, where Vincent's is most used, with Bex next most commonly used.

The Committee is of the opinion that effective control of the sale and distribution of compound analgesic preparations will be the first step towards reducing the incidence of analgesic nephropathy. Such control would accord with the proposed national strategy which seeks a balance between programs to reduce the supply of drugs and programs to reduce demand for them. At present there is no effort at all to reduce supply. Single-ingredient drugs, such as aspirin alone or paracetamol alone, should continue to be available to the general public for self medication. If special preparations are needed, a doctor should be consulted and a prescription obtained. Packaging all analgesic tablets individually in foil

or strip packs and limiting the numbers sold at any one time to less than the potentially lethal dose would help in avoiding acute poisoning. The containers of all analgesics sold should carry a warning advising the public that they should be used only as directed.

Finally, the Committee acknowledges that a complete solution to the problems of analgesic abuse would require changes in the structure of

124

society and in the capacity of people to cope. Abuse of analgesics is not only a medical problem; it is also a social and perhaps a psychological problem as well. The Committee agrees that controlling the sale of compound analgesics would assist in lessening analgesic abuse and resultant physical disease, but it would not deal with the causes which led to drug dependency in the first place. Carefully researched and effective educational programs aimed at all levels of society must be more actively pursued if we are to make susceptible people aware of the dangers of possible habituation to analgesics. A national research program must be undertaken to identify the real causes of self-induced analgesic abuse leading to kidney failure and death.

References 1 Evidence, p. 2098. 2

Evidence, p. 2100. 3 Evidence, p. 2549. 4 A. F. Burry, R. A. Axelsen & P. Trolove, •Analgesic Nephropathy: Its Present Contri­ bution to the Renal Mortality and Morbidity Profile', in The Medical Journal of Australia,

12 January 1974, p. 32. 5 Evidence, p. 2114. 6 Burry, Axelsen & Trolove, pp. 31-6. 7 R. P. Irwin, •Minor Analgesic Use Among High School Students', in The Medical Journal

of Australia, 12 October 1976, pp. 522-7. 8 Australian Kidney Foundation, letter dated 22 February 1977. 9 Australian Kidney Foundation, letter dated 22 February 1977. 10 Evidence, p. 2514. 11 P. D. Niall, An Investigation of Chronic Renal Failure, Dialysis and Renal Transplantation

in Regard to Epidemiology and Utilisation of Resources (unpublished thesis, University of Sydney). 12 Evidence, pp. 2553, 2108. 1 3 Evidence, p. 2114. 14 Evidence, p. 2116. 15 Evidence, pp. 2511-12. 1 6 Evidence, p . 2096. 17 W. Jarvie & G. McCalden, The Incidence of Analgesic Nephropathy in the Hunter Region

(Newcastle, February 1976), pp. 20-1. 18 Evidence, p. 2513. 19 Evidence, p. 2495. 20 Evidence, p. 2114. 21 Evidence, p. 2113. 22 Evidence, pp. 2507-8.

23 Evidence, p. 2096. 24 R. S. Nanra and P. S. Kincaid-Smith, •Renal Papillary Necrosis in Rheumatoid Arthritis', in The Medical Journal of Australia, 15 February 1975, pp. 194-7.

25 Evidence, p. 2512.

25a Evidence, p. 2563. 26 Evidence, p. 2512. . .

27 Professor P. S. Kincaid-Smith and Professor D. N. Wade, personal commumcation. 28 Evidence, p. 2521. 29 Professor D. N. Wade, letter dated 30 March 1977. 30 Evidence, p. 2555. 31 Evidence, p. 2118. 32 Evidence, p. 2097. .

33 I. Ferguson, F. Johnson, B. Reay & R. Wigley, •Aspirin, Phenacetin, and the Kidney: A Rheumatism Clinic Study', in The Medical Journal of Australia, 11 June 1977, p. 950. 3 ' Professor D. N. Wade, letter dated 30 March 1977. 3 5 Burry, Axelsen & Trolove, p. 35. 3 6 A. Burry & J. Hopkins, •phenacetin and Analgesic Nephropathy', in The Medical Journal

of Australia, vol. 1 (1977), p. 879. 3 7 Evidence, pp. 2097, 2522. 38 Evidence, p. 2483. 39 Evidence, p. 2557. 40 Evidence, pp. 2522-4. u Senate Select Committee on Drug Trafficking and Drug Abuse, Drug Trafficking and

Drug Abuse (Canberra, 1971), p. 95. 42 Evidence, p. 2523. .

4 3 National Health and Medical Research Council, press statement, 26 Apnl 1977.

125

44 Evidence, p. 2104. 45 Evidence, p. 2556. 46

Hon. Ralph Hunt, Minister for Health, press statement, 29 March 1977. 47 Evidence, p. 2467. 48

Beckers Pty Ltd, letter dated 18 January 1977. 49 Evidence, p. 2554. 50

Senate Select Committee on Drug Trafficking and Drug Abuse, pp. 89, 90. 51 Senate Standing Committee on Health and Welfare, Continuing Oversight of the Report of th e Senate S elec t Committee on Drug Trafficking and Drug Abuse (Report No. 1)

(February, 1975), pp. 49-51.

126

CHAPTER 5 Cannabis

The History of Cannabis

In this chapter the term 'cannabis' is used to cover the dried leaf, hashish and hashish oil and all purified forms of tetrahydrocannabinol. 'Marihuana' is used for the dried leaf only. However, when referring to source material the term used in that material is used in the text.

Of all the drugs our society chooses to use, cannabis has excited the widest range and quality of comment, research and protestation, and has given rise to a research literature varying enormously in quality and interpretation. Both denigrators and advocates of cannabis use have harangued, and continue to harangue, the public, law makers and law enforcers. The result is a most difficult tangle of half-truths, fact and fiction. Unfortunately for our society, this tangle has been partly brought

about by some of the people in professions, on whom we have traditionally relied as providers of impartial and factual information, becoming emotive advocates for particular attitudes on the use and the dangers of cannabis.

The debate on cannabis needs to become relevant to everyone, including cannabis users. If the rhetoric continues to be partisan, biased and irrel­ evant, the credibility of those taking part in the debate will continue to suffer. More importantly, the credibility of those concerned about the use of drugs such as heroin will suffer. The lack of rational debate on the cannabis problem inhibits the development of rational methods of control of cannabis use, and also rational discussion and action in relation

to the more serious problem of opiate use.

The hemp plant has been known since antiquity, and is probably well known to most people as the plant from which hemp rope is manufactured.

The Chinese Emperor Shen-Nung wrote about the effects of cannabis in 2737 BC, prescribing it for various ailments. The Chinese medicinal treatise Rh- Ya, in the fifteenth century BC, noted its common use, and in 220 AD the biography of the physician Hoa-Tho recorded its frequent

use as a surgical anaesthetic. Native literature in India, where the plant was called 'bhang', extols the virtue of this 'holy' plant. The Susruta, dated before 1000 BC, mentions the euphoria-producing effects of bhang. Scholars in ancient Assyria described the plant accurately in 650 BC and wrote about its various properties. 1 The Assyrians used it as incense (just as later its smoke was to be inhaled from open fires to relieve ail­ ments such as toothache) under the name 'Qunnabu'. This name ap­ parently was derived from an old East Iranian word 'Konabu', corres­

ponding to the Scythian name 'Kavva Bis', hence 'cannabis'. 2

127

Mention of the plant and its effects is to be found in the writings of Homer. Herodotus, Democritus, Pliny, Dioscorides and Galen wrote of it as a useful medicinal plant. Arabian texts of 950 AD show it as being in common use to dispel depression and headaches. Evidence also shows that the Carthaginians traded hashish throughout the Mediter­ ranean. In the twelfth century, the strange sect known as 'Hassasins' arose. Followers of the fanatic Hasan-Ibn-Sabbah, they were trained to kill on his orders without demur; hence the word 'assassin'. While pursuing their dread tasks, they were usually under the euphoric influence of hashish-a matter remarked on at some length by Marco Polo in 1271.

In 1789 Napoleon found chronic hashish abuse among the lower classes during his invasion of Egypt, and Dr Livingstone recorded exten­ sive use of cannabis among the younger men in the region of the Upper Zambesi.

Cannabis appears to have come late to Europe, and to have made its debut in 'high society' in Paris in 1844 through the exclusive Hotel Primodan, where the specialite de Ia maison was Dawamesc, a sweetmeat which contained hashish.

There is some evidence that Montezuma II, the last Aztec ruler, was a regular smoker of cannabis, thus associating it with various religious festivals in Mexico. In 1611, cannabis was first purposely planted in what is now the United States, near Jamestown, Virginia, on the orders of

King James I, to increase the production of hemp. By 1630, it was the staple of the colonial clothing industry. 3 It should perhaps be noted that the most widespread and pervasive use of cannabis throughout a society arose when the plant made its way from Virginia to Jamaica where, under the name 'ganja', it has become an integral part of Jamaican society and culture.

In 1762, to encourage production of hemp fibre, 'Virginia awarded bounties for hempculture and manufacture, and imposed penalties upon those who did not produce it'. 4 Between the mid-nineteenth and early twentieth centries, cannabis was widely used for medicinal purposes in America. Leading pharmaceutical firms such as the Parke Davis, Squibb, Lilly and Burroughs Wellcome companies marketed fluid extracts, and these were sold over the counter

by drug stores at modest prices. 5 Dr J. Russell Reynolds, Fellow of the Royal Society and Physician in Ordinary to Her Majesty's Household in the reign of Queen Victoria, writing in The Lancet in 1890, declared that he had been prescribing cannabis for 30 years and considered it 'one of the most valuable medicines we possess'. 6 Until 1942, the United States Pharmacopeia listed cannabis as a recognised medicine under the name 'Extractum Cannabis'. 7 A substance which was named 'cannabinol' was first isolated and identified in 1899. Between 1940 and 1969 a num her of forms of tetrahydrocannabinol were identified and some were synthesised.

The use of freely available cannabis for recreational purposes through the nineteenth and early twentieth centuries in America was 'at best limited, local and temporary'. 8 After the price of alcohol was raised in 1920, the use of cannabis became more general. 9

128

A Federal Bureau of Narcotics was established in the United States in 1932. By 1937, forty-six of the forty-eight States, as well as the District of Columbia, had adopted anti-cannabis laws. The Federal Marihuana Tax Act, which was passed in the same year, imposed licence fees for the possession and sale of cannabis for medicinal purposes, and outlawed possession or sale for non-medicinal purposes. After 1937, restrictive legislation multiplied and increased in severity, until in most States the laws specified that penalties for the possession and use of cannabis should

be at the level applying to heroin. 10 The American community's attitude to cannabis moved remarkably rapidly from regarding it as an acceptable drug in the early 1920s, until in the 1960s, in Alabama, judges were required to sentence the possessor of one cannabis cigarette to not less than 5 years' imprisonment, and for a second possession offence, a minimum of 10 years and a maximum of 40 years were prescribed. Suspended sentences and probation were

prohibited in all cases. 11 Very little has been written about the history of cannabis use in Aus­ tralia. In the late nineteenth century, recreational use of the drug by oral ingestion or by smoking appears to have been unknown; cannabis was

used mainly for medicinal purposes and could be obtained without prescription. It was listed in official pharmacopoeias until the 1920s. 12 In 1925, the League of Nations held two Opium Conferences to try to co-ordinate international action against illicit trafficking in narcotic drugs. These conferences resulted in the Geneva Convention, in which the

signatory nations, including Australia, agreed to limit and control the distribution and sale of various narcotic drugs. Cannabis was included in the specified narcotic drugs at the request of Egypt, Turkey and South Africa, 13 which were concerned about particular problems of hashish

use in their populations. 14 Since that time, most countries have controlled and restricted the use of cannabis in the same manner as the use of opium and cocaine. The more recent United Nations Single Convention on Narcotic Drugs, which is discussed latter, still classifies cannabis as a

narcotic drug.

Extent of Use There is no agreement on the extent of cannabis use in Australia. For example, on 23 April 1976, The Canberra Times quoted police sources as having said that 90 per cent of secondary students in Canberra schools had experimented with cannabis. However, representatives of the Welfare

Branch of the Department of the Capital Territory, in evidence to the Committee, were quite adamant that their experience and specific inquiries showed that this was not so. 15 We believe that neither of these sources of information would deliberately distort the extent of cannabis use. The fact is that there is genuine confusion.

A number of studies have been done in Australia to monitor drug use . However, the cautions on interpretation given in Chapter 7 must be once again briefly repeated. Firstly, many of the studies are not com­ parable, because the questions asked were different. Secondly, such studies

129

have concentrated almost exclusively on what have been considered to be the 'at-risk' groups. While these studies are most useful, they tell us little of drug use in the general population or of any processes of social change which may be taking place.

In 1971, a random sampling of first and second year students at the University of Sydney, with a response rate of 65 per cent, showed that 17.9 per cent of respondents had used cannabis at least once. The survey also revealed that the frequency of use was lower than had generally been expected 16 (see Appendix 6).

In 1971 , a random survey of 639 persons between the ages of 14 and 65 in a northern beachside suburb of Sydney showed that 8.9 per cent of the sample had tried marihuana and of these slightly more than half claimed to have given up using itY As Table 5.1 shows, over half of those who did smoke it did so less frequently than once a month.

Table 5.1 Amount and frequency of marihuana use among 25 users in a random sample survey

Occasionally Occasionally Less than during during once per

Amount week month month Total

Less than 1 joint 0 1 5 6

1 to 2 joints 3 2 6 11

3 to 5 joints 3 3 1 7

6 + joints 0 0 J 1

Total 6 6 13 25

Source: Anne George, 'Survey of Drug Use in a Sydney Suburb', in Th e M edical Journal of Australia, 29 July 1972, p. 236.

In 1973, in a random sample of 1011 persons between the ages of 14 and 65 in a Sydney western suburb, Anne George found that 5.5 per cent of the total sample had used marihuana. 1 8 In 1971-73, the Health Com­ mission of New South Wales conducted annual surveys of selected groups. These groups were divided into two categories: the 'sensitive group', including fourth and sixth form high school students, technical college students and trainee nurses; and the 'risk group', including prisoners, probationers and delinquent youths. The high school samples for these surveys were 5211 students-3369 from fourth form and 1842 from sixth form, with median ages of 15.7 years and 17.6 years respectively.1 9 Table 5.2 shows the incidence of marihuana usage among these students.

130

Table 5.2 Current marihuana use in New South Wales high schools, 1971-73

Form 4 Form 6

1971

per cent 6.5 7.0

1972

per cent 8.7 10.9

1973

per cent 9.8 13.5

Source: D. S. Bell, R. A. Champion and A. J. E. Rowe (Health Commission of New South Wales), Monitoring Drug Use in New South Wales, p. 38.

Not only did the total number of marihuana users increase between 1971 and 1973, but in 1973 3.5 per cent claimed they used it every week as against 1.8 per cent in 1971. Table 5.3 gives the frequencies in 1973.

Table 5.3 Frequency of marihuana use in New South Wales high schools, 1973

Less

Never Given than

used up monthly Monthly Weekly

per cent per cent per cent per cent per cent

Form4 85.2 4.9 3.3 3.1 2.6

Form 6 80.8 5.8 5.1 4.8 3.0

Most days

per cent 1.0 0.5

Source: D. S. Bell, R. A. Champion and A. J. E. Rowe (Health Commission of New South Wales), Monitoring Drug Use in New South Wales, p. 39.

As can be seen from Table 5.4, technical college students (median age 19.9 years), nurses (median age 19.3 years) and three selected risk groups had a higher incidence and frequency of use than did school students.

Table 5.4 A. Current marihuana users-Technical college students, nurses and risk groups, 1971-73

1971 1972

per cent per cent

Technical College-Trade 19.5 26.1

Day matriculation . n.a. 29.7

Art school n.a. 41.5

Nurses-General n.a. 9.6

Psychiatric n.a. 33.6

Risk Groups-Prison . 16.6 28.0

Probation n.a. 27 .7

Delinquent youth n.a. 31.9

n.a. = Not available.

1973

per cent(a)

28 .8 33 . 3 48.0

ll.5 34.6

36 .2 31.4 34 .6

131

B. Frequency of marihuana use-Technical college students, nurses and risk groups, 1973

Less

Never Given than

used up monthly Monthly Weekly

per cent per cent per cent per cent per cent (a) (a) (a)

Technical College-Trade 60.6 10.8 7.1 7.4 11.3

Day matriculation 54.7 11.9 12.2 10.3 9.5

Art school 36.2 15.8 19.9 13.4 11.2

Nurses-General 77.1 11.2 4.4 3.0 3.9

Psychiatric 54.9 11.7 8.1 9.8 11.2

Risk Groups-Prison 49.7 14.6 5.2 5.2 10.5

Probation. 54.9 13.7 7.2 6.5 10.4

Delinquent youth 50.2 13.0 6.0 5.5 15.5

Most days

per cent (a)

2.7 1.3 3.5

0.2 5.3

14.6 7.2 7.8

(a) Addition of dissected figures in B does not correspond exactly with total for 1973 in A because of rounding to first decimal place in dissected figures. Source: D. S. Bell, R. A. Champion and A. J. E. Rowe (Health Commission of New South Wales), Monitoring Drug Use in New South Wales, pp. 68, 70, 80, 82, 98 and 99.

In 1973, a survey of drug use among 4000 youths, in the age range from final-year secondary to third-year tertiary, was carried out in Melbourne. The response rate varied greatly, being 98 per cent for the secondary school sample, about 60 per cent for the university sample, 84 per cent for the students of colleges of advanced education and 24.5 per cent for the school leavers. The authors claimed that this did not create a bias. 20 As can be seen from Table 5. 5, 11 per cent of the secondary students,

16 per cent of the working youths and 23 per cent of the tertiary group had used marihuana at least once.

Table 5.5 Use of marihuana by Melbourne youth survey participants, 1973

Once 3-4 5-19 20-49 50+

Non- or oc- oc- oc- oc- Not

user twice casions casions cas ions cas ions known

per per per per per per per

cent cent cent cent cent cent cent

Secondary 88.8 4.5 2.3 2.7 0.8 0.8 0.1

Tertiary 76.8 5.9 3.6 6.6 2.7 4.2 0.2

Working youth 83.9 3.9 2.3 3.3 2.3 3.9 0.4

Total 83.6 5.0 2.8 4.3 1.7 2.4 0.2

Source: J. Krupinski and A. Stoller (edd.), 'Drug Use by the Young Population of Melbourne', in Mental Health Authority, Victoria, Special Publications No.4 (Melbourne, 1973), p. 27.

A corresponding survey in Ballarat in 1974 gave remarkably similar results. 21

132

Of 3362 Queensland school students in grades 6 to 12 who were surveyed in 1974, 4.7 per cent claimed to have used cannabis at some stage. 22 Table 5.6 shows the incidence of male and female usage and the differing incidence of usage among students in the various forms.

Table 5.6 Use of cannabis in Queensland schools, 1974 ·

Grade

Weight-

Ever used 6 7 8 9 10 11 12 ed total

per per per per per per per per

cent cent cent cent cent cent cent cent

Males-Yes 3.6 3.3 3.0 3.3 9.1 12.4 15.7 5.8

No 96.4 96.7 97.0 96.7 90.0 87.6 84.3 94.2

Sample size 253 243 230 210 274 210 262 1682

per per per per per per per per

cent cent cent cent cent cent cent cent

Females-Yes 0.8 1.0 2.3 4.2 1.8 9.7 19.4 3.6

No 99.2 99.0 97.7 95.8 98.2 90.3 80.6 96.4

Sample size 241 209 263 287 170 215 217 1 602

per per per per per per per per

cent cent cent cent cent cent cent cent

Total-Yes 2.2 2.2 2.6 3.8 6.3 11.0 17.6 4.7

No 97.8 97.8 97.4 96.2 93.7 89.0 82.4 95.3

Sample size(a) • 496 453 493 497 445 426 478 3 288

(a) In some instances, total may not correspond to sum of dissected numbers due to round- ing in calculating weighted figures. Source: Terence J. Turner and Lyndall McClure, Alcohol and Drug Use by Queensland School Children (Report No. 1) (Department of Education, Brisbane, July 1975), p. 65.

The survey, however, produced only limited information about fre-quency of use, because it did not distinguish the school grades of users (see Table 5.7). 23

Table 5.7 Current frequency of cannabis use in Queensland schools, 1974

Current frequency

About About About

Once a 3 or 4 once or 2 or 3 Once a

day ;or times a twice times a month Sample

more week a week month or less size

per cent per cent per cent per cent per cent

Weighted total percentage 8.2 12.5 11.9 16.6 50.8 133

Source: Terence J. Turner and Lyndall McClure, Alcohol and Drug Use by Queensland School Children (Report No. 1) (Department of Education, Brisbane, July 1975), p. 68.

133

Law Enforcement as an Indication of the Extent of Use

Conclusions on the Extent of Use

In 1975, throughout Australia, 7770 detected offenders were involved only in cannabis use and a further 505 in the use of cannabis and other drugs. 24 Of all persons arrested for all drug offences, the overwhelming proportion are under 30 years of age (see Figure 5.1 and Appendix 7).

The Australian Narcotics Bureau seized increasing amounts of cannabis and cannabis extracts from 1972 to 1976, as shown in Table 5.8.

Table 5.8 Seizures by Australian Narcotics Bureau, 1972-76

Cannabis oil (grams) Cannabis (grams)

1972 1973

6193

533 846 1 101 406

Source: 1972-75 figures from Evidence, p. 1057.

1974

4 809 342 405

1975 1976

32 859 45 083

885 476 1 226 922

1976 figures from the Australian Narcotics Bureau, personal communication.

In 1975, State police also seized substantial amounts of cannabis and cannabis derivatives. 25 Law enforcement figures do not reflect the extent of use. Police witnesses were convinced that enforcement was not detecting the vast majority of users or instances of use. In fact, one police officer estimated a detection rate of only 5 per cent. 26 This will be discussed in more detail later in the chapter.

This brief examination of statistical material, while not all inclusive, is fully representative of the material available; studies not mentioned have not been ignored. The overall picture of just how many Australians use cannabis, and who they are, is by no means clear. Firstly, it must be remembered that the available studies are up to five years old, and the use of cannabis obviously is escalating. The study by Bell, Champion and Rowe in New South Wales is one of the most up to date and compre­ hensive. However, like many others, it is a study of 'at risk' groups. 27

As a result of differing survey designs, results cannot be compared. Conclusions about the overall population's use of cannabis are difficult. George's 1971 and 1973 studies of drug use in two Sydney suburbs, by populations over 14 years of age, showed that in the northern suburb 8.9 per cent of the sample had used cannabis and in the western suburb 5.5 per cent had used it. 28 S. L. M. Hasleton told the Committee:

Research into the levels of use of cannabis suggests that the drug may have been tried on one or more occasions by about 25 per cent of twenty-year-old adults, and that about 10 per cent of the eighteen to thirty-five-year-old group use the drug once a month or more often, about 3 per cent ten or more times per month, and slightly less than 1 per cent use it 100 times a month or more

often.29 The Health Commission of New South Wales submitted that the suburbs George surveyed were in high-use areas. 30 In the context of all the surveys quoted, Hasleton's figures seem a reasonable estimate. They suggest that, given the age distribution of the Australian population, as many as 400 000 Australians, or about 3 per cent of the total population, use

134

Who Uses Cannabis?

24819/77--10

cannabis at least once a month. This compares with an estimated 4 per cent of intermittent and regular users in the United States as identified by the National Commission on Marihuana and Drug Abuse (Shafer Commission), in 1972. at

Those users coming to the attention of the police are overwhelmingly the young. For example, in South Australia, 519 persons were arrested or reported for cannabis offences in 1974-75; of these, only twenty were over 30 years of age. 32 In the Australian Capital Territory, all thirty-nine

persons charged with cannabis offences in 1976 were under 27. 33 Figure 5.1 illustrates the age distribution for all drug offenders in Australia, 86.3 per cent of whom were involved only with cannabis. Even if the residual 13.7 per cent were not taken into account in plotting

the curve, the basic shape would not be radically altered.

Figure 5.1 Distribution of detected drug offenders (all drug offences), by age, 1975

(lOOs)

14

12

10

4

2

15

(&under)

20 25 30

Age in years

35

(&under)

Source: Commonwealth Police, Drug Abuse in Australia-A Statistical Survey (Technical Report No. 8) (Canberra, November 1976), p. llA.

135

There has been a steady reduction in charges against offenders over 25 years of age. Whether people 25 and over are using drugs less or whether police are concentrating on areas where persons aged less than 25 years are more likely to be detected is hard to say. One solicitor was quoted in The Age newspaper on 10 April 1976 as having said:

It's the born losers, the kids in jeans in the street who get busted . Police rarely stop and search the Mercedes or the Volvos. But their drivers are trying it too. The young are much more visible and much less sophisticated in keeping their use 'private', and have become the true drug stereotype. George's random population survey of a sample of 639 in a northern Sydney suburb in 1971 revealed no users over thirty.34 That study is now far behind recent developments. Survey responses present difficulties

because some younger respondents claim they are using cannabis when they are not; others, especially those in the older age groups, find it difficult to admit that they have broken the law, even if confidentiality is preserved. Young people certainly use cannabis more than others do, but continual surveys of only the under-25 age group, while instructive, give an incomplete picture. They fail to identify either the behaviour of those who no longer belong to this age group or any new behaviour which may develop in older age groups. Comprehensive surveys of all age groups are essential.

All studies made before 1973 which were examined by the Committee consistently reported that males used cannabis significantly more than females did. The difference was quite large in some cases. George, in her study of a western Sydney suburb, found that 8.7 per cent of males were users compared with 2.7 per cent of females. Hasleton and George, in earlier studies, also found differences of the same order. 35 Bell, Champion and Rowe did not separate usage by each sex. 36 However, two of the latest studies show what could be an emerging trend. R. P. Irwin found that the proportion of females aged 18 years or younger using marihuana was rising to approach that of males. Females were in fact increasing their usage as they progressed in school. 3 7

The Turner and McClure survey in Queensland gave further evidence of this emerging trend, though not as consistently through all forms. As can be seen from Table 5.9, female usage in Queensland surpassed male usage in form 6, but overall the survey compared fairly consistently with Irwin's study in Canberra.

136

Table 5.9 Comparison of marihuana users in high schools in Canberra and Queensland

Boys Girls

Form Queensland Canberra Queensland Canberra

per cent per cent per cent per cent

1 2.0 0 . 5 0 . 0 0.5

2 2.6 2.1 0.8 0.7

3 2.8 4 . 2 1.7 4.9

4 5.8 7.4 1.2 6.4

5 7.7 7.9 6.0 9.9

6 10.3 10.9 12.5 8 . 8

So urce: R. P. Irwin, Drug Education Programs and th e Adolescent in the Drug Ph enomena Problem (Canberra, 1976), p. I .40.

The sex ratio for detected offences has not matched the social trend. It appears that female cannabis users are not being detected as readily as males. In 1975, 86.4 per cent of all detected offenders in Australia were males. The sex ratios for 1971 to 1975 are shown in Table 5.10.

Table 5.10 Ratio of males to females among detected offenders

1971 1972 1973 1974 1975

4.68 : 1

5 . 84 : 1

5. 99 : I

6 . 59 : 1

6.35 : 1

Source: Commonwealth Police, Drug Abuse in Australia­ A Statistical Survey (Technical Report No. 8) (Canberra, November 1976), p. 13 .

We can conclude that the sex ratio of detected offenders does not reflect the sex ratio of users, among whom males predominate by two or three to one. There are few hard data on the geographic incidence of drug abuse within Australian communities. The impressions of experienced officers of the Health Commission of New South Wales as to what were high-use areas in Sydney38 were not reflected in figures relating to detected offences which have been released by the New South Wales Bureau of Crime Statistics and Research. 39

About two-thirds of the Australian population lives in the capital cities. But crime statistics show that the rural population is not under-represented to a significant extent (see Table 5.11). It appears that the law enforce­ ment agencies are finding as high a proportion of illegal drug users in the country as in the capital cities.

Table 5.11 also shows significant variation between the percentage of detected offenders in certain States and the percentage of population in those States. As yet, there is no evidence that percentage differences in arrest rates are reflected in usage rates.

137

Table 5.11 Home address origins claimed by detected drug offenders, 1975

Offenders in State's

State as a proportion

Capital proportion of of national

State or Territory city Other national total population

per cent per cent

New South Wales 3 286 1 555 53.47 35.5

Victoria 890 297 13.18 27.2

Queensland 635 665 14.43 14.8

South Australia 450 82 5.90 9.1

Northern Territory 127 72 2.20 0.64

Tasmania 75 17 1.02 3.0

Australian Capital Territory 126 126 1.40 1.4

Western Australia . 532 199 8.11 8.3

Total . 6116 2 887 100 .00 (a)100.00

(b)(67. 90 (32.05

per cent) per cent)'

Unknown Postcode 5 (0.05

per cent)

(a) Discrepancy due to rounding of decimal figures. (b) Proportion of Australian population in capital cities, 64.4 per cent. Source: Commonwealth Police, Drug Abuse in Australia-A Statistical Survey (Technical Report No. 8) (Canberra, November 1976), p. 17.

State population percentages from the Australian Bureau of Statistics.

The only data on social status of users relate to detected offenders and are therefore liable to be selective. Table 5.12 shows percentages of offenders by occupational groups. One should interpret the data cautiously because of the large numbers in the 'Not adequately described/ unemployed' category.

138

Table 5.12 Australian drug offenders (all drugs) in selected occupational classifications

Number in classification

Classification 1974 1975

Professional, etc .. 320 533

Administrative

:} 61 } Clerical 338 501 Sales. 299 Farmers/fishermen, etc. 200"') Miners

Expressed as a proportion of total population in class{{ication

1974 1975

per cent per cent

0 .05 0.078

0.03

0 .017 0 .051 0 .061 0.048

0.10 Not known

Transport and communications

J 2 753 324 18 J 0 .095 Craftsmen/labourers 3 788 0 .199 Service/sport, etc. 333 524 0 .07 0.097 Armed Services 50 136 0 .08 0.197 Students (full-time secondary and tertiary) 338 489 0.09 0 .037 Housewives/pensioners 63 Not known Not adequately described/unemployed 1 595 2 072 0.63 0.055 Source: Commonwealth Police, Drug Abuse in Australia-A Statistical Survey (Technical Report No. 8) (Canberra, November 1976), p. 15. The 'Craftsmen/labourers' and 'Armed Services' groups had the highest proportions of offenders in 1975. The percentage of offenders in the 'Students' category declined in 1975. The New South Wales Bureau of Crime Statistics and Research has found that unskilled workers are consistently over-represented in drug convictions. However, it should be acknowledged that many defendants may misstate their occupational status, particularly downwards, to avoid any repercussions from charges brought against them. Table 5.13 Occupational status of drug offenders, New South Wales General Drug offenders Sydney population Status 1975 1974 1973 1972 1971 1973-74 No. per cent per cent per cent per cent per cent per cent Professional/managerial 9 0.3 0.1 0.7 0.3 0.7 3.8 Semi-professional/middle management 95 3.3 4.2 4.5 4.2 4.8 19 .2 Sales, small business, clerical. skilled trades 1 441 50.4 49 .6 50.3 44 .3 44 .3 56.6 Unskilled 1 311 46.0 46.1 44.5 51.2 50.1 20.4 Total 2 356 100.0 100.0 100.0 100.0 100 .0 100 .0 Source : New South Wales Bureau of Crime Statistics and Research, Court Statistics 1975 (Statistical Report 7, Series 2), p. 48. The foregoing rudimentary information seems to be all that is available to show who uses cannabis. Surveys continue to concentrate on the young and what may be termed risk groups. The Committee received very little 139

useful information concerning socio-economic groups. All we know is that users are predominantly young, though, as was pointed out before, there has been no concerted attempt to discover an age correlation for the whole population. It seems that offenders belong predominantly to lower socio-economic groups, but these groups are always over-represented in crime statistics.

Attitudes The community is polarised over the use of cannabis. The reasons for which side is taken in the controversy sometimes appear to have little to do with the merits of a particular case. Some people's beliefs as to the propriety of use or non-use depend on factors which have little to do with the nature and effects of use of the drug. In April and May 1973, Hasleton and D. Simmonds commissioned ANOP Market Research Pty Ltd to conduct a survey in all States, but not in the Northern Territory or the Australian Capital Territory. On a stratified random probability system, ANOP took a sample of the whole electorate in which 1886 persons were interviewed. Hasleton and Simmonds concluded:

... marihuana is a 'political' issue, in that attitudes toward the use of this substance are a function of age, education, urban residence, church attendance and voting intention. 40 However, it was noted that some minority opposition to the present legal proscription of marihuana was found within all groups surveyed. 41 In surveys conducted in 1969 and 1970, as in that of 1973, a question about the legalisation of marihuana was asked. Each year the proportion of responses in favour of legalisation rose, from 7.4 per cent in 1969 to 9 per cent in 1970 and 17 . 3 per cent in 1973, when 78.4 per cent were not in favour and 4. 3 per cent were unsure. 42 Bell, Champion and Rowe, in their school surveys, found . approximately the same level of support for the free availability of marihuana-14.9 per cent of the sample in form 4 and 23.2 per cent in form 6. They also found that 19.4 per cent of the sample in form 4 and 30. 9 per cent in form 6 saw marihuana as either 'good' or 'not dangerous'. 43

From all these surveys, it can be seen that opinions in favour of legal­ isation and opinions of marihuana as being good or not dangerous were being increasingly held. This trend was evident also in the surveys by Bell, Champion and Rowe, for technical college students and nurses, though not quite as consistently in this last group. 44

The Committee is concerned at the lack of consistency in the attitude of the Australian community to different drugs (see also Chapter 1). One submission quoted a social worker's experience: At one home, parents experienced such anguish as a result of their nineteen­

year-old daughter's use of 'pot' that when their younger daughter started drinking heavily they were deeply relieved! 'She'd get so drunk', a social worker explained, 'she would be throwing up in the morning. Yet her parents were happy. ' 45

The Committee believes that the use of cannabis to excess has deleter­ ious effects. However, making unreasonable comparisons between cannabis

140

Extremist Literature on Cannabis

and other drugs, or giving cannabis an unreal image, can damage the whole case for control.

In recent years there has been a vast increase in the amount of literature on this subject produced for commercial sale throughout Australia. Numerous books have appeared in paperback and other inexpensive forms, ranging all the way from Penguin reprints of the report of the Commission of Inquiry Into the Non-Medical Use of Drugs (the Le Dain report), in Canada, and of the standard book The Marzhuana Papers edited by D. Solomon, to novels and ·plays about the effects of the drug.

Many of these books have been of high quality and have substantially advanced the public debate on the cannabis issue; indeed, a number have been used and quoted from by the Committee.

But side by side with this material there has grown up a whole corpus of literature which extols and promotes the use of cannabis in a quite unscientific and polemic fashion. In the past, such material was available only from outlets which specialised in 'underground' literature of various kinds, but recently these publications have made their way onto the bookshelves of legitimate stores and newsagencies.

Books and pamphlets-most of them inexpensive and cheaply produced -now give 'recipes' for cooking and preparing food with cannabis (cookies, soups, salads etc.). Pamphlets tell how to prepare various illegal drugs with home chemical sets. Advice is given on the planting, cultivation, breeding, harvesting, drying and preparation of cannabis plants, both in the open and under conditions of artificial light. Special growing-boxes are described, along with methods for the production of 'non-recognisable' hybrids of the Indian hemp plant. Some of these pro-cannabis polemics extend to giving advice about concealment, legal matters and trafficking.

While most of these publications originate in the United States, there are two produced in Australia to which the Committee particularly directs attention.

All about Grass is published in Sydney and sells for under $2 in several bookshops and many newsagencies in Sydney, and presumably in other cities. Its chapter headings include 'The smoking of marijuana in this country is illegal-not wrong but illegal', 'How to get some dope',

'Dealing with the pusher', 'Growing your own' , 'Improving your stash' , 'Hiding it!' etc.

The second publication is a large tabloid newspaper of some 30 pages, produced in Melbourne and sold under the title The Australasian Seed­ All the Dope on Dope. It sells for under $1 in many outlets, and has recently been distributed by the publishers to students outside schools in Griffith, New South Wales. This paper not only advocates the use of cannabis, but also promotes a very 'soft' line on hard drugs such as

141

heroin and cocaine. It advertises for sale cannabis seeds and the paraphern­ alia associated with the smoking of marihuana. It also contains articles alleging police corruption and others describing the 'political' nature of the anti-drug campaign.

The Committee directs attention to the existence of such literature in order to indicate that there is a very substantial body of material, freely and cheaply available, which encourages and promotes the use of cannabis and, by implication, the breaking of the law as it stands at present. We are distressed that such material is made available through legitimate and otherwise responsible retail outlets, which apparently have some market for this kind of literature. The Committee believes that the manage­ ments of many of these outlets may not be aware of the exact nature of the publications, and places on record its view that such publications serve only to distort this most serious debate by their presentation of an unbalanced and often irrational view of the problems associated with cannabis abuse and with drug abuse in general.

There is available also literature which presents an opposite and equally unbalanced view of the problems associated with cannabis. One such leaflet produced by the Australian Festival of Light is entitled 'Marijuana: deadly assassin'. It cites only those studies which have reported marihuana use as physically and mentally degrading and quotes subjective, emotional statements by well known anti-cannabis activists. One example is a refer­ ence to a statement by Harry Anslinger, formerly Commissioner of the

United States Federal Bureau of Narcotics: Marijuana is only and always a scourge which undermines its victims and degrades them mentally, morally and physically ... a small dose taken by one subject may bring about intense intoxication, raving fits, criminal assaults ... the moral barricades are broken down and often debauchery and sexuality result. The drug has a corroding effect on the body and on the mind, weakening the entire physical system and often leading to insanity after prolonged use. 46

Even the United Nations Bulletin on Narcotics has published articles which could at best be classed as misinformation. For example, in April 1966 it published a story about the case of J. 0., who was said to have confessed that he had murdered a friend and put his body in a trunk 'while under the influence of marijuana'. However, in 1939, an article in the Journal of the American Medical Association had already clearly shown that the story was false. This article pointed out that an investiga­ tion by the 'probation department' had found that J. 0. was a psycho­ pathic liar. That investigation had also failed to find evidence that cannabis had been used by him. 4 7

The Committee is concerned because it appears that a person seeking information is more likely to encounter unbalanced misinformation than relevant knowledge conducive to responsible personal decision-making.

Health Controversy continues to rage over the possible deleterious health effects of cannabis. It has been variously described as lowering immunity, destroying chromosomes and brain cells, lowering testosterone levels,

142

destroying motivation and causing psychosis as well as numerous other physical and mental disabilities. Psychosocial effects of cannabis use have been documented in hundreds of scientific papers and in the reports of a number of official investigations. Full coverage of the claims made can be found in Marihuana and Health (Fifth and Sixth Annual Reports

to the United States Congress) presented in 1975 and 1976 by the Secretary for Health, Education, and Welfare; Ganja in Jamaica: A Medical Anthro­ pological Study of Chronic Marijuana Use, by V. Rubin and L. Comitas; and the bibliographies contained in these publications.

The conclusion of the Secretary for Health, Education, and Welfare provides the most useful guide in exploring the health implications of marihuana use:

Progress in the marihuana research program has made us aware that as our knowledge has increased so has our awareness of our need for more subtle understanding of marihuana use and its possible implications. 48

With the exception of some observations on intoxication, the Com­ mittee does not intend to state any major deliberative conclusions as to the effects of cannabis on health. As has already been pointed out, present evidence on the physical effects of cannabis is inconclusive. One difficulty occurs in relating observed phenomena to the occurrence of disease; for example, long tetrahydrocannabinol (THC) half-life in the body does not automatically correlate with a particular disease process. From a health

perspective, certain conclusions can be reached concerning cannabis use, no matter what ultimate conclusions are made concerning its physical effects.

One of the most striking facts concerning cannabis is that its acute toxicity is low compared with that of any other drugs. A recent experience of a man smuggling hashish oil in swallowed balloons, one of which burst in his stomach in transit, exemplified this: although disturbed in behaviour for some 48 hours, he was not seriously ill as a result. 49

One conclusion is that not all users of cannabis need treatment solely on account of their cannabis use, in the short term, and perhaps not even in the long term. The Committee was told that 'ordinary usage of mari­ huana seems to have absolutely no serious effects in terms of ill health'. so Cannabis has been in use for centuries and to date no physical ill effects due to its use have been manifest. However, adverse effects of tobacco did not emerge for several centuries after its use began. It seems a potent argument that, given the length of time that cannabis has been in use

and the number of studies of its health effects, nothing has manifested itself in the community as physical ill health directly attributable to cannabis use.

Of the several witnesses asked whether all cannabis users-as opposed to abusers-needed treatment, every one answered no. 51 Apart from effects on psychomotor skills such as driving, the Committee knows of no dangerous short-term physical effect from using the drug infrequently

and in small quantities.

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It is difficult to grade usage as small, moderate or high in a meaningful way. This is due partly to variation in the THC content of different preparations and partly to researchers' lack of agreement on the definition of terms. For these reasons, it is difficult or impossible to collate or compare much published information on cannabis. Obviously, this is an area which needs thorough scientific research .

Many observers have argued that cannabis causes or induces an 'amoti­ vational syndrome'. However, the quality of the research on which this claim depends has been marred by lack of adequate control groups, poor research design, and poor diagnostic criteria, associated with nutritional deficiencies and other life-style factors. In 1975, in Marihuana and Health (Fifth Annual Report to the United States Congress), the Secretary for Health, Education, and Welfare summed up the situation as follows:

.. . attempts to create experimental models for testing the existence of such an 'amotivational syndrome' have had serious limitations. Tasks chosen as tests may significantly depart from more realistic work tasks ; the artificia l environment of the research setting may not provide more typical motivational conditions. Two studies involving marihuana administration coupled with monetary reward for work performance did find a decline in productivity with heavier marihuana consumption. In one the task was simple and relatively undemanding, involving repetitive button pushing that could be carried on simultaneously with other activity. In the other, a more typical work task­

the making of wooden stools-was carried on. The distinction between a direct effect on performance as a result of marihuana and on performance as a result of a decline in motivation is not easily made, however. In a third, quite lim ited study of agricultural performance undertaken in connection with the Jamaican study of chronic users, researchers found some decline in work performance although the decline was not dramatic. 52

Following cannabis use, there is a short-term interference with normal function. This effect is temporary but nonetheless important. Referring to intoxication and its effects, the same report stated: Impaired memory, altered time sense and performance decrements on a variety

of tasks have been experimentally confirmed. Generally, the more complex the task, the greater the degree of disruption produced by acute intoxication. Tasks which are relatively simple and with which the person is familiar are minimally affected. As the task becomes more demanding and novel and/or the dose of drug increases, performance decrements become larger. At lo wer doses, evidence confirms users' assertions that they are often able to 'suppress the marihuana high' when the situations so demand. 53

The Committee accepts the reality of acute intoxication, reduced work performance and psychomotor impairment. Quite apart from the obvious relation to driving, cannabis probably represents a significant hazard in certain industrial situations.

The long-term effects of cannabis are more obscure. However, as noted earlier, no major health effects have manifested themselves in the community. This does not mean that there are no adverse health effects; nor is it suggested that cannabis should be used, or is safe to use. Constant use may well produce severe long-term effects analogous to the effects of tobacco smoking. Further, cannabis is often mixed with tobacco, and long-term cannabis users may suffer the same long-term effects as

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Cannabis and Driving

cigarette smokers. Studies of the effects of cannabis on pulmonary functions, using small samples of about 28 subjects and lasting for restricted periods of approximately two months, have shown that these functions though subject to variation, have remained within normal limits. 54 A vast range of psychopathological and neurological studies have failed to produce any conclusive evidence of sustained behavioural change due to cannabis use.

As to tolerance and dependence, the Fifth Annual Report cited earlier summarised the situation in the following manner : Tolerance to cannabis-diminished response to a given repeated drug dose­ has been substantiated by research evidence.

The meaning of cannabis dependence is often somewhat vague. If we define it as a physical dependency manifested by physical symptoms foll owing drug withdrawal, there is now evidence that it can occur. The symptoms that have been reported following discontinuance of high dose chronic administration of delta-9-THC include: Irritability, restlessness, decreased appetite, sleep disturbance, sweating, tremor, nausea, vomiting and diarrhea. It should be noted, however, that the after effects reported follo wed unusually high doses of orally administered THC under research ward conditions. Such changes have not commonly been observed in other studies nor has a 'withdrawal syndrome' typically been found among users here or abroad. 55 ·

The conclusion that can be drawn from available studies is that we do not know nearly enough about the health implications of cannabi s use. The development of scientific method and epidemiological research is recent and as yet there are no adequate observations of the effects of cannabis, even in those communities where it has been in use for several centuries. We need to know a great deal more about its use in Australian

society and about the effects on health. The tas k is urgent, given the increasing social acceptability and level of usage of cannabis. The Committee notes with concern that previously funded studies on cannabi s at the University of Sydney have not been funded in 1977.

Accordingly, we recommend: That the Commonwealth Minister for Health direct that appropriate studies of the health implications of cannabis use in Australia be made, in order to provide within five years a data base adequate for the intro­

duction of a national policy.

Cannabis has an adverse effect on driving skills. P. Bech and fi ve colleagues, in a joint study, demonstrated that an intake of 300 milligrams of tetra­ hydrocannabinol delayed braking time by about 20 per cent, and an intake of 500 milligrams by 66 per cent. In a comparative test, 70 grams of alcohol (equivalent to seven 10-oz glasses of beer) delayed brakin g time by 44

per cent. 5 6 Joint studies by F. T. Melges and others ,S 7 and by V. S. Ellingstad and others, 5 8 found that cannabis use distorted judgment of time. J. E. Manno and others, in a joint study, found a decrement in driving per­ formance after the administration of 5 milli grams of THC. 59 P. Kielh olz

145

and others, in a joint study, noted a marked decrement in driving skills five to six hours after intake, and some subjects reported a definite effect eight to ten hours after intake. 60 As with alcohol, deterioration in driving skill is thought to be propor­ tional to the amount of cannabis ingested. This conclusion is supported by M. A. Evans and six colleagues, who made a joint study which found 'a linear decrease in balance stability with increase in dose of THC'. 61 However, unlike the research effort on alcohol, there has been little research into the level of THC intake above which driving is hazardous. One reason for the lack of research is the difficulty of detecting THC in the body. The quantity of THC needed to produce a given effect is much smaller than the amount of alcohol required to produce a corresponding effect. Moreover, THC is rapidly transformed into metabolites which differ chemically from the originally consumed material. Further, THC is absorbed into fat and may persist in the body; thus the significance of tissue levels may be difficult to interpret.

However, in the last two years there has been progress in improving sample detection techniques. Radioimmunoassay (RIA) is a technique in which an antibody specific to a drug or its metabolites is developed and then 'tagged' by means of a radioactive molecule in its structure. The accuracy of RIA is now being compared with that of more cumbersome procedures.

A second technique under development is the enzyme multiplied immunoassay test, or EMIT. It has the added advantages of involving less work and less sophisticated equipment, and of being more rapid, making it more suitable for quick screening. Field trials on EMIT are under way. Two other methods which may be available shortly are likely to be useful for traffic safety purposes. They utilise breath and urine samples in a manner roughly analogous to present roadside detection of alcohol intoxication. The United States National Institute on Drug Abuse has produced a monograph which contains much technical information about all the methods discussed above. 62 However, there are serious caveats on the use of blood, urine and breath samples. 63

Increased general use of cannabis is likely to lead to more use in associa­ tion with driving, and to a resultant rise in the number of cannabis­ related crashes. At present, persons found driving after using cannabis are charged with driving under the influence. The evidence supporting this charge takes the form of a description of physical appearance and behaviour. There have already been reports of road crashes due to cannabis. One such crash was reported in The Lancet of 24 April 1976. 64 Further­ more, a study of drivers in the greater Boston area, which was conducted by the Boston University Accident Investigation Team, showed that 'marihuana smokers were over-represented in fatal highway accidents when compared to a control group of non-smokers of similar age and sex'. 66 It is likely that some crashes related to cannabis have occurred without the relationship to the drug being recognised. Therefore, it is desirable that effective methods of proving cannabis use, similar to those used to prove alcohol use, be adopted as soon as they are available.

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Governments must be encouraged to identify maximum permissible levels of cannabinol in tissue as a matter of urgency. While it might appear that any level could be grounds for conviction, the long half-life ofTHC in the body may require some modification of this view.

Introduction of effective new methods of detecting cannabis use would not only allow for the detection of drug-driving offenders but also provide valuable data on the part that cannabis is playing in motor crashes. However, formal mechanisms for appropriate inquiries are often non­ existent. As Dr Gerald Milner has written:

. . . the full effects of alcohol on driving competence were not evident from traffic police records before the development of objective measures of alcohol intoxication and their correlation with different levels of accident involvement risk and psychomotor impairment. 66

The Committee recommends:

1. That the proposed Sub-committee on Drugs and Driving within the National Standing Control Committee on Drugs of Dependence (outlined in Chapter 2}-(a) Study recent developments in cannabinoid detection in order

to advise on suitable equipment, procedures and standards for the road patrol sections of State and Territory police forces; (b) Monitor research on the effects of various levels of cannabinoid on driving performance so that correlations can be established

for purposes including the fixing of penalties for cannabis-driving convictions; and (c) In conjunction with the Australian Law Reform Commission, produce model legislation to identify offences resulting from

cannabis-driving and to set appropriate penalties. 2. That, as soon as possible, State and Territory legislation be amended to provide for the introduction and use of appropriate methods of detecting tetrahydrocannabinol in drivers and for the imposition of

appropriate penalties.

Until now, road safety education programs have concentrated on the dangers of alcohol in association with driving. Little mention has been made of the effects of other psychotropic substances. All such programs should include information about the effects of cannabis on driving.

However, because there are few data on what is a 'safe' level of THC in the blood, because all cannabis use is illegal and because at present there is no way that the potency of any form of cannabis can be estimated by the person using it, we believe that road safety programs should advise those who insist on breaking the law by using cannabis that driving should not be undertaken for at least 10 hours after the ingestion of cannabis.

The Committee recommends: That information on the effects of cannabis on driving be included in existing education programs on road safety.

147

International Conventions and Cannabis

Major

International Cannabis Studies

Australia is a signatory to two major United Nations Conventions on drugs-the 1961 Single Convention on Narcotic Drugs and the Convention on Psychotropic Substances, both of which have significant effects on drug policy. Australia has ratified the narcotics Convention and has moved toward ratification of the psychotropic substances Convention. The Committee believes that these Conventions provide the basis for effective international co-operation. However, the way in which they deal with cannabis requires special attention.

Narcotics are selective depressants of the central nervous system. They relieve pain and produce drowsiness, euphoria and respiratory depression. The principal opiate narcotics are heroin, morphine, codeine and opium. These and some other drugs are derived from the opium poppy. Methadone and pethidine are two synthetic substances with actions similar to those of the opiates. 6 7 Cannabis is not a narcotic and is not addictive in the same way as are narcotic drugs. The social effects of cannabis use may be similar in some instances to those produced by the use of narcotics, and may include social entree to a wider range of illicit drugs, but the health effects are not analogous.

The Senate Select Committee on Drug Trafficking and Drug Abuse recommended that: the Australian Government should initiate action for the transfer of cannabis and its derivatives from Schedule 1 of the 1961 Single Convention on Narcotic

Drugs to an appropriate schedule in the Convention on Psychotropic Sub­ stances. 68 We feel that the understanding and control of drug abuse are ill served by the listing of cannabis with narcotics, and we express our concern at the absence of any Australian initiative to implement the recommend­ ation made six years ago.

Though the processes involved may be tedious and time consuming, the Committee recommends:

That, as a matter of urgency, action be initiated to have cannabis moved to an appropriate schedule in the United Nations Convention on Psychotropic Substances.

For almost a century, scientists and expert commissions in various parts of the world have been studying the cannabis problem with a view to making recommendations to governments about appropriate responses and changes which might be made in the law. The major studies are described below.

Indian Hemp Drugs Commission Report 1894 The scope of this study is impressive and has led one author recently to refer to it as 'the most complete and systematic study of marijuana under­ taken to date'. 6 9 The Commission concluded:

In regard to the physical effects, . . . the moderate use of hemp drugs is practically attended by no evil results at all ... In respect to the alleged mental effects of the drugs, ... the moderate use of hemp drugs produces no injurious effects on the mind .. .

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... for all practical purposes it may be laid down that there is little or no connection between the use of hemp drugs and crime. 7o

Panama Canal Zone Military Investigations

These were conducted between 1916 and 1929 by military authorities among American servicemen in the Canal Zone. In 1925, the authorities reported:

There is no evidence that marihuana as grown here is a 'habit-forming' drug in the sense in which the term is applied to alcohol, opium, cocaine, etc. , or that it has any appreciably deleterious influence on the individual using it. 71

LaGuardia Committee Report 1944

An expert committee appointed by the New York Academy of Medicine at the request of Mayor LaGuardia studied the marihuana problem in the City of New York, taking the investigation right into the 'tea-pads' and other marihuana centres of the city. 72 Among other things, the Committee reported:

The practice of smoking marihuana does not lead to addiction in the medical sense of the word.

The use of marihuana does not lead to morphine or heroin or cocaine addiction ...

Marihuana is not the determining factor in the commission of major crimes.

The publicity concerning the catastrophic effects of marihuana smoking in New York City is unfounded. 73

Wootton Report 1968

In 1967, the United Kingdom Advisory Committee on Drug Dependence appointed a Hallucinogens Sub-Committee, with membership including several of Britain's most eminent drug authorities, under the chairmanship of Baroness Wootton. Among the Sub-Committee's conclusions were

the following: ... the long-term consumption of cannabis in moderate doses has no harmful effects. 74

It is the personality of the user, rather than the properties of the drug, that is likely to cause progression to other drugs.

The evidence of a link with violent crime is far stronger with alcohol than with the smoking of cannabis. 75

Le Dain Report 1972

In May 1969, the Canadian Government appointed a Commission of . Inquiry Into the Non-Medical Use of Drugs, with Mr Gerald Le Dain as Chairman. This Commission presented an interim report in April 1970 and issued a supplementary separate report on cannabis in 1972.

149

The Le Dain Commission destroyed many popular myths about cannabis. In the interim report, it stated: In Canada ... it appears that heavy use of sedatives (alcohol and barbiturates) rather than cannabis has most frequently preceded heroin use. 76 The Commission also indicated that legalisation of the use of cannabis in leaf form would not be impossible despite Canada's having signed the Single Convention on Narcotic Drugs. 7 7 In the long run, the Le Dain Commission recommended repeal of the prohibition against simple possession of cannabis, 7 8 stating that 'research has not clearly established that cannabis has sufficiently harmful effects to justify the present legis­ lative policy towards it'. 7 9

Shafer Report 1972

Another American investigation was carried out by the National Com­ mission on Marihuana and Drug Abuse, under the chairmanship of Raymond P. Shafer, a former Governor of Pennsylvania. Presented in 1972, this report endorsed the findings of the other major studies cited, specifically rejected the stepping-stone theory of progression to other drugs, 80 and recommended decriminalisation of the personal use of marihuana in private and the possession of small amounts of marihuana. 81 Above all, however, the Shafer report rejected the allegation that mari­ huana posed a major threat to the continued existence and stability of American society. 82

United Nations Reports 1973-74

Various organs of the League of Nations and the UN, in particular the World Health Organisation (WHO), had taken a strong line against marihuana for a number of years, as can be seen from the history of conferences preceding the adoption of the Single Convention in 1961. 83 A WHO report of 1961 described cannabis abuse as 'very likely to be a forerunner of addiction' to other drugs and stated that such abuse was 'a form of drug addiction'. 84 Following a resolution of the General Assembly of Interpol, the UN Division of Narcotic Drugs, in October

1974, prepared an article on cannabis. After reviewing the scientific literature on cannabis, the Division declared: It should nevertheless be recalled that the World Health Organization Expert Committee on Drug Dependence, at its sixteenth session, strongly

reaffirmed the opinions expressed in its previous reports that cannabis is a drug of dependence, producing public health and social problems, and that its control must be maintained. 85

Eastland Sub-committee 1974

In October 1974, a United States Senate sub-committee under the. chair­ manship of James 0. Eastland produced a report entitled The Marihuana­ Hashish Epidemic and Its Impact on U.S. Security. Senator Eastland stated:

The epidemic began at Berkeley University at the time of the famous 1965 'Berkeley Uprising'. 86

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24819/77-11

He added that marihuana use was encouraged 'not only by the entire underground press and by certain New Left organizations, but also by a number of prominent academicians, headed by the infamous Dr Timothy Leary'. 8 7 Eastland presented findings to indicate that cannabis was a massive danger to the entire cellular process, caused severe brain damage and atrophy, affected both the reproductive system and the genetic processes, caused various respiratory complaints, induced 'pathological forms of thinking resembling paranoia' and produced the amotivational

syndrome. He warned:

If the cannabis epidemic continues to spread at the rate of the post-Berkeley period, we may find ourselves saddled with a large population of semi­ zombies. 88

The Jamaican Study 1975

Ganja in Jamaica presents the findings of a major investigation financed by the United States Institute of Mental Health, which dealt with cannabis (ganja) in Jamaica, where its use has developed extensively over the last 100 years and is now widespread throughout the working classes. 89

This report was released in 1975. It was estimated that 60 per cent to 70 per cent of the lower section of the rural population were regular users of ganja, which is smoked, brewed as medicine or tea, cooked in food or applied externally as a liniment. 90 The report concluded that

there was no evidence to confirm any of the allegations about the dele­ terious effects of the drug. 91 It also indicated that ganja was often used in place of alcohol, being regarded as a more 'sociable' and 'peaceful' drug, thus reducing the alcohol problem in Jamaica by comparison with

other West Indian nations. 92

The Greek Study Another study sponsored by the United States Government was conducted in Greece. The report was completed in 1975. Forty-seven males who used cannabis were matched with 40 non-users, although matching was

not as careful as in the Jamaican study. A variety of neurological, psycho­ logical and physical examinations found few changes caused by cannabis, and there was no evidence of brain damage. 93 Psychopathological con­ ditions, particularly anti-social personality disorders, were significantly

higher in heavy users of cannabis. But it was not possible to determine whether these disorders predisposed the subject to heavy use of cannabis or were caused by such use. 94

The Costa Rican Study A third study, the report on which was completed in 1975, and which was sponsored by the United States Government, was conducted in Costa Rica. Forty males who used cannabis were carefully matched with 40 non-users, for variables such as age, marital status, education, tobacco

smoking and alcohol use. Extensive medical examinations, with special attention to pulmonary and neuropsychological functioning, found no evidence to suggest greater incidence of disease or of psychological

151

Major Australian Cannabis Studies

deterioration in the experimental group. There was no evidence of in­ creased psychopathology or of any amotivational syndrome stemming from the use of cannabis. 95

Egyptian Studies

The National Centre for Social and Criminological Research in Cairo has conducted a series of studies of cannabis use since I957. One study examined the psychosocial differences between 204 users of cannabis and I 15 controls in the city of Cairo and also between forty-nine users and forty controls in semi-urban and rural parts of Egypt. A self­ reporting method was used to elicit the required information. The results revealed that the users had less favourable family backgrounds and were more anxious than the controls. The experimental group reported psychological and psychomotor changes when they were under the influence of cannabis or when they felt deprived of it. 96

A later study in the same series found that the scores on most of the administered psychological and psychomotor tests were significantly lower for the 850 subjects in the experimental group than for the 839 controls. Comparison of heavy users with moderate users revealed that heavy users had a greater dependence on cannabis and were more likely to use opium, alcohol and coffee. There was a positive correlation between duration of cannabis use and opium taking. Cannabis users had a signifi­ cantly lower record of criminal offences, other than those relating to the use and/or sale of narcotics. 97

To date, two major parliamentary reports and one major report prepared by a State Health Commission have dealt with cannabis. These are summarised below.

Senate Select Committee Report 1971

The present Committee has referred on several occasions to the work and recommendations of the Senate Select Committee on Drug Trafficking and Drug Abuse. Apart from restating our concern that its recommendation for the transfer of cannabis from Schedule I of the Single Convention on Narcotic Drugs to an appropriate schedule in the Convention on Psychotropic Substances has not yet been acted on, we wish at this point only to endorse its views concerning the need for greater research into cannabis and a more appropriate response to the problems of young offenders. 98

Health Commission of New South Wales Report 1973

In 1973, the Division of Health Education within the Commission pub­ lished a handbook entitled The Use and Abuse of Drugs. Like most other reports on the subject, this report indicated no evidence of deaths directly related to cannabis smoking or eating-as distinct from indirectly related accidents etc.; no evidence of adverse effects on human chromosomes causing deformities in children; little relationship between cannabis use

152

Cannabis and the Law

and crime; and no evidence of physical dependence on cannabis. The Commission found that a causal connection between cannabis use and amotivational personality changes had still to be proved. It also detected no evidence that marihuana use led to the use of 'stronger' drugs, though an association with social groups and sub-cultures involved with more dangerous drugs might be facilitated. 9 9

New South Wales Joint Parliamentary Committee 1977 The New South Wales Joint Committee of the Legislative Council and Legislative Assembly upon Drugs presented a Memorandum on its work in March 1977, though further investigations were still under way. The Joint Committee commented:

Evidence available to the Committee suggests that Cannabis taken in moderate doses may not cause physical damage to the user nor develop a physical dependence. However, continued or long-term use of Cannabis may develop psychological dependence.! oo By a majority vote, with three of the nine members dissenting and one

absent, the Committee recommended that 'offences for the personal use of Cannabis be no longer considered criminal offences'. 101

Cannabis use, possession and trafficking currently can attract severe penalties under the law in every State and Territory of Australia. In 1975, 13 487 persons were prosecuted for all drug offences in Australia 102-some 85 per cent of these for offences relating to cannabis. 1 03 About 1 per cent of charges were not proceeded with or were dismissed. 1 04 In South Australia in

1975, 6 per cent of detected cannabis offenders were gaoled and a further 12 per cent were given suspended sentences. 105 In New South Wales in 1975, 7 per cent of detected cannabis offenders were either imprisoned or sent to an institution106-about 2.6 per cent for trafficking and about 4.3 per cent for using cannabis. 107 In New South Wales, apparently, gaol terms have been almost abandoned as a deterrent to cannabis use, accord­ ing to that State's Chief Stipendiary Magistrate, as reported in The

Sydney Morning Herald of 14 December 1976. Altogether, throughout Australia in 1975, there were 256 gaol sentences for unlawful possession, use, importation and trafficking, and fines totalling $627 594 for offences related to all drugs. 108

It is important that the law be evaluated against stated and implied objectives, although the law itself never explicitly states its objectives. Stated and implied objectives, as distilled by the Committee from the views presented to it, are summarised below.

Stated objectives of the law might be: 1. To stop the use of cannabis. 2. To detect and punish cannabis users. 3. To detect and punish cannabis traffickers/producers.

4. To deter people from using cannabis. 5. To deter traffickers/producers. 6. To protect the individual from harming himself. 7. To protect people from recruitment to cannabis use.

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Evaluation of Stated Objectives of the Law

Implied objectives of the law might be: 1. To deter people from moving on to 'hard' drugs, such as heroin. 2. To act as a channel between treatment resources and people who need treatment. 3. To protect the young from unwittingly using a harmful substance. 4. To stop the immoral act of using a mind-altering substance.

5. To protect the moral fibre of society.

The Committee has attempted to evaluate evidence of these social policies but has found it almost impossible to do so because necessary data are not available. The following evaluation does not pretend to be rigorous but it does give an indication of the effectiveness of the law.

Stated Objective 1: To Stop the use of Cannabis.

Evaluation: Surveys, conviction rates and anecdotal evidence, without exception, indicate increasing use of cannabis. Stated Objective 2: To Detect and Punish Cannabis Users.

Stated Objective 3: To Detect and Punish Cannabis Traffickers/Producers.

Evaluation: One police officer who appeared before the Committee claimed that the detection rate in his State was 5 per cent at most. 109 There is no Australia-wide survey evidence on the extent of cannabis use. The Committee has assumed from the available surveys that approximately 8 per cent of the population have used cannabis at least once. Given this figure, some rough calculations can indicate what the true detection rate

might be. These calculations can be made only in respect of New South Wales, however, for that is the only State which has supplied crime statistics in sufficient detail to enable us to estimate the detection rate. If the 8 per cent incidence of usage is applied to the 1975 estimate of the population of New South Wales, the indicated number of cannabis users in that State is some 270 000. A usage of twice each month is as­ sumed. It is felt that this is a reasonable, albeit conservative, assumption of use; while a large proportion of the 8 per cent have experimented once, another large proportion use cannabis on a weekly basis. The number of users is then multiplied by 24 to get an approximate measure of the number of incidents of cannabis use in New South Wales each year; The number of detected offenders-2880-represents about 1 per cent of users and certainly less than one-tenth of I per cent of the instances of use.

These figures give only an estimate of the orders of magnitude, and should not be interpreted literally. They substantiate the low level of detection and support evidence which indicates that the law has failed in its objective of detecting and punishing cannabis users and traffickers.

Between 1971 and 1975, the proportion of detected cannabis offenders sentenced to terms of imprisonment by the courts in New South Wales declined from 7. 7 per cent to 6 per cent. 11° Furthermore, the average term of imprisonment diminished. 111 There appears to be some ambiva­ lence on the part of the law as to what constitutes proper punishment.

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The Committee noted that anecdotal evidence shows a trend to more use among older groups and to a marginally increasing proportion of young people among those charged. 112 Further, as seen from the survey evidence, while females are increasing their usage, the proportion of

males among those charged rose from 80.7 per cent in 1971 to 87.9 per cent in 1975. 113 It seems that the law enforcement system is biased in its detection of users.

Stated Objective 4: To Deter People from Using Cannabis. Evaluation: The law does deter a significant group in the population from the use of cannabis. The size of this group, however, is declining. Not one witness or commentator has disputed that the use of cannabis is increasing, and surveys cited earlier confirm the trend. Each year,

convictions rise and fewer people consider the law as important, or relevant, to their use of cannabis. Courts in New South Wales and South Australia are now using gaol sentences rarely as they are not regarded as an effective deterrent. New South Wales is currently looking at proposals for a diversionary scheme to replace gaol sentences.

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.

Stated Objective 5: To Deter Traffickers/Producers. Evaluation: As was noted earlier, Commonwealth seizures of cannabis continue to rise sharply. Within Australia, police continue to discover larger and better-organised cannabis cultivations. The Department of

Business and Consumer Affairs told the Committee: Overseas holidays, particularly to Europe and South East Asia, continue to be popular with young Australians. The attraction of profits to be made by acting as couriers or by importing drugs for resale accounts for a large pro­ portion of the cannabis, L.S.D. and opiates which reach the illicit market. These individuals (or small groups) collectively constitute a major problem.l14 It seems that ordinary, otherwise 'honest' people are not being deterred

by the law. Trafficking continues to increase in spite of legal sanctions, and to that extent the objectives of the law are not being met. One can only speculate on the extent to which the law is failing to deter Australian production of cannabis. But the Committee's impression is that the law

has failed to cope with this emerging situation.

Stated Objective 6: To Protect the Individual from Harming Himself. Evaluation: Whether this is a valid objective is a question which has been disputed. 115 However, 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. The same might be said of the influence of legal sanctions on the amotivational syndrome associated with heavy ingestion of cannabis. Apart from these factors, it is difficult to document damage due to cannabis which may be occurring. Therefore,

this objective cannot yet be fully evaluated.

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Evaluation of Implied Objectives of the Law

Stated Objective 7: To Protect People from Recruitment to Cannabis Use.

Evaluation: All surveys indicate that recruitment to cannabis use is increasing and that this objective is not being achieved. However, it is not known what the rate of recruitment would be if there were no legal sanctions.

Implied Objective 1: To Deter People from Moving on to 'Hard' Drugs, such as Heroin.

Evaluation: This aim is difficult to evaluate for several reasons. Those who do move to the 'hard' drugs have usually used a number of drugs; it then becomes difficult to speak of any single 'precedent' drug. Further, a statistical relationship does not necessarily identify causal factors. Professor Blewett told the Committee:

First we should note that if there is a causal connection it is certainly a complex and qualified connection, because the great majority of marihuana users do not commit other crimes or escalate to hard drugs. Secondly, we should note that the link between alcohol and crime appears statistically more significant than between marihuana and crime, although people do not seem

to label alcohol crimogenic. Again statistically, users of barbiturates are more likely to use hard drugs than users of marihuana, but nobody seems to argue that barbiturates are a stepping stone to hard drugs. Finally, neither in the biochemistry of marihuana, nor in its typical effects, is there any sign of a causal mechanism which might explain progress to hard drugs or propensity

to crime. Rather the reverse for marihuana tends to inhibit aggression, and increased sensitization appears to develop with greater use. The explanation of the statistical link appears to lie in a common factor, or factors, which explain why some people both use marihuana and hard drugs ... 116

A different view has been put, particularly by police witnesses, who said that cannabis use led to involvement with a particular environment: Firstly, I know of no reason why one should graduate from cannabis to any other drug because of any chemical within the drug cannabis. I believe

that when a person becomes involved in cannabis abuse he becomes engrossed in a certain type of environment and in many cases I have actually seen such people become dependent on the environment rather than on the drug . . . People in such a group become rebellious towards their parents and towards society, and support their social group. In social groups where marihuana is abused you wiJI quite often find other drugs and so this leads to a graduation in drug abuse. 11 7 There is also a need to determine whether cannabis is ever 'spiked' with other substances, such as heroin.

Implied Objective 2: To Act as a Channel between Treatment Resources and People who need Treatment. Evaluation: This objective has the same problems as the previous objective, in that the objective itself is open to much dispute. There is no agreement as to whether treatment is required by some users solely on account of cannabis use. But it is clear that not all users need treatment solely on that account.

156

Conclusions on Stated and Implied Objectives of the Law

Implied Objective 3: To Protect the Young from Unwittingly Using a Harmful Substance.

Evaluation: Young people are the predominant users of cannabis; obviously they are using it more and more, despite the proscriptions in the law. The extent to which this use is unwitting cannot be evaluated. Implied Objective 4: To Stop the Immoral Act of Using a Mind-altering

Substance. Evaluation: Clearly, this objective also is not being achieved, for the use of cannabis is increasing.

Implied Objective 5: To Protect the Moral Fibre of Society. Evaluation: This objective, while less commonly held than previously, still determines many attitudes. As the Shafer report stated: 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 funda­

mental principles and values upon which the society rests are far too enduring to go up in the smoke of a marihuana cigarette. 11s To the extent that the moral fibre of society may not be in danger, the objective may be irrelevant.

The Committee concludes that achievement of the stated and implied objectives of the law relating to cannabis use has been minimal. We are unable to say how much worse the situation might have been had present laws not existed.

The law as it operates at present deals inadequately with cannabis use, and urgently needs revision. The objectives which the law is required to serve should be clearly, adequately and authoritatively stated. Cannabis is not a narcotic. It should not be listed as an addictive drug

in the same category as narcotics, as it is at present. Not one witness before the Committee claimed that the present listing is appropriate. For over seven years, committees and various professional and eminent people have called for an appropriate differentiation, both in Australian law and in

international conventions. The present wrong classification of cannabis weakens the cases for the control both of cannabis and of narcotics. Punishment has not reduced the use of cannabis or other illicit drugs in Australia. No examples could be given to the Committee to demonstrate

that a significant drug problem had been overcome by punishment of any degree. Cannabis, like all drugs, has potentially harmful effects, although, as with alcohol and tobacco, these are more likely to occur after persistent, prolonged, heavy use.

There has been altogether too much emphasis, consciously and un­ consciously, on the moral aspects of cannabis abuse. Policies should be based on the harm, actual or potential, which may result from cannabis use rather than on judgments about the politics, sexual mores, dress and

vague hedonism of the youth culture.

157

Recent

United States Experience

It is important that more people begin to realise that escalating statistics of drug offenders and seizures of drugs are a sign of laws failing, not of Jaws succeeding. The Committee continually endeavoured, but without success, to obtain an indication of the cost of administering drug laws. Much time and money are being spent on a model of control which, in its present form is demonstrably failing to achieve its objectives.

Senators Tehan and Walters dissent from this section (see dissent on the section 'A National Strategy on Cannabis' appended at page 190). Nine American States (and at least four countries-Italy, Switzerland, the Netherlands and Colombia) have amended their laws relating to cannabis. These amendments constitute what is referred to in the United States as 'decriminalisation'. Though this term has no relevance in the Australian legal system, the provisions are worth noting. The details for eight States are shown in Table 5 .14.

Table 5.14 Summary chart-marijuana citation laws

Maximum Max imum Criminal

fine amount or civil

State imposed possessed violation Effective date

$

Oregon 100 1 oz Civil 5 October I973

Alaska IOO Any amount in Civil I March I976

private for personal use or I oz in public

Maine 200 Any amount(a) Civil I March I976

for personal use

Colorado(b) 100 I oz Class 2 petty I July I975

offence-no criminal record

California(b) 100 1 oz Misdemeanour 1 January 1976

-no permanent criminal record

Ohio( b) 100 100 grams Minor 22 November 1975

(approx. 3!- oz) misdemeanour -no criminal record

South Dakota 20 1 oz Civil 1 April I977

Minnesota. (c)IOO It oz Civil 10 April 1976

(a) There is a rebuttable presumption that possession of less than 11 oz is for personal use, and possession of more than I t oz is with an intent to distribute. (b) Distribution of marijuana by gift, or for no remuneration, is treated the same as possess ion in California (for up to I oz), Colorado (for up to I oz), and Ohio (for up to 20 grams). (c) Second offence within a two-year period carries a possible 90 days in jail and a $300 fine . Source: National Organization for the Reform of Marijuana Laws.

The ninth State-New York-introduced changes in the law very recently and details are not available to the Committee at the time of writing. Several surveys have been made in an endeavour to evaluate the new law, and the attitudes to it, in Oregon, the State with the longest experience of decriminalisation. Two of these were commissioned from a marketing

158

research firm in 1974 and 1975 by the Drug Abuse Council Inc., of Washington, DC. The two studies so commissioned were random surveys of persons aged eighteen years and over, based on balanced samples of 802 in 1974 and 800 in 1975.

Both surveys showed that 58 per cent of the sample favoured the elimination of criminal penalties for the possession of small amounts of marihuana. They also indicated that the number of users had not signifi­ cantly increased since the change in the law. Furthermore, a large pro­

portion of marihuana users in the samples-40 per cent in 1974 and 35 per cent in 1975-reported that they were using less than before. Only a small proportion-S per cent in 1974 and 9 per cent in 1975-reported that they were using marihuana more than they had been previously.

Nineteen per cent of the sample in 1974 and 20 per cent in 1975 reported that they had used marihuana at least once. Current users were 9 per cent of the sample in 1974 and 8 per cent in 1975. In 1974, 6 per cent of the current users in the sample reported using marihuana for less than one

year, and 91 per cent for more than one year. In the 1975 survey, 3 per cent of the current users reported that they had been using marihuana for less than one year and 8 per cent for one year to one year and eleven months. In both surveys, all who reported using marihuana for less than one year

were aged between nineteen and twenty-nine. 119 Dr Hardin B. Jones, of the United States, however, has pointed to these two surveys to support his contention that the use of marihuana in Oregon has increased since the law was changed:

In 1973, Oregon became the first state to change its marijuana laws. At the time the change was made, the National Drug Abuse Council commissioned a market research firm in Portland, Bardsley & Haslacher, Inc., to study patterns of marijuana use for two years. The council concluded from the surveys that marijuana use and attitudes toward it had remained much the

same as before. The 1974 survey figures show, however, that out of 802 persons interviewed, sixty-nine were using marijuana; of these four had begun using it after the laws were changed. This is an increase of 6 per cent. The 1975 survey shows that out of 802 persons interviewed, sixty-five were using mari­ juana; of these nine had begun using it after the laws were changed. This is

an increase of 16 per cent for the twenty-four-month period following the enactment of the new laws. The numbers of marijuana users interviewed in these surveys are too small to determine accurately the increase in the number of users. However, the numbers are sufficient to establish by statistical inference

that the increase in new users could be as high as 18 per cent per year (95 per cent confidence limit) for the period under study. The survey included only subjects who were eighteen or over. However, in determining the increase in drug use, it must be remembered that people under eighteen are more susceptible

to drug use. In 1974, in a small-scale survey of my own of students of several Oregon college campuses, I found that marijuana use among undergraduates had increased by 12 . 3 per cent during the year following revision of Oregon's marijuana laws.

Marijuana use in Oregon has definitely increased since the new laws were put into effect. The only questions remaining are the magnitude of the increase and whether the trend is different from what it would have been if the law had not been changed. Several other states have recently reduced their penalties for possession of marijuana, and more extensive studies will probably be done. Reliable results will, however, take years to obtain. 120

159

The conclusions about recruitment rates drawn by Dr Hardin Jones from these two surveys are questionable, as Table 5.15 shows. This table does not purport to indicate any change in the incidence of marihuana use following the changes in the law. It merely enables one to understand how the percentage recruitment rates cited by Dr Hardin Jones were derived and how they compare with other calculations of recruitment and use .

Table 5.15 Different interpretations of survey results indicating marihuana use in Oregon after the adoption of decriminalisation in October 1973

Number recruited to use after changes in

the law as Number

a proportion recruited to

Number of sub-group use after

Number recruited to Number of previous changes in

of users as use after of previous users the law as

Size of Number a proportion changes in users (Dr Hardin a proportion

Year survey sample of users of sample the law in sample B. Jones) of sample

per cent per per

cent cent

1974 802 69 (b)8 . 6 4 65 6 (;,,) 0.5

1975 (a)802 65 (b)S .1 9 56 16 (;.) 1.1 < s:z)

(a) The size of the sample in 1975 was in fact 800 persons, according to the Committee's information. (b) Shown as whole numbers (9 per cent and 8 per cent respectively) in the reports on the surveys. S ource: Drug Abuse Council Inc., 'Survey of Marihuana Use-State of Oregon' (Washington, DC, 15 December 1974), and 'Survey of Marihuana Use and Attitudes: State of Oregon' (Washington, DC, I December 1975); and

Hardin B. and Helen C. Jones, Sensual Drugs (Cambridge University Press, 1977), pp. 281-2.

Firstly, Dr Hardin Jones has made allowance for new recruits to mari­ huana use but has not allowed for some cessation of drug-taking. Secondly, he has ignored the lower incidence of use in the 1975 sample. Thirdly, he has calculated the percentage increase in drug-taking with previous users, not the total sample, as denominator in the fraction.

A third survey was reported on in the course of an official study of the effects ofthe Oregon law decriminalising marihuana which was undertaken by the legislative research service of the Oregon State Assembly. The report on this study, which was presented in December 1974, concluded:

What evidence there is suggests that decriminalization of marihuana has successfully removed small users or possessors from the criminal justice machinery without relaxing the criminal penalties for pushers or sellers of the drug, and has enabled officials in law enforcement, district attorneys' offices and courts to concentrate on other matters within their jurisdiction.

Finally, the laws do not appear to have precipitated any of the major negative effects which those who object to the decriminalization trend had predicted would happen if a state reduced its criminal penalties for those possessing or using marihuana. 121

160

A National Strategy on Cannabis

The Committee also notes the views expressed by Dr Robert L. DuPont, Director of the National Institute on Drug Abuse, who has been a senior advisor on drug abuse strategies to three American Presidents. Dr DuPont states:

Decriminalization of marihuana possession makes sense on economic and humanitarian grounds. The widespread assumption that it is a short step from decriminalization to legalization of marihuana is, in my judgment, neither inevitable nor wise.I 22

He goes on to argue that any program which seeks to tackle marihuana use should not do so in isolation from a policy which seeks the overall reduction of other forms of drug abuse. 123

A lengthy report by the State Office of Narcotics and Drug Abuse within the Health and Welfare Agency in California, dated January 1977, examined the effects of that State's decriminalisation law (SB 95), which had been in effect since I January 1976. Among its major conclusions

were the following:

... six in ten (61 per cent) California adults either approve of SB 95 or believe that possession of small amounts of marijuana should be legalized . ..

In the first six months of 1976, reported marijuana possession offenses were reduced by nearly half compared to the same period in 1975. Concurrently, arrests of heroin addicts and other drug offenders increased significantly. Comparative marijuana trafficking arrests and amounts of the drug seized

actually show a small but measurable decline.

The loss of a marijuana workload in some of the larger counties' drug programs has been supplanted by treatment placements stemming from increased non-marijuana arrests in 1976 combined with greater willingness on the part of courts to use community treatment alternatives for drug abusers

eligible for diversion under AB 1274. 124

AB 1274 is a statute extending the diversion program-

A survey ... found that while 35 per cent of adults report having at least tried marijuana, 14 per cent consider themselves current users. Less than 3 per cent reported that they first tried marijuana within the past year,-That is, since the operation of the new law-

and only one in eight of this number said they were more willing to try mari­ juana or to use it more often because penalties have been reduced.

The reduction in penalties for possession of marijuana for personal use does not appear to have been a major factor in people's decision to use or not to use the drug.125

Senator Melzer dissents from part of this section (see dissent appended at page 189), and Senators Tehan and Walters jointly dissent from part (see dissent appended at page 190).

Cannabis is an extensively used drug and Australia is a drug-taking society. However much one may deplore both these facts, one cannot

161

deny them. Furthermore, recognition of their existence is a fundamental prerequisite for developing appropriate and effective strategies which will enable us to reduce all levels of drug-taking in Australia. We must recognise that cannabis is used in Australia not as a fibre, food or medicine, but as an intoxicant. We must recognise that its use is widespread, with many regular users, extending across age, sex and socio­ economic barriers.

Cannabis and cars are a lethal mixture. Cannabis is a potential health hazard in the work place. The use of cannabis and alcohol in combination intensifies the danger of both. Despite claims to the contrary at both extremes of the debate, the long-term adverse health effects of constant, heavy cannabis use are not completely known and need further study.

Recognising the above, the Committee believes that the use of cannabis in Australia should be positively discouraged; that our society should continue to express its disapproval of the use of this drug. We do not recommend its legalisation. Our long-term aim regarding cannabis is exactly the same as our long-term aims regarding other drugs: we wish to see its use significantly reduced and, if possible, ultimately discontinued.

'Decriminalisation' is a term which is popularly used throughout the Western world when discussing the cannabis issue. A number of different meanings are ascribed to it; they cause much confusion. The Committee therefore considered that the use of this expression in the report would be ill advised, except in the section in which we have discussed recent experience in the United States, where the law recognises a concept known as 'decriminalisation'. Since there are differences of opinion about the meaning of the term, the Committee has attempted to describe the process it advocates without giving it a precise name.

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.

Existing measures, legal and otherwise, have failed to prevent the increasing use of cannabis or to eliminate trafficking in the drug. On the other hand, the existing legal situation has led to some unfortunate consequences. Among these are growing suspicion of corruption in the processes of law enforcement; diminished respect for the law and for enforcement authorities; deterioration of the relationship between young people and the police ; and, on clear evidence, non-random application of the law.

On this latter point, a number of witnesses, including police, told the Committee that the use of cannabis crossed socio-economic and age lines, and said that the courts failed to treat all offenders on an equal basis. One witness, speaking of activities involving cannabis use among the young, said:

I think it is not so much because they practise them more-though I said in my paper that cannabis is a drug of the young rather than the elderly section

162

of the population-but simply because they do not have the privacy or the experience to the same extent which protects more middle-aged, more experienced people from falling into encounters with the police in these matters.126 This leads the Committee to a further important observation: the use of cannabis by the young cannot be seen in isolation from the drug use of

the rest of the community. For example, in his Annual Report for 1975-76, the Commonwealth Director-General of Health commented on the refusal by many people to acknowledge the existence of an alcohol problem and said:

It is seen in the attitude of many adult moralists who castigate young people for their attitudes to drugs while at the same time declining to moderate their personal over-indulgence in alcohol-a double standard which is indefensible in the eyes of the young.l 2 7 Because of this, it has been argued that proscription of cannabis is inconsistent with our acceptance of excessive use of alcohol and tobacco.

On balance, the Committee rejects this view. We acknowledge that our society is still willing to allow the use of drugs which cause major health and social problems. These include various ethical prescription drugs, as well as alcohol and tobacco. The Committee strongly endorses the view stated by Dr DuPont:

Just because we allow people to take risks with one substance, or several substances, is not a very good argument to have more of that go on. On the other hand, it is a good argument for not putting people in jail. 128 We recognise that the debate on cannabis has produced an important by-product in that it has highlighted the failures of our present approaches to alcohol and tobacco, and has demonstrated the failure of previous

strategies to achieve our desired goals. There are many who approach this question as if illegal trafficking in cannabis were the drug problem; as if improved methods of detecting and punishing traffickers would solve the problem. This is clearly not so. Supply will always match demand, as the history of all attempts at

prohibition plainly illustrates. The real necessity is to reduce demand, though action to reduce supply must, of course, continue in an appro­ priate balance. Consequently, the strategy recommended by the Committee is based

on two premises: that there is a need to reduce the overall consumption of cannabis and that there is also a need to have deterrents and responses which are appropriate and effective in meeting this initial requirement. Such a strategy must recognise the realities of our contemporary situation,

and the overall aspirations and changing attitudes of Australian society . Accordingly, the Committee recommends:

That the objectives of policies to control the use of cannabis be­

(a) To reduce national consumption of cannabis in respect of both recruitment and present personal use. (b) To acknowledge and account, in law and law enforcement, for the difference between the abuse of cannabis and of other illicit drugs.

163

Recommendations on the Law Relating to Cannabis

(c) To reduce, and finally to prevent, cannabis use, especially while drivinl or performing other complex psychomotor functions.

(d) To reduce the social harm resulting from contact with criminal suppliers.

(e) To ensure that the legal controls are not of such a nature as to inhibit rehabilitation of the user or to cause more social damage than use of the drug causes.

(f) To increase respect for the law and the law enforcement system. (g) To identify those people who need treatment as a consequence of cannabis abuse, and to develop effective treatment methods.

Senators Melzer, Tehan and Walters jointly dissent from part of this section (see dissent appended at page 194). Earlier in this chapter, we recommend that cannabis be placed in the appropriate schedule of the United Nations Convention on Psychotropic Substances, which realistically reflects the properties of the drug. Further­ more, we believe that cannabis should not be associated with opiate narcotics in any Australian laws and that separate cannabis legislation should be enacted to encompass the principles already discussed in this chapter.

The Committee recommends:

That the Commonwealth and the States enact cannabis legislation which recognises the significant differences between opiate narcotics and cannabis in their health effects and in the criminal impact on users and the community.

The laws relating to the use of cannabis in Australia have not been effective. They should be changed to restore public respect for the law and law enforcement authorities, and to minimise the social damage done by the manner in which the law enforcement system operates. To this end, the positive features of some recent laws relating to the use of cannabis in the United States offer some guidelines for Australia.

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.

Changes in the laws on cannabis are necessary and are not related to any specific considerations of the health issues involved in cannabis use. Changes are needed to correct the mistakes of the past; to relate social intervention to contemporary knowledge about the effects of the drug and to current social realities regarding its use; and to end the present selective operation of the law. It should not be thought, however, that suggested changes in the law will be irreversible or that they will be the first step toward legalisation.

164

The Committee notes that the law is only one means of intervention. It should not be relied on excessively to the exclusion of other means. In considering how the possession of cannabis for personal use might be treated, the Committee has noted the following statement in Halsbury's

Laws of England:

If the proceedings will result in the punishment of a party, the conduct in question will be a crime notwithstanding that it may be a matter of small consequence. Where an act is commanded or prohibited by statute, dis­ obedience is prima facie criminal unless criminal proceedings manifestly appear

to be excluded by the statute. An act may be prohibited or commanded by a statute in such a manner that the person contravening the provision is liable to a pecuniary penalty which is recoverable as a civil debt; in such an instance contravention is not a crime. 12 9 A footnote states:

Whether or not a statute creates a criminal offence is a question of inter­ pretation, e.g. if the word 'penalty' as distinct from the word 'fine' is used, the general rule is that the penalty must be recovered as a debt in a civil court; ... 130

The Committee therefore recommends:

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 photo­

graph defendants. (g) No record of conviction kept by the courts or the police shall be used in subsequent proceedings or in relation to any application by the offender for employment. (h) A conviction should not, of itself, disqualify a person for employment.

It is appropriate that possession of an amount of cannabis greater than that defined as being for personal use be regarded as prima facie evidence of trafficking. It is appropriate also that growing on a commercial scale be treated as trafficking.

The existing laws do not deter trafficking in cannabis, as demand finds a ready supply. The law should punish traffickers and effectively deter trafficking. In a letter to the Committee dated 18 November 1976, the

• In most States, possession of up to 25 grams (about 1 ounce) is deemed to be possession for personal use.

165

Minister for Business and Consumer Affairs referred to a meeting of Commonwealth and State Ministers on 1 October 1976, at which drug abuse was discussed. He said:

At this meeting Ministers accepted a recommendation to increase maximum penalties for trafficking and large scale importation of drugs (excluding cannabis leaf) to 25 years imprisonment and/or a fine of $100 000. There was a general consensus that cannabis in leaf form be excluded from the increase and that the existing maximum penalty of 10 years and/or a fine of

$4000 be retained for offences of trafficking and large scale importation. The New South Wales Joint Committee of the Legislative Council and Legislative Assembly upon Drugs, in a Memorandum on its work which was presented in March 1977, noted that the courts do not impose maximum penalties under existing laws:

In considering the penalties for trafficking two things stand out from the Court statistics. Firstly the rate of trafficking has not diminished since the introduction of higher penalties in 1970. Secondly the Courts have not made use of the existing maximum sentences. For example, in 1975 of a total of

177 trafficking convictions under Commonwealth and State legislation, no sentence exceeded 8 years; and only eighteen offenders received gaol sentences between 5 years and 8 years. 131 We are aware of some recent large seizures of cannabis, particularly at plantation sites, and we therefore recommend:

That the maximum prison penalty and fine for trafficking in marihuana be raised to levels more appropriate to the quantities involved in seizures.

Hashish and hashish oil and all purified forms of tetrahydrocannabinol are potent substances which should continue to attract the full weight of the law. Accordingly, the Committee recommends:

1. That penalties for the possession of hashish, hashish oil and all purified forms of tetrahydrocannabinol remain at present levels.

2. That penalties for the importation, manufacture and sale of hashish, hashish oil and all purified forms of tetrahydrocannabinol be substantially increased in accordance with the principle of introducing higher penalties adopted at the meeting on drug abuse held by Commonwealth and State Ministers on 1 October 1976. The Committee is also aware that personal cultivation of small quantities of marihuana can be considered the concomitant of possession for private use. Persons who cultivate their own supply need no longer be in constant contact with dealers who may offer other illicit drugs for sale. Personal cultivation offers an alternative to buying from a drug seller. The

Committee therefore recommends:

That where necessary Commonwealth and State Governments consider clarifying the law so as to impose, for the cultivation of a specified and limited amount of marihuana for personal use, the same level of penalty as for possession. The Committee does not advocate an approach based solely on legal sanctions. As we stated in Chapter 1, diversionary programs in the

166

24819177-U

form of medical or treatment or education are now being

encouraged. We beheve they are worth pursuing. Accordingly, the Committee recommends:

That appropriate diversionary programs be developed and instituted for both possessors of and traffickers in cannabis.

Measures adopted to control the use of cannabis ought to be evaluated to ensure that they are appropriate and effectual. The Committee recommends:

That the Commonwealth Government initiate annual reviews of the effects of any changes in the law relating to cannabis to determine any need for further action.

References 1

E. R. Bloomquist, Marijuana (Glencoe, United States of America, 1968), pp. 17-33. 2

Health Commission of New South Wales, The Use and Abuse of Drugs (Canberra, 1973), p. 2.

3

Bloomquist, pp. 17-33. 4

E. M. Brecher & the Editors of Consumer Reports, Licit and Illicit Drugs (Boston, 1972), p. 403. 5

Brecher & the Editors of Consumer Reports, p. 406. 6

Brecher & the Editors of Consumer Reports, p. 405. 7

Brecher & the Editors of Consumer Reports, p. 405. 8

Brecher & the Editors of Consumer Reports, p. 409. 9

Brecher & the Editors of Consumer Reports, p. 410. 10 Brecher & the Editors of Consumer Reports, pp. 413-21. 11

Brecher & the Editors of Consumer Reports, p. 419. 12 The Study Group of the Victorian Foundation on Alcoholism and Drug Dependence, Drug Dependence: The Scene in Victoria (Melbourne, 1974), p. 17. 1 3

The Study Group of the Victorian Foundation on Alcoholism and Drug Dependence, p. 17.

14 The League of Nations, Records of the Second Opium Conference, Geneva, November 17, 1924, to February 19, 1925 (Geneva, August 1925), vol. i, pp. 132-8; and vol. ii, p. 297. 15 Evidence, pp. 977-9. 16

S. L. Hasleton, 'The Incidence and Correlates of Marihuana Use in an Australian Under­ graduate Population', in The Medical Journal of Australia, 7 August 1971, p. 302. 17 A. George, 'Survey of Drug Use in a Sydney Suburb', in The M edical Journal of Australia, 29 July 1972, p. 235. 1 8 A. George, 1973 Survey of Drug Use in a Western Suburb of Sydney (New South Wales

Health Commission), p. 10. 1 9 D. S. Bell, R. A. Champion & A. J. E. Rowe, Monitoring Drug Use in New South Wales

(Health Commission of New South Wales), p . 33. 20 J. Krupinski & A . Stoller (edd.), Drug Use by the Young Population of M elbourne (Mental Health Authority, Victoria, Special Publications No. 4) (Melbourne, 1973), p. 16. 21 Victorian Institute of Mental Health, Research and Post Graduate Training, Drug Use

by the Young Population of Ballarat (unpublished paper), p. 2. 2 2 T. J. Turner & L. McClure, Alcohol and Drug Use by Queensland School Children (Report No. 1) (Department of Education, Brisbane, July 1975), p. 65. 2

3 Turner & McClure, pp. 68-70.

2 4 Commonwealth Police, Drug Abuse in Australia: A Statistical Survey (Technical Report

No. 8) (Canberra, November 1976), p. 59. 25 Commonwealth Police, p. 72. 26 Evidence, p. 1931. 27 Bell, Champion & Rowe, p. 20. 28 George, 'Survey of Drug Use in a Sydney Suburb', p. 235; George, 1973 Survey of Drug

Use in a Western Suburb of Sydney, p. 10. 29 Evidence, p. 699. 30 Evidence, p. 2286. 3 1 Evidence, p. 1290. 32 Evidence, p. 1291. 3 3 Evidence, pp. 879-80. 34 George, ' Survey of Drug Use in a Sydney Subur.b', p . 235. ,

3 5 Hasleton, p. 303; George, 'Survey of Drug Use m a Sydney Suburb , p. 235. 3 6 Bell, Champion & Rowe, p. 39.

167

37 R. P. Irwin, Drug Education Programs and the Adolescent in the Drug Phenomena Problem (Canberra, 1976), p. 2.19. 38 Evidence, p. 2286. 3 9

Department of the Attorney-General and of Justice, New South Wales Bureau of Crime Statistics and Research, Drug Offences 1974 & Community Comparisons (Statistical Report 3, Series 2) (New South Wales, 1975), p. 8. 40 Evidence, p. 711. 41 Evidence, p. 708. 42 Evidence, p. 705. 43

Bell, Champion & Rowe, pp. 49, 52. 44 Bell, Champion & Rowe, pp. 71, 73, 83, 84. 4 5 Rev. P. Ramsay, submission to the Senate Standing Committee on Social Welfare

(Canberra, 1976), p. 11. 46 K. Harrison, 'Marijuana: deadly assassin' (Australian Festival of Light), p. 6. 47

Brecher & the Editors of Consumer Reports, p. 415. 48 Secretary for Health, Education, and Welfare, Marihuana and Health (Sixth Annual Report to the United States Congress) (Washington, DC, 1976), p. 28. 49

H. H. Lopez, Jr, S. M. Goldman, I. I. Liberman & D. T. Barnes, 'Cannabis-Accidental Peroral Intoxication', in Journal of the American Medical Association, 4 March 1974, p. 1041. 50 Evidence, p. 1897.

51 Evidence, pp. 90-1, 743, 1270, 1919. 52 Secretary for Health, Education, and Welfare, Marihuana and Health (Fifth Annual Report to the United States Congress) (Washington, DC, 1975), p. 7. 53 Secretary for Health, Education, and Welfare (Fifth Annual Report), p. 5. 54 D. P. Tashkin, B. J. Shapiro, Y. E. Lee & C. E. Harper, 'Subacute Effects of Heavy

Marihuana Smoking on Pulmonary Function in Healthy Men', in New England Journal of Medicine, vol. 294, No. 3, p. 125. 55 Secretary for Health, Education, and Welfare (Fifth Annual Report), p. 6. 56

P. Bech, L. Rafaelsen, J. Christiansen, H. Christrup, J. Nyboe & 0. J. Rafaelsen, 'Can­ nabis and Alcohol. Influence on Simulated Car Driving', in Nordisk Psychiatrisk Tids­ skrift, vol. 25, 1971, p. 350; cited in G. Milner, 'Marihuana and Driving Hazards' (Lecture Notes, No. 60) (Melbourne, 1976), p. 2. 57

F. T. Melges, J. R. Tinklenberg, L. E. Hollister & H. K. Gillespie, 'Temporal Disintegra­ tion and Depersonalisation During Marihuana Intoxication', in Archives of General Psychiatry, vol. 23, No. 3 (1970), p. 204; cited in Milner, p. 3. 58 V. S. Ellingstad, L. H. McFarling & D. L. Struckman, 'Alcohol, Marihuana and Risk

Taking' (Final Report) (Human Factors Laboratory, Department of Psychology, University of South Dakota, 1973); cited in Milner, p. 3. 59 J. E. Manno, G. F. Kiplinger, N. Scholz, R. B. Forney & S. E. Haine, 'Influence of Alcohol and Marihuana on Motor and Mental Performance', in Clinical Pharmacology

and Therapeutics, vol. 12 (1971), p. 202; cited in Milner, p. 2. 60 P. Kielholz, L. Goldberg, V. Hobi, D. Ladewig, G. Reggiani & R. Richter, 'Hashish and Driving Behaviour. An Experimental Study', in Deutsche Medizinische Wochenschrift, vol. 79, No. 20 (1972), p. 789; cited in Milner, p. 3. 61 M. A. Evans, R. Martz, D. J. Brown, B. E. Rodda, G. F. Kiplinger, L. Lemberger & R.

B. Forney, 'Impairment of Low Doses of Marihuana', in Clinical Pharmacology and Therapeutics, vol. 14, No. 6 (1973), p. 936; cited in Milner, p. 2. 62 R. E. Willette (ed.), Cannabinoid Assays in Humans (National Institute on Drug Abuse Research Monograph Series, No. 7) (Maryland, 1976).

63 A. E. Robinson, Problems of Drug Analysis (Department of Forensic Medicine, London Hospital Medical College); a copy also held by the Senate Standing Committee on Social Welfare. 64 D. Teale & V. Marks, 'A Fatal Motor-car Accident and Cannabis Use: Investigation by

Radioimmunoassay', in The Lancet, 24 April 1976, p. 884. 65 R. S. Sterling-Smith, 'A Special Study of Drivers Most Responsible in Fatal Accidents'

(Summary for Management Report, Contract No. DOT HS 310-3-595, April 1976); cited in Secretary for Health, Education, and Welfare (Sixth Report), p. 24. 66 G. Milner, 'Drugs and Driving: A Survey of the Relationship of Adverse Drug Reactions,

and Drug-Alcohol Interaction, to Driving Safety', in Monographs on Drugs, vol. 1 (Sydney, 1972), p. 73. 6 7 Senate Select Committee on Drug Trafficking and Drug Abuse, Drug Trafficking and

Drug Abuse (Canberra, 1971), p. 12. 6 8 Senate Select Committee on Drug Trafficking and Drug Abuse, p. 60. 69 T. H. Mikuriya, 'Physical, Mental and Moral Effects of Marijuana', in International

Journal cf th e Addictions, vol. 3 (1968), p. 253; quoted in Brecher & the Editors of Con­ sumer Reports, p. 451. 70 D. Solomon (ed.), The Marihuana Papers (New York, 1968), p. 240. 71 Solomon, pp. 240-1. n Brecher & the Editors of Consumer Reports, p. 451. 73 Solomon, p. 307.

168

74 Ad .

19;8Is)ory Committee on Drug Dependence, Cannabis (The Wootton Report) (London, • p. 7.

Adviso.ry .committee .on Drug Dependence 1

p. 13.

CommiSSIOn of Inqmry Into the Non-Medical Use of Druo-s Interim Report (Le Dain Report) (Ottawa, 1970), p. 85. "' '

:: of Into the Non-Medical Use of Drugs, pp. 242-3.

CommissiOn of Inqmry Into the Non-Medical Use of Drugs, Cannabis (Le Dain Report) (Ottawa, 1972), p. 302. :: Con;tmission of I?q_uiry Into the Non-Medical Use of Drugs, Cannabis, p. 301. Natwnal CommiSSIOn on Marihuana and Drug Abuse, Marihuana: a Signal of Mis-8 1 (Shafer Report) (Washington, DC, 1972), pp. 87-9. .

8 2 on Marihuana and Drug Abuse, pp. 152-5.

Natwnal Commisswn on Marihuana and Drug Abuse p 107 8 3 Advisory Committee on Drug Dependence pp. 64-9. ' . -· 84 Advisory Committee on Drug Dependence: p. 69. 8 5 United Nations, Division of Narcotic Drugs, 'Cannabis' (Information Letter, No. 10) (October 1974), p. 4. Un!ted States, Congressional Record-Senate, 3 October 1974, p. S 18172. 8 8 States, Congressional Record-Senate, 3 October 1974, p. S 18171. Umted States, Congressional Record-Senate, 3 October 1974, p. S 18173. 8 9 V. Rubin & L. Comitas, Ganja in Jamaica: A Medical Anthropological Study of Chronic Marihuana Use (The Hague, 1975), p. 1. 90 Rubin & Comitas, p. 38. 91 Rubin & Comitas, pp. 165-7. 92 Rubin & Comitas, pp. 142-6. 93 Secretary for Health, Education, and Welfare (Fifth Annual Report), p. 8. Secretary for Health, Education, and Welfare (Sixth Annual Report), p. 20. 9 " Secretary for Health, Education, and Welfare (Fifth Annual Report), p. 8. 9 6 M. I. Soueif, 'Hashish Consumption in Egypt, with Special Reference to Psychosocial Aspects', in The Bulletin of Narcotics, vol. 19, No. 2 (1967), pp. 1-11. 97 M. I. Soueif, 'The Use of Cannabis in Egypt: A Behavioural Study', in Th e Bulletin of Narcotics, vol. 23, No. 4 (1971), pp. 17-28. 98 Senate Select Committee on Drug Trafficking and Drug Abuse, p. 60. 9 9 Health Commission of New South Wales, Division of Health Education, The Use and Abuse of Drugs (Canberra, 1973), pp. 28-9. 100 Joint Committee of the Legislative Council and Legislative Assembly upon Drugs, Memorandum (Parliament of New South Wales, 30 March 1977), p. 9. 101 Joint Committee of the Legislative Council and Legislative Assembly upon Drugs, p. 10. 102 Commonwealth Police, p. 68. 103 Commonwealth Police, pp. 22, 68. 104 Commonwealth Police, p. 68. 10 5 Evidence, p. 1290. . 106 Department of the Attorney-General and of Justice, New South Wales Bureau of Crime Statistics and Research, Court Statistics 1975 (Statistical Report, No. 7, Series 2) (New South Wales, 1976), p. 52. 107 Department of the Attorney-General and of Justice, New South Wales Bureau of Crime Statistics and Research, Court Statistics 1975, p. 52. 108 Commonwealth Police, p. 68. 109 Evidence, p. 1931. 110 Department of the Attorney-General and of Justice, New South Wales Bureau of Crime Statistics and Research, Court Statistics 1975, p. 52. 111 Department of the Attorney-General and of Justice, New South Wales Bureau of Crime Statistics and Research, Court Statistics 1975, p. 50. 112 Commonwealth Police, p. 11. 113 Department of the Attorney-General and of Justice, New South Wales Bureau of Crime Statistics and Research, Court Statistics 1975, p. 46. 114 Evidence, p. 1059. 115 Evidence, pp. 1282-334. 116 Evidence, p. 1297. 117 Evidence, pp. 1961-2. 11s National Commission on Marihuana and Drug Abuse, p. 102. 119 Drug Abuse Council Inc., 'Marijuana Survey-State of Oregon' (Washington, DC, 15 December 1974), & 'Survey of Marijuana Use and Attitudes: State of Oregon' (Washington, DC, 1 December 1975). 120 Hardin B. & Helen C. Jones, Sensual Drugs: Deprivation and Rehabilitation of th e Mind (London, 1977), pp. 281-2. 1 21 Legislative research service of the Oregon State Assembly, Effects of the Oregon Laws Decriminalizing Possession and Use of Small Quantities of Marijuana (Salem, 31 December 1974), pp. 61-2. . . . 122 R. L. DuPont, Marihuana: Our Next Step (Natwnal Institute on Drug Abuse, Washmgton, DC. 4 February 1977), p. 1. 169

123 DuPont, pp. Iff. 12' Health and Welfare Agency, State Office of Narcotics and Drug Abuse (California), A First Report of the Impact of California's New Marijuana Law (SB 95) (January, 1977), in House of Representatives Select Committee on Narcotics Abuse and Control, De­

criminalization of Marihuana (Hearings, Ninety-Fifth Congress, 14, 15, 16 March 1977) (Washington, DC, 1977), p. 543. 125 Health and Welfare Agency, State Office of Narcotics and Drug Abuse (California),

pp. 552-3. 12s Evidence, pp. 1305-6. 127 Commonwealth Department of Health, Annual Report of th e Director-General of H ealth

1975-76 (Canberra, 1976), p. 5. 128 National Institute on Drug Abuse, Marihuana and Health : in Perspective (Summary and Comments on the Fifth Annual Report to the United States Congress from the Secretary for Health, Education, and Welfare, 1975) (Washington, DC, 1976), p. 10. 1 29

Halsbury's Laws of England (4th edn, London, 1976), vol. II , p. II. 1 3 0 Halsbury's Laws of England, p. 12 . 131

Joint Committee of the Legislative Council and the Legislative Assembly, p. 7.

170

CHAPTER 6 Amphetamines and Barbiturates

The Committee received very little substantive evidence on the use and abuse of amphetamines and barbiturates. They are included in this report because we wish to present the limited but valuable information which we do have and because we want to give added perspective to our

discussion of the total drug problem. In marked contrast to the consumption of most other drugs, ampheta­ mine and barbiturate use has declined over the last five to ten years. 1

Amphetamines Although the amphetamine problem in Australia did not reach the epidemic proportions found in the 1960s in other Western countries, it was large enough to cause considerable alarm. In the 1960s, ampheta­ mine abuse was a common cause of psychiatric morbidity. 2 Amphetamines were then being prescribed for depression, fatigue, obesity and epilepsy, and were very easy to obtain. 3 In 1968, Australia imported 301 . 04 kg

of amphetamines4 and much of this inflow was being used for non-medical purposes. In 1970, in response to a recommendation by the National Health and Medical Research Council, restrictions were placed on amphetamines. Everywhere in Australia, except in the Australian Capital Territory and the Northern Territory, prescription is now limited to persons suffering from narcolepsy or from the brain-damaged child syndrome, unless the

prior approval of the State Director-General of Health has been obtained. This restriction has been successful in controlling amphetamine abuse. A witness representing the South Australian Government told the Committee:

The restrictions on the Amphetamines have reduced the consumption of this group of drugs by 90 per cent. 5 Imports fell dramatically from 251.525 kg in 1969 to 0. 891 kg in 1970, and by 1976 no amphetamines were being imported. 6 Amphetamine psychosis is now a relatively rare illness. 7 The Committee recognises the role that restrictions on the medical use of amphetamines in the States have played in decreasing the problem of amphetamine abuse, and

believes that present restrictions should remain in force. During the inquiry, the Committee was informed that existing restric­ tions on amphetamines in the Australian Capital Territory and the Northern Territory are inadequate. Amphetamines are available on prescription from a registered medical practitioner without approval from health authorities and are available also for the treatment of animals

on the prescription of a registered veterinary surgeon. 8 Statistics provided by the Commonwealth Department of Health, when related to population,

171

show that in 1975 per capita consumption of amphetamines in the Aus­ tralian Capital Territory was almost four times the national figure; in the Northern Territory over-use does not appear to be a problem (see Appendix 8).

A draft amendment at present being prepared would restrict use of these drugs in the Australian Capital Territory to the treatment of narcolepsy and the brain-damaged child syndrome, and of other conditions on the authority of the Commonwealth Director-General of Health. Similar legislation is before the Northern Territory Legislative Council.

The Committee recommends:

That proposed amendments to the ordinances in the Australian Capital Territory and the Northern Territory relating to restrictions on the use of amphetamines be treated as a matter of urgency.

Barbiturates The major adverse reactions associated with this class of drugs are chronic intoxication and withdrawal symptoms. Barbiturate dependence was a major problem about ten years ago, particularly among middle-aged women. 9 In 1960, barbiturates became readily available on the pharma­ ceutical benefits list. From that time, the amount prescribed increased steadily. A study by Professor F. A. Whitlock showed that the quantity of barbiturates supplied in Queensland by hospitals and on the pharma­ ceutical benefits list rose from 43 700 000 doses in I 962 to 9 I 400 000 in

I967. 10 Restrictions were then placed on the use of barbiturates and allowable quantities of hypnotic-strength doses were reduced to twenty­ five tablets or capsules per prescription, with no repeat supplies being permitted.

Professor Whitlock reported that by 1973 the quantity of barbiturate drugs so supplied in Queensland had fallen to 37 400 000 doses. 11 The restriction on the number of tablets or capsules available per prescription was partly responsible for the decrease in consumption, but the major causes were the increased awareness among medical practitioners of the adverse effects of barbiturates, and the availability of safe alternative medication. Most doctors now prescribe the less harmful benzodiazepines (for example, Valium), and thus the barbiturate problem has been considerably reduced. 12

However, these newer tranquillisers are now creating their own problem. Professor Whitlock informed the Committee that, although the overall prescribing rate has declined, barbiturates are still being prescribed in considerable quantities, particularly for pensioners. He added:

The depressing effect of these drugs on the central nervous system is parti­ cularly hazardous for elderly patients and medical practitioners need to be more aware of the possible consequences of prescribing this group of drugs. 13 The Committee intends to review the trends in amphetamine and barbiturate consumption later as part of its continuing oversight of the use and abuse of drugs.

172

References 1

Evidence, pp. 1874, 1878. 2 Evidence, p. 1878. 3

Senate Select Committee on Drug Trafficking and Drug Abuse, Drug Trafficking and Drug Abuse (Canberra, 1971), p. 37. 4

Commonwealth Department of Health, personal communication. 5 Evidence, p. 1336. 6

Commonwealth Department of Health, personal communication. 7

Evidence, p. 1878. 8 Commonwealth Department of Health, Control of Amphetamines (supplementary paper submitted to the Senate Standing Committee on Social Welfare), p. 3. 9

Evidence, p. 1873. 1° F. A. Whitlock, 'Suicide in Brisbane, 1956 to 1973: The Drug-Death Epidemic', in The M edical Journal of Australia, 14 June 1975, p. 740. 11 Whitlock, p. 740.

1 2 Evidence, p. 1874. 1 3 Evidence, p. 1873.

173

CHAPTER 7

Co-ordination and Research

Definitions

Supplementary Policy Considerations

The 1971 report of the Senate Select Committee on Drug Trafficking and Drug Abuse commented on the lack of research and co-ordination in the field of drug use. 1 It is disappointing that the commitment to general research into drug use has not significantly improved in the last six years.

The National Standing Control Committee on Drugs of Dependence (see Chapter 1) is the major body which co-ordinates action to combat the drug problem. There appears to be no body co-ordinating action and research into the problems of alcohol and tobacco. The Australian

Foundation on Alcoholism and Drug Dependence performs some co­ ordinating role by collecting and publishing articles on drug use and abuse. Some similar function is performed by the Commonwealth Department of Health's National Drug Information Service.

In the national strategy for the control of drug use and abuse in Aust­ ralia which we have recommended in Chapter 1, we have emphasised the importance of national co-ordination of policy direction. A single ident­ ifiable authority should direct overall policies and co-ordinate the measures

taken in pursuing those policies. We believe that the appropriate authority is the Commonwealth Department of Health.

At present there is no generally accepted definition of terms basic to the study of drug problems, such as 'drug abuser', 'heavy drinker' and 'problem drinker'. Agreed definitions of these terms would assist the socio­ medical worker in the treatment of persons with specific drug problems;

and they are essential for the researcher who is trying to quantify drug problems and for the planner who is seeking to develop strategies for response and control. As one example of the confusion, Dr Margaret Sargent informed the

Committee that in many Australian writings an intake of 80 g of alcohol per day is cited as an 'at risk' level of drinking. She believed that the unwary may, by extrapolation, assume that this is the level that was adopted by the World Health Organisation Expert Committee on Drug Dependence, whereas the level accepted by the Expert Committee is

120 g2 (equivalent to twelve 10-oz glasses of beer). In fact, although two WHO technical reports published in 1973 3 and 1974 4 cited 150 ml (120 g) of alcohol per day as being 'excessive consumption', the WHO Regional Office for Europe, in a joint report, made the following observation:

. . . the lowest level of chronic alcohol consumption which constitutes a specific hazard to longevity has yet to be determined. It is almost certainly substantially less than a daily equivalent of 120 gms and could possibly be below 60 gms. 5 It is important that an agreed and acceptable level of 'risk' be established

for the purpose of research and evaluation.

175

The Committee recommends:

That the Commonwealth Department of Health be responsible for the development and dissemination of approved definitions of the various terms used in describing the drug problem.

Surveys The Committee notes that available survey data on the use of most drugs do not present an adequate picture of the overall extent and nature of drug use. Survey data on the use of some drugs provide no picture at all. Many surveys have used samples which are not representative of the whole population. They have tended to concentrate on groups which are pre-judged to be 'at risk' and have therefore not reflected the total situ­ ation. Such non-random selection may fail to identify changing patterns in society. Where methods of collecting data have not been uniform, comparison of the results is often not valid. In the United States, the National Institute on Drug Abuse has published a monograph on the types of problems which the researcher into drug use may encounter and ways in which these problems might be met. 6

The Committee recommends: That the Commonwealth Department of Health develop and dissemin­ ate a standard protocol for the collection of comparable data and that researchers working on drug-use problems be encouraged to use this protocol.

In 1971, the report of the Senate Select Committee on Drug Trafficking and Drug Abuse recommended: that urgent action should be taken by the Commonwealth Department of Health with the co-operation of State Departments of Health, to organise,

survey and assemble statistics on all forms of drug abuse on a uniform basis throughout Australia and that such information be made available freely to research and other interested organisations. 7 In 1975, the Victorian Government conducted an eight-month pilot survey of illicit drug use. The results were presented to the National Standing Control Committee on Drugs of Dependence in April 1976 and have not yet been released. In February 1975, the Senate Standing Committee on Health and Welfare urged implementation of the recommendation and stated :

The Victorian pilot study is a start in this direction but still falls far short of the Select Committee's recommendation. 8 The present Committee concurs with this statement but cannot comment on the desirability of setting up similar surveys in other States until the results of the Victorian pilot study are known. However, we wish to stress that the major problems are caused by licit, not illicit, drugs.

The Committee does not recommend that all research workers choose projects which satisfy the needs of governments. However, there should be available a set of national priorities which identifies the main questions requiring urgent research. These stated priorities could act as a guide to research institutions and workers who may wish to assist the Common­ wealth and State Governments in the achievement of their research goals.

176

Detection Agencies

Intoxication and Criminal Responsibility

The Committee recommends:

That the Commonwealth Department of Health produce and regularly upgrade an appropriate statement of national goals, in order of priority, for research into drug use.

The Australian Narcotics Bureau is responsible for the interception of illegal imports of drugs. However, in spite of its tireless efforts, huge quantities of narcotics are smuggled into Australia. As Superintendent Kent, of the Australian Capital Territory Police, said:

I realise that the customs people go to great lengths to prevent its importation, but a ... lot of it does get in. 9

When questioned by the Committee, a representative of the Bureau said that it had no way of estimating what proportion of illegal imports it detected and seized but 'it would be less than 50 per cent certainly'. 10 One's view of the effectiveness of the Bureau must depend on one's

understanding of the role it is expected to fulfil. If the role is seen in terms of the quantity of heroin seized, the functions of the Bureau can be said to have been achieved with distinction. However, if the role is seen in terms of the interdiction of imports and supplies available for illicit use in Australia, the Bureau can be said to have failed. By its own account, it sees an increasing supply of imported heroin as likely to be available in spite of its energetic and dedicated attempts to interrupt

supply routes and importation. State and Territory law enforcement agencies co-operate with the Narcotics Bureau in their task of detecting trafficking in and use of illicit drugs. These agencies also seem to be operating without sufficiently clear definition and understanding of their roles and without measurement of their performance in appropriate terms.

The functions of the Australian Narcotics Bureau and relevant State and Territory law enforcement agencies should be more clearly defined to allow proper evaluation of their performance. It could be possible simultaneously to claim failure for them in terms of affecting community

use patterns and to claim success in the interdicting of supplies. Society must decide which of these goals is primary, and against which of them the performance of these agencies ought to be judged.

The Committee recommends: That the functions of the Australian Narcotics Bureau and relevant State and Territory law enforcement agencies be expressed in terms of community patterns of drug use. and that failure to affect these patterns appropriately be considered prima facie evidence of inadequate perform­

ance requiring re-evaluation of the roles. structures and funding of such agencies.

At present, voluntary intoxication, either by alcohol or by any other drugs, may be a defence to a crime if it renders the defendant incapable of forming the specific intent which is an element of the crime. It is not

177

Transcendental Meditation

always a defence, as the evidence of intoxication rendering the defendant incapable of forming intent must be considered together with other facts proved.

The extent to which intoxication may be used as a defence is not certain. Further, there have been attempts to extend the use of intoxication as a defence to a charge which requires only that intent, other than specific intent, be proved. There have also been suggestions that, in relation to drug use and the criminal law, the question of specific intent requires further examination.

Accordingly, the Committee recommends: That the Commonwealth Attorney-General refer to the Australian Law Reform Commission for inquiry and report such changes to the criminal law, if any, as may be necessary to ensure that persons who choose to use intoxicating substances are deemed to be responsible for offences which they commit while under the influence of such substances.

When speaking of the needs that drug taking satisfies, R. P. Irwin commented: One of the most intriguing effects of the psycho-active drugs is their ability to alter consciousness, to change mood. To attempt to educate for a non­

behaviour, no use of drugs, would appear to be running counter to what has been seen as a basic need of man, the alteration of consciousness. Alternatives to the chemical modification of mood and behaviour, are suggested as mo re realistic for educational programs. Educational endeavours can be positive in such areas as physical exercise, rest, relaxation, recreation , participation in all art forms; in the study of personal interaction, yoga and mystical studies; and in the use of bio-feedback, and auto-suggestion. 11 From this statement it would seem that a technique such as transcendental meditation may have a valid part to play in counteracting drug abuse.

There are several studies which indicate that transcendental meditation may decrease drug abuse. H. Benson and R. Wallace studied 1862 subjects who had been practising transcendental meditation for three months or more. The subjects were asked questions about drug-taking habits six months before commencing transcendental meditation and at various intervals afterward. Benson and Wallace commented:

Following the start of the practice of transcendental meditation, there was a marked decrease in the number of drug abusers for all drug categories. As the practice of meditation continued, the subjects progressively decreased their drug abuse until after practising 21 months of meditation most subjects had completely stopped abusing drugs. 12

Another study of 484 subjects who attended a resident course on transcendental meditation at Squaw Valley, California, in 1969, showed: Of the 143 'regular' drug users , it was found that 83 per cent stopped the use of all drugs after contacting T.M. , 15 .5 per cent significantly decreased the

use of one or more drugs after contacting T.M., and 1. 5 per cent increased the use of one or more drugs. 13 The Committee believes that transcendental meditation could have a valuable role to play in the prevention and treatment of drug abuse.

178

References 1

Senate Select Committee on Drug Trafficking and Drug Abuse, Drug Trafficking and Drug Abuse (Canberra, 1971), p. 8l. 2

Evidence, pp. 638-9. 3

World Health Organisation, Study Group on Youth and Drugs (Technical Report Series, No. 516, Geneva, 1973), p. 11. • World Health Organisation, Expert Committee on Drug Dependence, Twentieth Report (Technical Report Series, No. 551) tGeneva, 1974), p. 61.

5

K. Bruun, G. Edwards, M. Lumio, K. Makela, L. Pan, R. E. Popham, R. Room, W. Schmidt, 0. Skog, P. Sulkunen & E. Osterberg, Alcohol Control Policies in Public Health Perspective (The Finnish Foundation for Alcohol Studies and the Addiction Research Foundation of Ontario) (Forssa, 1975), p. 28. 6

J. Eliason & D. Nurco (edd.), 'Operational Definitions in Socio-Behavioural Drug Use Research 1975' in National Institute on Drug Abuse Research Monograph (series 2) (Rockville, 1975). 7 Senate Select Committee on Drug Trafficking and Drug Abuse, p. 22. 8 Senate Standing Committee on Health and Welfare, Continuing Oversight of the Report

of the Senate Select Committee on Drug Trafficking and Drug Abuse (Canberra, 1975), p. 6. 9

Evidence, p. 903. 10 Evidence, p. I 076. 11 R. P. Irwin, Drug Education Programs and the Adolescent in the Drug Phenomena Problem (Canberra, 1976), p. 11.20.

1 2 H. Benson & R. K. Wallace, 'Decreased Drug Abuse with Transcendental Meditation­ A Study of 1862 Subjects', in Hearings Before the Select Committee on Crime (House of Representatives, Ninety-Second Congress, Serial No. 92-1) (Washington, DC, 1971), pp. 682-8. 13 J. B. Marcus, 'Transcendental Meditation: A New Method of Reducing Drug Abuse',

in Drug Forum, vol. 3, No. 2 (1974), p. 113.

179

CHAPTER a Education

Education in Australia

The aims of drug education are to reduce ignorance, to modify behaviour, and to uphold the mores of society. The Committee is aware that informa­ tion alone can be counter-productive and may even contribute to an increase in the incidence of drug use.

There is considerable variability in the type, content and quality of educational programs and it is likely that they have differing effects on behaviour. It is wrong to assume that every educational intervention is in itself desirable. All education programs should be evaluated and those

which cannot demonstrate a positive effect should be abandoned.

In 1971, the Senate Select Committee on Drug Trafficking and Drug Abuse declared: The Committee has concluded that existing programs aimed at correcting drug abuse are inadequate and that any program directed against drug abuse

in isolation would be ineffective. It believes that education programs in schools should be designed as 'education for living' as the best long-term preventive measure. I

The Select Committee recommended: that there should be established a National Education Council representative of the Commonwealth and all States. Its membership should be drawn from a variety of disciplines including:

• education; • medicine-including social health; • legal profession; • social workers; and • youth leaders. The Chairman of the Council need not necessarily be drawn from any one of the professions outlined but should have the qualities of being a dynamic leader with achievements in organisation and administration and the ability to gain the co-operation of others.

In addition the Council should be financially supported by the Common­ wealth Government. 2

In 1970, the Drug Education Sub-committee of the National Standing Control Committee on Drugs .of Dependence (NSCC) was set up to integrate, co-ordinate and advise on educational activities relating to drug abuse. 3 This Sub-committee formulated the National Drug Education Program and has supervised its implementation. Since 1970-71, the Federal

Government has provided funds for this Program-at the rate of $750 000 per annum since 1973-74. 4

181

The Program is meant to be very flexible and each State Education Department is free to develop its own curriculum. The general objectives for all programs are: (a) To prevent drug abuse:

(i) Prevent the non-committed from adopting habits which could lead to drug dependency or any other deviations harmful to society or the individual. (ii) Encourage people to make informed choices about their own

behaviour by increasing knowledge and facilitating the formation of discriminatory attitudes about drug use. (b) To allay public anxiety about the drug problem. (c) To increase the amount of information in the community about drugs and

the drug problem. (d) To increase communications between the generations about drug use and abuse. (e) At the individual level to help people develop personal resources which

will enable them: (i) to cope constructively with life stresses and problems, and (ii) to develop self-satisfying life styles which will benefit others as well as themselves. 5 In 1974, an assessment team visited all States and after reviewing their programs reported to the Drug Education Sub-committee in December

1974. Assessment was in the form of a description of each project, with comments where appropriate. One effective way of evaluating programs is to compare data relating to the extent of the use of drugs before an education program is begun with data obtained at intervals of time afterward. However, when the assessment was made in 1974 such data were not available except in one municipality in Sydney. One cannot believe that such an assessment was either comprehensive or adequate and it is therefore impossible to comment on the effectiveness of these programs

One study which was indirectly funded by the NSCC compared data. -on drug taking before and after the implementation of a drug education program. This study was carried out by R. P. Irwin in 1973 and 1974 in nineteen Canberra high schools. The project was conducted in three phases:

1. An initial survey was conducted to investigate the attitudes, beliefs and intentions of the students. The results were ·used to develop experimental programs. 2. Three educational approaches were introduced and the results were

compared with those for a control group which received no program. These programs were peer-led, teacher-led and individual. 3. A follow-up survey was conducted to measure differences from the previously established base line.

Some of Irwin's findings were: 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

182

24819!77-13

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 multicausal nature of drug use. The group discussion method without some sequence and progression, becomes bogged down in the '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. 6

Irwin's study also found that some educational approaches are counter­ productive with certain age or sex groups. For example, first form girls in the individual program had a significantly greater recruitment to drug use than did girls in the control group or those who had participated in

the teacher-led or group-led studies; and first form boys participating in the teacher-led approach had a rate of recruitment to drug use significantly higher than that of boys in the control group. 7

The First International Congress on Drug Education, which was held in Switzerland in 1973, concluded that the use of information alone, particularly when not given as part of a continuing program, is counter­ productive, and recommended that its use be abandoned. Some of the

activities judged by the Congress to be counter-productive were: (a) The use of selective statements such as: (i) 'the use of drug X always causes Y effect' (ii) 'the use of drug X never causes Y effect'

(b) The concept that drug abuse is the only problem involved in drug abuse (c) The concept that only youth is involved in drug abuse (d) The use of fear (e) The concept that all drugs can be lumped together as a homogeneous

group

(f) The use of ex-addict testimonials.

At the time of the conference only twenty papers had been published on evaluated drug education programs throughout the world. These showed: (a) Positive attitude change occurs only in long term programs based on

active participation (b) Behaviour change occurs when a long term program changes values (c) All other types of programs have failed. 8

183

Conclusions The conclusions drawn from the International Congress on Drug Educa­ tion, the report of the Senate Select Committee on Drug Trafficking and Drug Abuse, and Irwin's study generally support the view that drug education must aim at broad-value education rather than just at instructing on one specific form of behaviour. The aims of the present National Drug Education Program are consistent with this view.

The Committee recommends:

That the community be made fully aware of the objectives of the National Drug Education Program.

In view of the possible counter-productive effects of drug education, the Committee recommends:

That all drug-education programs be evaluated against the stated aims of the National Drug Education Program. No Commonwealth funds should be available to State programs which do not evaluate their work.

We also recommend:

1. That funds be withdrawn from drug-education programs which are found to be ineffective.

2. That, where possible, evaluation of the various State drug-education programs be conducted by means as effective as those used by R. P. Irwin in his studies of Canberra high school students in 1973 and 197 4.

3. That the annual allocation of Commonwealth funds to the National Drug Education Program be increased to allow for proper evaluation of the programs under its supervision.

References 1 Senate Select Committee on Drug Trafficking and Drug Abuse, Drug Trafficking and Drug Abuse (Canberra, 1971), p. 72. 2

Senate Select Committee on Drug Trafficking and Drug Abuse, p.73. 3 Drug Education Sub-committee, Statement on Policy (Commonwealth Department of Health, Canberra), p. 1. 4

Evidence, p. 1621. 5 Report of Assessment Team to Drug Education Sub-committee of the National Standing Control Committee on Drugs of Dependence (Commonwealth Department of Health, 1974), pp. 16-17. 6 Evidence, p. 1532. 7 R. P. Irwin, Drug Education Programs and the Adolescent in the Drug Phenomena Problem

(Canberra, 1976), p. 11. 8. 8 R. A. J. Webb, 1st International Congress on Drug Education, October 14-18, 1973, Montreux, Switzerland (Health Commission of New South Wales, 1973), pp. 6, 7.

184

CHAPTER s Background and Conduct

of the Inquiry

Background The Senate Standing Committee on Social Welfare is one of seven Legislative and General Purpose Standing Committees established by resolution of the Senate on 2 March 1976. This Committee replaced the former Senate Standing Committee on Health and Welfare. Under the

terms of the resolution, the present Committee was empowered to inquire into and report on such matters in its area of responsibility as had been referred to the Legislative and General Purpose Standing Committees appointed during previous sessions and not been disposed of by those

Committees.

The Collection of Evidence

One of the references remaining from the former Health and Welfare Committee was the continuing oversight of relevant aspects of the report of the Senate Select Committee on Drug Trafficking and Drug Abuse which had been presented on 6 May 1971. In February 1975, the Standing

Committee on Health and Welfare presented to the Senate a report on its continuing oversight of the drug use problem. That report considered all the recommendations of the Select Committee's 1971 report and identified areas which the Health and Welfare Committee believed

warranted further investigation. The twenty-six recommendations made by the Select Committee are listed at Appendix 9 and the sixteen sug­ gestions and/or recommendations made by the Health and Welfare Committee appear at Appendix 10.

There is still much inquiry to be made in the area of drug use, . particu­ larly at the national level. This view was reinforced by the Senate Standing Committee on Constitutional and Legal Affairs in April1976, in a report on outstanding references, in which it recommended that the continuing

oversight of the Select Committee's report be carried out by one Com­ mittee, namely, the Standing Committee on Social Welfare. Accordingly, on 26 May 1976, Senator Baume, on behalf of the present Committee, presented a report on outstanding references from the former Standing Committee on Health and Welfare and advised the

Senate that the Standing Committee on Social Welfare had resolved to continue the oversight and from time to time to investigate selected aspects raised in earlier reports. The Committee had also resolved that it would, initially, examine further the extent and nature of the inappropriate use

of alcohol, tobacco, narcotics and other drugs. Following prorogation of the Parliament on 28 February 1977, the Senate Standing Committee on Social Welfare was reappointed on 17 March 1977 without change in its membership.

In an attempt to achieve a co-ordinated approach and to gain the latest available information, the Committee advertised its terms of reference

185

Ocher Current Inquiries

Acknowledgments

widely in the national press on 5 June 1976 and invited written sub­ missions. In addition, we wrote to some sixty individuals, departments, organisations and universities and invited contributions from them in the form of written submissions.

The Committee also took evidence from sixty-one witnesses at eighteen public hearings, which were held in Adelaide, Brisbane, Hobart, Mel­ bourne, Perth and Sydney, as well as in Canberra.

The Committee was fortunate that the members were able to attend the Seventh International Conference on Alcohol, Drugs and Traffic Safety held in Melbourne from 23 to 28 January 1977. World experts presented papers in many fields associated with drugs of dependence. In addition, some of the overseas speakers at the conference met informally with the Committee for discussions on matters of mutual concern. The time spent with the Committee by these experts was appreciated. The resolutions adopted at the close of the International Conference have been noted by the Committee and are at Appendix 11.

Finally, we are aware of the South Australian Royal Commission into the Non-Medical Use of Drugs, and the New South Wales Royal Com­ mission of Inquiry into Drug Trafficking. A national royal commission on drugs has also been proposed. Our Committee has a continuing reference to oversight the problems of drug abuse, and will examine with interest the findings of such inquiries.

This Senate Standing Committee report is unique: it presents the most comprehensive survey yet published concerning the drug situation in Australia and its attendant social problems, and makes the first attempt to develop a comprehensive national strategy to deal with drug-use problems.

This would not have been possible without the assistance of a large number of people. In the first place, we thank the witnesses who appeared before the Committee. They presented to us comprehensive evidence more thorough in detail than has ever before been made available on many of the issues canvassed. Some of the responses by industry groups to our inquiry should serve as a model for other groups which may in future be called on to help inquiries of the National Parliament. Particu­ larly pleasing was the wholehearted co-operation from some State Premiers and their departments, from many organisations and from individual witnesses.

The Committee has been assisted by the dedicated work of its pro­ fessional staff. Messrs R. P. Joske and R. G. Thomson acted as secretaries to the Committee; Ken Bone and Pat Mayberry were our principal research officers. We thank them all for their significant contribution to the production of our final report. Thanks should also be given to the

186

research staff of the Parliamentary Library, Canberra, and to Mrs Denise Devir, our steno-secretary, who was subjected to constant rewrites of chapters as our views developed and crystallised.

The Senate, Canberra. October 1977.

PETER BAUME Chairman

187

Senator Melzer Chapter 5

Dissents by Committee Members

A National Strategy on Cannabis

I dissent from that part of the section 'A National Strategy on Cannabis', . in Chapter 5, which extends from the beginning of paragraph 8 to the conclusion of the first passage in paragraph 9 which is quoted from the evidence and which relates to activities involving cannabis use among

the young. Presenting some of this material in a different way, I would make the following comments. Clearly, the existing legal sanctions, as they have been applied, have failed to prevent the increasing use of cannabis or to eliminate trafficking

in the drug. Equally, whatever other measures have been taken have failed. However, legal sanctions enforced throughout the community without preference or privilege, in conjunction with community programs designed to reduce the demand for all drugs, could be effective as a

deterrent. Laws framed to allow courts, in determining the severity of a penalty, to differentiate between age groups and to take cognisance of the amount of cannabis found in the possession of a defendant, of the number of previous offences and of the role of the defendant-whether as user, 'pusher' or grower-would seem the most appropriate.

I believe-and I think the community is of the same opinion-that the use of this drug is not socially desirable, and that the present legal system exists to show that displeasure. From evidence given to the Committee by a number of witnesses, including police, it is evident that the use of cannabis crosses socio­ economic and age lines. It is equally evident that the police have appre­

hended more offenders in the younger age groups and that courts have failed to treat all offenders on an equal basis. One witness, speaking of activities involving cannabis use among the young, said: I think it is not so much because they practise them more-though I said

in my paper that cannabis is a drug of the young rather than the elderly section of the population-but simply because they do not have the privacy or the experience to the same extent which protects more middle-aged, more experienced people from falling into encounters with the police in these

matters.1 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. I agree with the remainder of the Committee's section 'A National Strategy on Cannabis'.

Referer.ce 1

Evidence, pp. 1305- 6.

189

Senators Tehan and Walters jointly Chapter 5

A National Strategy on Cannabis

We agree with the opening five paragraphs of the section in Chapter 5 of the report, 'A National Strategy on Cannabis', and we share the concern expressed by our colleagues in their statement that the use of cannabis in Australia should be positively discouraged. We, too, strongly desire to see its use significantly reduced. Clearly, the existing legal sanctions, as they have been applied, have failed to prevent the use of cannabis from increasing or to eliminate trafficking in the drug. Similar legislation has also failed to prevent the abuse of alcohol, particularly the offence of driving under its influence. Equally, other measures which have been tried, such as education programs, have failed to prevent the abuse of either cannabis or alcohol. It is manifestly unfair, however, to put the blame for the increase of cannabis use exclusively on any one factor, such as existing legal sanctions or the failure of the police and law enforcement officers to charge people found offending. Notwith­ standing that the present deterrents have failed to prevent the abuse of cannabis and trafficking in the drug, we believe that it would be irre­ sponsible to discard them in the absence of proven, effective alternative methods of control.

There are a number of misconceptions abroad in the community about the use of cannabis. We quote from the majority report, at page 162: . . . the existing legal situation has led to some unfortunate consequences. Among these are growing suspicion of corruption in the processes of Jaw

enforcement; diminished respect for the law and for enforcement authorities; deterioration of the relationship between young people and the police ... These include, we believe, a number of unsubstantiated, emotional cliches often expressed by those members of the community who un­ wittingly tend to undermine established law and order. It is manifestly inaccurate to lay solely at the door of the cannabis problem any supposed corruption or deterioration of the relationship between young people and the police, and there was no evidence before the Committee to support this suggestion.

While we recognise that cannabis is used by all age and socio-economic groups, there was evidence to show wider use by the youth of the com­ munity than by older age groups. This is recognised by the statement in the majority report, at page 129:

A number of studies have been done in Australia to monitor drug use. However, the cautions on interpretation given in Chapter 7 must be once again briefly repeated. Firstly, many of the studies are not comparable, because the questions asked were different. Secondly, such studies have con­ centrated almost exclusively on what have been considered to be the 'at-risk' groups. These surveys have been carried out only in the recognised 'at-risk' areas such as universities, schools, colleges and nursing centres. We agree with the view of some witnesses that, as the user becomes older and moves from one social milieu to another, he gives up cannabis for the more socially acceptable drug of alcohol. 1

190

The Committee, as indicated in the report, is unanimously opposed to the legalisation of cannabis. We go further, however, and oppose 'de­ criminalisation' also (see dissent on 'Recommendations on the Law Relating to Cannabis', at page 195).

We agree with the evidence before the Committee which indicated that decriminalisation would in fact increase the use of cannabis. 2 We recognise that the debate on cannabis has highlighted the failure of our present approaches to alcohol-our major national drug problem­

and has underlined the need to control this new drug, cannabis, before it, too, reaches similar proportions. We are strongly of the view that the use of cannabis should not be legalised simply because it is legal to take alcohol. It has been claimed that the proscription of cannabis has been

inconsistent with the attitude to excessive use of alcohol and tobacco. We reject this claim and support the view expressed in evidence by Mr King, a marihuana user, who said: Cannabis is the most frequently used of the illegal drugs. Its popularity is

growing and will continue to grow. 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'. The inference is direct, precise and almost always implicit. The act of getting stoned is very deliberate. It is shared in turns and in comparison with alcohol short and quick. Getting stoned is rarely incidental to smoking as getting drunk may be to drinking. 3 This view is supported by other witnesses 4 and by surveys which show

that the use of cannabis often is limited to once a week or once a month, at times when intoxication would not interfere with normal activity. We disagree with the inferences drawn by the majority from recent United States experience. One of the nine States (South Dakota) referred

to in Table 5.14 of the majority report (see page 158), has already legis­ lated to recriminalise possession of small quantities of marihuana. This action has reversed its stance from last year when legislation was passed to take possession of less than 1 oz of marihuana off the criminal list and

make it a petty offence carrying a fine of $20. 4a This is a clear indication that at least one State has had second thoughts. A campaign has also been launched in the State of Maine to recriminalise possession of marihuana on the grounds that:

. . . the rush to 'decriminalise' and legalise marihuana and hashish by a highly active lobbying organisation and a massive, misleading, propaganda campaign is being pushed, state by state, without suitable consideration of: (1) necessary legal safeguards to discourage use, (2) new cautionary medical

evidence and (3) the fact that such legal decriminalisation by governments is giving the drug an unwarranted 'good housekeeping seal of approval' as a 'harmless' substance and suggests a social sanction especiall y to youth. 4b At pages 158-61, the report deals with surveys made in Oregon in 1974 and 1975-the two years immediately following the adoption of decrimi­

nalisation legislation in that State; with an official study by the legislative research service of the Oregon State Assembly, which was presented in December 1974; with a statement by Dr Robert L. DuPont ; and with

191

extracts from a report by the State Office of Narcotics and Drug Abuse within the Health and Welfare Agency in California. The two surveys conducted in 1974 and 1975 were commissioned by the Drug Abuse Council Inc. from a market research firm in Portland. It is claimed that these surveys indicate that there had been no increase in the use of marihuana in Oregon following the adoption of the decriminalisation law. We are of the opinion that the inferences drawn are misleading and unreliable. The reports on the surveys do not purport to make a com­ parison between the number of users prior to and the number after the change in the law, and there are no figures available to show the number of users for the year immediately before decriminalisation.

The report of the majority, at pages 159-60, quite properly draws attention to a fallacy in the conclusions reached by Dr Hardin B. Jones concerning the percentage increase in the number of users following decriminalisation. It should be pointed out, however, that there are available no surveys which disclose any decrease in the number of users.

The survey figures, moreover, included only subjects eighteen years or over, as was pointed out by Dr Hardin Jones. We would direct attention to the situation in Australia, where there is a significant and growing problem among those under eighteen, as disclosed in surveys throughout Australia (see pages 129-37).

Mr D. W. Murdoch rejected decriminalisation of marihuana use in Oregon as a model for Australia when he said: 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. 5 Mr F. D. Potts 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. 6

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. 1 understand they were particularly concerned about international control. 7 Dr Gerald Milner commented as follows:

First, people need proper information. Information about the driving hazards and the progression and the chronic effects of cannabis use has not been disseminated. Let us face it, a lot of government-sponsored inquiries are carried out by public servants who know which side their bread is buttered and they move from an unwarrantable assumption to a forgone conclusion; I think that is the case with the Oregon survey in the United States recently. I would like you to look at the Indian and the Egyptian studies-and they are the · biggest, much bigger than anything the Americans have done­ which show the progression. You see in 1973 the Americans thought they had the drug problem licked; it was on the downgrade and they came out with all sorts of wild announcements about this. DuPont himself did; then in

1975 he said: 'I \-vas wrong; there now is a very worrisome increase'. What he had was a graph that was going like that, and on one of the little down­ swings everybody said: 'That is it; we have cured the problem' . But every­ body who keeps stocks and shares knows it is not the little down-swings you worry about, it is whether it is going steadily up over a long period. 8

192

We do not think that any conclusion that decriminalisation has reduced the use of marihuana can be drawn from the Oregon experience. In any event, what may be desirable in the United States is not necessarily desirable in Australian conditions. In various fields in the past, the American model has proved an unreliable guide for changes in attitudes

and policy in similar fields in Australia. We agree with the majority finding that the strategy recommended is based on two premises. The first is the need to reduce the overall con­ sumption of cannabis and the second is the need to have deterrents and responses which are appropriate and effective in meeting this initial requirement.

Accordingly, we recommend: That the national strategy on cannabis be: 1. To reduce national consumption in respect of both recruitment and present personal use.

2. To recognise the difference between the abuse of cannabis and of other illicit drugs and to ensure that both the law itself and the law enforcement agencies are made aware of this difference. 3. To highlight the dangers of cannabis use, particularly while driving

a motor car or performing other functions depending on complex psychomotor activity. 4. To identify people who need treatment as a consequence of cannabis use and to develop effective treatment methods, such treatment methods

to be available to the courts in dealing with offenders. 5. To provide uniform laws throughout Australia for deterring and treating offenders.

References 1 Evidence, pp. 612, 1909. 2 Evidwce, pp. 613, 931, 1089, 1681, 3028-9. 3

Evidence, p. 2053. ' Evidence, pp. 758, 1958. 40 International Drug Report, May 1977, p. 7. db International Drug Report, May 1977, p. 6.

:; Evidence, p. 1682. 6

Evidence, p. 2038. 7

Evidence, p. 2039. 8 Evidence, p. 2777.

193

Senators Melzer, Tehan and Walters jointly Chapter 5

Recommendations on the Law Relating to Cannabis

The second matter on which we find ourselves in disagreement with our colleagues relates to the section 'Recommendations on the Law Relating to Cannabis', in Chapter 5. We agree with the first recommendation proposed by them, together with the statement preceding it. This re­ commendation reads:

That the Commonwealth and the States enact cannabis legislation which recognises the significant differences between opiate narcotics and cannabis in their health effects and in the criminal impact on users and the community. Table I sets out the present position in relation to legislation in the Australian Capital Territory, the Northern Territory and each of the States in regard to marihuana, defined for the purpose of this chapter as dried leaf only.

Table I Penalties for offences related to Marihuana

State or Territory Possession

New South Wales . Imprisonment for up to 2 years and/or a fine of up to $2000

Victoria

Queensland .

Section 34, Poisons Act 1962: Imprisonment for up to 12 months and/ or a fine of up to $500

Imprisonment with hard labour for 2 years and/or a fine of $2000

South Australia A fine not exceeding $2000, or imprison­ ment for 2 years, or

both

Western Australia . Imprisonment for up to 3 years and/or a

fine of up to $2000

Tasmania Imprisonment for up

to 2 years and/or a

fine of up to $3000

Northern Territory Imprisonment for up to 2 years and/or a

fine of up to $800

Possession of small amounts

Australian Capital Imprisonment for up A fine of up to Territory to 2 years and/or a $100

fine of up to $800

(a) Legislation currently in the N.S.W. Parliament.

194

Cultivation Trafficking

Imprisonment for up to Imprisonment for up to 10 years and/ or a fine of 10 years up to $25 OOO(a)

Charge is under Health Act. First offence:

penalty, $200. Second or any subsequent of­ fence: penalty, $400 or imprisonment for not

more than 6 months

Before a judge: Im­ prisonment for life and/ or a fine of $100 000 Before a magistrate: Imprisonment for 2 years and/or a fine of

$2000

Imprisonment for up to 10 years and/or a fine of up to $4000

Before a judge: Im­ prisonment for life and/ or a fine of $100 000 Before a magistrate: Imprisonment for 2 years and/or a fine of

$2000

A fine not exceeding A fine not exceeding $4000, or imprison- $4000, or imprison­ ment for 10 years, or ment for 10 years, or both both

Imprisonment for up Imprisonment for up to 3 years and/or a to 10 years and/or a

fine of up to $2000 fine of up to $4000 (S. 52 (1))

Imprisonment for up Imprisonment for up to 2 years and/or a to 10 years and/or a

fine of up to $4000 fine of up to $4000

Imprisonment for up Imprisonment for up to 2 years and/or a to 2 years and/or a

fine of up to $800 fine of up to $800

Same as for possession Imprisonment for up to 2 years and/or a

fine of up to $800

It will be noted from this table that there is a lack of uniformity in the laws of the Commonwealth and those of the various States. It will also be noted from the table that the only legislature that provides for a separate penalty for possession of small amounts of marihuana is that in the Australian Capital Territory. We are of opinion that there should be

uniformity throughout Australia to provide for a separate offence for possession of small amounts of marihuana. We are also of opinion that there should be complete uniformity in the law throughout Australia, as to both marihuana and cannabis.

We note that, on 30 August 1977, Victoria proclaimed legislation which increased penalties for trafficking in cannabis, as distinct from marihuana, from a fine of up to $4000 and/or up to ten years in gaol to a fine of up to $100 000 and/or up to 15 years in gaol.

It may be useful if, before proceeding to our firm recommendations on the law relating to cannabis, we detail our objections to the recom­ mendations in the report, the first of which is that the offence of possession of marihuana for personal use not be defined in law as a crime. 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. 'Decriminalisation' is a term which is popularly used throughout the

Western World when discussing the cannabis issue. It is generally accepted as meaning a reduction in the gravity of the offence, either by removing it from its criminal context or by other means. The general thrust of the majority recommendations as to the law does, we believe, fall within this

definition. We further are of opinion that merely to change the word 'penalty' for the word 'fine' somewhat begs the question, as the important and relevant matter in our view is the consequences which flow to the person

charged after the offence is proved. To use what we regard as an artificial device to remove an offender against the law relating to the use of mari­ huana from the general stream of the criminal law is to accord special treatment to one section of offenders whose case we regard as no different from that of the normal run of persons convicted of offences against the

criminal law. We think that, if a reform of this nature is to be introduced, it should be done in the general context and against the background of the whole gambit of offences under the criminal law. Furthermore, we feel that no case has been made by evidence to the Committee that the

recommendation of the majority, if adopted, would in any way reduce the use of marihuana in the community. We strongly endorse the views expressed to the Committee by Detective Superintendent C. E. Kent, 1 Mr R. Tomasic, 2 Mr F. D. Potts, 3 Mr H. Bates 4 and Mr D. W. Murdoch 5

that decriminalisation or a more relaxed attitude to the law could increase the use of marihuana.

195

With regard to the second recommendation of the majority, we take the view that the courts should be vested with a discretion to impose a higher pecuniary penalty for a second or subsequent offence by the same person.

We also disagree with the majority finding as to a firm direction to the police not to take fingerprints or photographs of defendants. While some of us have reservations as to whether police should have the power to fingerprint and photograph prior to conviction, we believe that there should be no differentiation between an offender against the law relating to the possession of marihuana for personal use, or to the use of marihuana, and other offenders against the criminal law.

The third recommendation to which objection is taken provides that no record of conviction of any person kept by the police shall include particulars of a conviction for possession of small quantities of marihuana for personal use. The main thrust of our objection to this recommendation is that already made to the other recommendations, in that we can see no reason why the normal court and police record of conviction should not be kept for these offences on the same basis as for other offences against the criminal law.

With regard to trafficking, we agree with the recommendation of the Committee that the present penalties and the $4000 maximum fine for trafficking of cannabis in leaf form be raised to a level more appropriate to the quantities involved in seizures.

We reject the recommendation of the majority that where necessary Commonwealth and State Governments consider clarifying the law so as to impose, for the cultivation of a specified and limited amount of marihuana for personal use, the same level of penalty as for possession. We are of opinion that the law should prohibit absolutely the growing of the cannabis plant whether for personal use or otherwise, and that growing should attract the same penalties as trafficking.

Two major objections to this majority recommendation are: (a) the difficulty of policing the number of plants which could be claimed as required for personal use; and (b) the cannabis plant not only produces marihuana but also contains

harmful derivatives, for example, hashish and hashish oil, and the tetrahydrocannabinol content varies considerably from variety to variety. We quote from a paper entitled 'Forensic Chemistry in Australia with regard to Drugs of Dependence' presented by Dr I. Dainis at the 46th Australian and New Zealand Association for the Advancement of Science Congress in January 197 5:

The dried cannabis plant and specifically the flowering tops from the female plant may contain from 0-14 per cent THC. Normally most samples of good quality manicured cannabis contain from 0.2-1.0 per cent THC, whilst superior quality samples may reach 2 per cent THC. The form known as 'Buddha grass' or 'Thai sticks' (in the U.S.A.), is a specially manicured natural cannabis from Thailand which contains 4-14 per cent THC. This preparation is therefore at least some four to ten times more potent than normal manicured cannabis.

196

Cannabis resin itself is defined within the Customs Act as 'the resin, whether crude or purified from the plant Cannabis sativa', and this affords a distinction between hashish and liquid hashish. Thus we term hashish as crude cannabis resin, and liquid hashish (or hashish oil) as purified cannabis resin.

Hashish itself exhibits a wide diversity of THC content and this reflects the type of cannabis used and also the method of manufacture. When prepared by beating and sieving of cannabis tops it is a fibrous, greenish-yellow to gold powder. Samples rich in resin (and THC) are more brown in colour and also more plastic to the touch. This form is typical of Middle East manufacture and may contain 5-15 per cent THC. The hashish prepared in the Indian

Sub-continent by rubbing of the cannabis tops or similar means, comes in a bewildering array of shapes and colours, and it may contain 5-25 per cent THC. Both types of hashish still contain an appreciable (60-90 per cent) amount

of inert vegetable matter. When this is removed what is left is the purified resin as a dark syrupy liquid. Those samples seen in Australia have contained 5-40 per cent THC with an average content of 25 per cent THC. More potent preparations have been reported from the U.S.A. (62 per cent THC; DEA) and the upper natural limit would appear to be 78 per cent THC. No syn­ thetic THC, i.e. 100 per cent THC has yet appeared on the illicit market.

An analogy can be drawn here between alcoholic beverages and cannabis products in that the progression from cannabis to hashish oil is very similar to that from beer to neat alcohol. We are supremely conscious of the established relationship between the abuse of alcohol and the appalling carnage on the roads to which the increasing use of cannabis has added a new dimension. There is sub­

stantial evidence before the Committee as to the disastrous cumulative effect of combined intake of alcohol and cannabis. 6 We feel that for this reason alone any reduction in the penalties for use of cannabis should be vigorously opposed.

We offer no objection to, and in fact wholeheartedly support, the final two recommendations of the Committee, namely, that appropriate diversionary programs be developed and instituted for both possessors of and traffickers in cannabis and that the Commonwealth Government initiate annual reviews of the effects of any changes in the law to determine any need for further action.

Summary of Recommendations l. That the Commonwealth and States enact cannabis legislation which recognises the significant differences between opiate narcotics and cannabis in their health effects and in the criminal impact on users and the community. 2. That there be uniform laws throughout Australia for penalising and

treating offenders, including provision for a separate offence for possession of small amounts of marihuana. 3. That the courts be vested with a discretion to impose a higher pecuniary penalty for a second or subsequent offence by the same person. 4. That appropriate diversionary programs be developed and instituted for

both possessors of and traffickers in cannabis. 5. That the Commonwealth Government initiate annual reviews of the effects of any changes in the law to determine any need for further action .

. References 1 Evidence, p. 931. 2 Evidence, p. 613. 3 Evidence, pp. 2038-9. 4 Evidence, p. 1089.

5 Evidence, p. 1681. 6 Evidence, p. 2758.

197

24819/77-14

Appendix 1

Voluntary code for advertising of alcoholic drinks* 1. Advertisements for alcoholic drinks should be directed only to the adult audience.

2. Normally children should not be portrayed in an advertisement for drink; however in a scene where it would be natural for them to be present (e.g. a family situation or in a crowd or other scene, where the background is not under the control of the advertiser) they may be

included provided that it is made clear that they are not drinking alcoholic beverages. 3. Anyone shown drinking in any advertisement shall be obviously above the legal drinking age. 4. Advertisements should be directed to effect a change in the share of

the total market for alcoholic drinks and they should not aim at increased consumption of alcohol. 5. Advertisements should do no more than reflect people drinking responsibly in natural situations. 6. It is legitimate to show persons preferring or enjoying a particular

kind or brand of alCoholic drink, but advertisements should not imply that success sochll distinction accompanies drinking alcohol. 7. Advertisements should neither claim nor suggest that the drinking of alcohol can contribute towards sexual success. 8. Advertisements for alcohol will not show people drinking in work

situations. 9. Except in advertisements designed to educate consumers, characters may never be portrayed as both drinkers and drivers within an advertisement. 10. Advertisements should not 'dare' people to try a particular drink to

imply that they will 'prove' themselves in some way if they accept the 'challenge' by the drink.

11. Inducements to prefer specific brands within the market for alcoholic drinks, because of their high alcohol content, shall not be used. 12. No advertising of alcoholic drinks should encourage over-indulgence.

* Media of Australia, Voluntary Codes of Advertising Practice.

199

Appendix 2

Tar and nicotine yields of cigarettes sold in Australia as at April 1977

Tar

Brand (mg/cig)

Albany Filter 13

Albany Trim Size 11

Albany Trim Size Menthol . 11

Alpine Filter Menthol 13

Ardath Filter 14

Ardath Menthol 14

Ascot Filter 17

Belvedere Premium 16

Benson and Hedges Extra Mild 12

Benson and Hedges Special Filter 17

Black and White 12

Black and White Menthol . 12

Cambridge Extra Mild Menthol 13

Cambridge Extra Mild Virginia 12

Capstan Medium Cork 18

Capstan Mild Cork 16

Capstan Plain 18

Chesterfield Filter 18

Claridge Filter . 16

Consulate 17

Country Life Filter 16

Courtleigh 17

·Craven 'A' Cork 17

Craven Filter 17

Craven Special Mild 12

Dukes 18

Du Maurier 13

Dun hill 17

Dunhill International 19

Escort Filter 14

Escort Menthol 17

Fiesta Menthol . 17

Fifth A venue 14

Galaxy Filter 15

Garrick Filter 15

Glendale Menthol 16

Goldstream 8

Hallmark Dual Filter 8

Hallmark Dual Filter Menthol 8

Kent 14

Kent King Size . 15

Kingford Filter . 13

Kool 15

200

Nicotine (mg/cig)

1.0 0.8 0.7 0.8

1.0 1.0 I .4 1.2 0.9

1.3 0.9 0.8 0.8 0.9

1.2 1.1 1.1 1.1 1.2 1.3 1.0 1.2 1.2 1.2 0.9

1.2 1.0 1.2 1.4 1.0 1.1 1.0 1.0 1.0 1.1 1.1 0.5 0.5 0.5 1.1 1.1 0.9 0.9

Appendix 2-continued

Tar Nicotine

Brand (mgjcig) (mgjcig)

Marlboro Lights 11 0 . 8

Marlboro Menthol 14 0 .9

Marlboro Red 14 0.9

Marlboro (Soft Pack) 14 1.0

Martins 14 1.0

Mercedes 12 0.9

Most 16 1.1

Nelson 12 0.9

Pall Mall Filter . 22 1.5

Park Drive Filter 13 1.0

Park Drive Menthol 13 0.9

Peter Jackson King Size 13 1.0

Peter Jackson King Size Menthol 13 0 .9

Peter Stuyvesant 16 1.0

Peter Stuyvesant Extra Mild 13 1.0

Peter Stuyvesant International 16 1 .2

Peter Stuyvesant Luxury Length 16 1.3

Philip Morris Filter 13 0 . 9

Players Filter 18 I. 3

Players No. 6 17 1.3

Players Trent 12 0.8

Players Trent Menthol 13 0.9

Polo. 10 0.8

Rothmans Filter 16 I. I

Rothmans International 18 1.4

Rothmans Ransom 5 0.3

Rothmans Royals Virginia . 17 1.1

St Moritz. 13 0 . 9

State Express 555 19 1.3

Temple Bar 21 1.3

Turf Cork 15 1.0

Turf Filter 14 1.1

Viscount 14 1.0

Viscount Extra Mild 10 1.0

Vogue 17 1.4

Wild Woodbine Filter 14 1.0

Wills Super Mild 11 0.8

Wills Virginia 12 0.9

Winfield Export . 16 1.1

Winfield Extra Mild 11 0 . 9

Winfield Menthol 15 1.0

Winfield Virginia 15 1.0

Source : Hon. Ralph Hunt, Minister for Health, press statement, 17 May 1977 .

201

Appendix 3

Voluntary code for advertising of cigarettes in print media 1. Cigarette advertising shall be directed only to adult smokers and intended to effect a change of brand.

2. Except in crowd or other scenes, where the background is not under the control of the advertiser, no characters shall be employed in cigarette advertisements who are under 25 years of age. 3. No family scenes of father and/or mother handling cigarettes in

front of children may be included. 4. No advertising for cigarettes may include persons who have major appeal for children or adolescents under 18 years of age. 5. Where a cigarette packet is included in advertising it will bear the

health warning. 6. Advertisements shall not include well-known past or present athletes or sportsmen smoking cigarettes nor anyone smoking cigarettes who is participating or has just participated in physical activity requiring

stamina or athletic conditioning beyond that of normal recreation. 7. When an advertisement depicts success or distinction it shall not be implied that this is due to cigarette smoking. Advertising may use attractive models or illustrations thereof, provided there is no sug­

gestion that the attractiveness is due to cigarette smoking. 8. Cigarette advertising must be aimed only at smokers, but must not be intended to imply or convey that all persons are smokers. In practice, where there is a group of at least four people featured in an

advertisement, at least one shall be shown as a non-smoker. 9. Cigarette advertising must not show exaggerated satisfaction from the act of smoking. 10. No advertisement may claim health properties from any cigarette.

II. No claim for reduction of any ingredient from smoke of any cigarette may be included in advertising.

NOTE: This Code proposal was lodged with MCA by Cigarette Manufacturers, jointly representing Amatil Ltd, Rothmans of Pall Mall (Australia) Ltd, Philip Morris Ltd and R. J. Reynolds Tobacco (Australia) Pty Ltd.

202

Appendix 4

Table A Proprietary oral analgesics Proportions of National Sales Volume by Outlets

Proportion of total

Chemist Food Other national

Type shops stores outlets(a) sales

per cent per cent per cent per cent

Powders (pkts of 12) 5 . 1 55 .0 39 .9 50 . 2

Tablets (boxes of 24) 54.4 27.7 17.9 49 . 8

(a) Es timated volume through clubs, hotels, garages, milk bars, etc. Source : Reckitts Pharmaceutical D ivision, a divisi on of R. & C. Products Pty Ltd.

Table B Proprietary oral analgesics Sales Related to State Population

(N ational Chemist and Food Stores ; Other Outlets not Included)

Proportion of national Metro- State

State population Type politan Country total

per cent per cent per cent per cent

Queensland (including 15 .0 Pdrs 48.5 51.5 59 .6

Northern Territory) Tabs 51.1 48.9 40.4

New South Wales (in- 37 .2 Pdrs 53 . 8 46.2 50 .5

eluding Australian Tabs 58 . 5 41.5 49.5

Capital Territory) Victoria 27 . 5 Pdrs 65.0 35.0 13 .5

Tabs 66.4 33 .6 86.5

Tasmania 3.1 Pdrs 14.2

Tabs 85 .3

South Australia 9 .2 Pdrs 23.1

Tabs 76 .9

Western Australia 8.0 Pdrs 22.2

Tabs 77 .8

Source: Reckitts Pharmaceutical Division, a division of R. & C. Products Pty Ltd.

24819/77-15

Proportion Proportion of national of total sales, by national type sales

per cent per cent

34 .5 24.5

17 .2 52. 8 44. 2

38 .0

5.3 16 .7

25 . 1 0 .6 2.0

2.8 4 .0 7 . 3

9 . 8 2.8 5 .3

7.1

203

N

Appendix 4-continued 0 ""' Table C Proprietary oral analgesics Proportions of Market Shares

(National Drug Index and National Food Index)

Rest of

Rest of New

Queens- South Mel- Rest of South West em

Type National Brisbane land Sydney Wales bourne Victoria Tasmania Australia Australia

% % % · % % % % % % %

Aspirin 21.6 12.7 14.4 20.5 19 . 3 33.7 33 .1 29.8 21.4 33.1

Codeine Co. 9.5 5.3 5.5 9.2 7.5 16.8 14.4 11.7 13.3 10.8

Codeine Co. plus Caffeine . 4.7 3.9 4.7 4.8 4 .5 5.4 5.5 6.6 4 .3 4.4

Paracetamol 5.0 4.0 3.8 5.4 5.1 5.3 5.1 3.9 6.2 5.2

Bex-Aspirin

1Tablets Phenacetin 2.8 0.2 0.2 0 .3 0.4 7.5 10.4 12.0 6.7 9.0

Caffeine j Powders . 17.1 17.6 20.9 17.4 22.2 8.4 9.5 6.2 17.2 16.5

Total 19.9 17.7 21.1 17.7 22.6 15.9 19 .9 18.2 23.9 25.5

Vincent's-Aspirin I

Salicylamide J Tablets . 1.0 0.2 0.3 0.5 0.7 1.7 1.6 8.4 1.6 2.0

Caffeine Powders . 26.2 41.8 38.4 33.1 32.0 4.9 5.3 7.8 7.2 7.3

Total 27.2 42 .0 38 .7 33 .6 32.6 6.6 6.9 16 .2 8.8 9.3

Others-Tablets 11.4 12 .9 10 .3 7.8 7.8 16.1 15.0 13.4 22.1 11.5

Powders 0.8 1.3 1.4 1.1 0.7 0 . 1 0 .1 0.1 0.1 0.2

Total 12.1 14.2 11.7 8.9 8.5 16.2 15.1 13.5 22.1 11.7

Total Tablets 55.9 39.3 39.3 48 .4 45.2 86 .5 85.1 85.9 15.5 76.0

Total Powders 44.1 60 .7 60.7 51.6 54.8 13.5 14 .9 14.1 24.5 24.0

Source: Reckitts Pharmaceutical Division, a division of R. & C. Products Pty Ltd.

Appendix 5

Obtaining consumption from data supplied by Reckitts Pharmaceutical Division (i) For Tasmania, South Australia, Western Australia: Proportions of total national market (0.020, 0.073, 0.053 respectively)

were multiplied by percentage market shares within each State to give consumption in arbitrary units, e.g. for aspirin in Tasmania-0.020 X 29.8 = 0.60 (ii) For other States:

Additional steps were necessary because of the metropolitan/country split. First we calculated shares of the national market as follows­ (proportion market for powders x proportion of powders in analgesic sales + proportion market for tablets x proportion of tablets in

analgesic sales) proportion of national market in State. Example for Sydney proportion of national market is-(0.538 X 0.505 + 0.585 X 0.495) 0.442 = 0.248 remaining results are-

rest New South Wales and Australian Capital Territory = 0.194 Brisbane = 0.121 rest Queensland and Northern Territory = 0.124 Melbourne = 0.111 rest Victoria = 0.056. Secondly, consumptions were obtained as in (i), amounts for metro­ politan and non-metropolitan regions being added, e.g. for aspirin in Queensland and Northern Territory:

0.121 X 12.7 + 0.124 X 14.4 = 3.32 (iii) The results of these calculations are shown in Table A.

Obtaining Consumption Rates

Consumptions were divided by percentage populations to give consumption rates in arbitrary units. This is shown in Table B.

205

Appendix 5-continued

Table A Proprietary oral analgesics

Consumption (arbitrary units)fa) by State

New South Wales

Queensland (including (including Australian Northern Capital South Western

Type Territory) Territory) Victoria Tasmania Australia Australia

Aspirin. 3.32 8.83 5.59 0.60 1.56 1. 75

Codeine Co. 1.32 3.74 2.67 0.23 0.97 0.57

Codeine Co.

:} 1.05 2.06 0.91 0.13 0.31 0 .23 + Caffeine Paracetamol 0 .96 2.33 0.87 0.08 0.45 0.28

Bex (aspirin + phenacetin+ caffeine)-Tablets 0.05 0. 15 1.42 0.24 0.49 0.48

Powders 4.72 8.62 1.46 0.12 1.26 0.88

Total 4.76 8.77 2.88 0. 36 1. 75 1.35

Vincent's (aspirin + salicylamide + caffeine)-Tablets 0.06 0.26 0.28 0.17 0.12 0.11

Powders 9.82 14.42 0.84 0.16 0.53 0.39

Total 9.88 14.66 1.12 0.32 0.64 0.49

Others-Tablets 2.84 3.45 2.63 0.27 1.61 0.61

Powders 0.33 0.41 0.02 0.00 0.01 0 .01

Total 3. 17 3.86 2.64 0.27 1.61 0. 62

Total tablets 9.63 20.77 14.37 1.72 5.51 4.03

Total powders 14.87 23.43 2.33 0.28 l. 79 1.272

(a) Per cent proprietary analgesic market shares x proportion of national sales (see page 205).

206

Appendix &-continued

Table B Proprietary oral analgesics Consumption {arbitrary units)

New South Wales

Queensland (including (including Australian Northern Capital

Type Territory) Territory) Victoria Tasmania

Aspirin. 22 .2 23 .7 20 .3 18.4

Codeine Co. 8.8 10.1 9.7 7.6

Codeine Co.

:} 7.0 5.6 3.3 4.3 +Caffeine Paracetarnol 6.4 6.3 3.2 2.5

Bex (aspirin + phenacetin + caffeine)-Tablets 0.3 0.4 5.2 7.7

Powders 31.5 23.2 5.3 4.0

Total 31.7 23 . 6 10.5 11.7

Vincent's (aspirin + salicylamide + caffeine)-Tablets 0 .4 0.7 1.0 5.4

Powders 65.5 38.8 3. 1 5.0