I move amendment No. 17:
In page 6, subsection (1), line 13, to delete " regulating " and substitute " permitting ".
This changes subparagraph (a) of sub-section (1) of this section to read: " prohibiting absolutely, or permitting . . ." We thought the word " permitting " would be a better word here than " regulating ". There is a reference to regulations in the main part of subsection (1).
If that is the way the Minister feels about it. I would think " regulating " is a better word.
It is more in keeping when taken in the context of the line preceding it: you make regulations regulating and now you say " permitting ".
I do not see anything wrong with saying making regulations regulating.
We will not argue over that.
It is the Minister's Bill.
I move amendment No. 18:
In page 6, subsection (1), line 20, to delete " sale or supply, the offering for sale or" and substitute " supply, the offering to ".
This is another small point by way of clarification.
Which will have it reading now: " (iii) the supply, the offering to supply or the distribution of controlled drugs,".
It tidies up the wording.
I move amendment No. 19:
In page 6, between lines 22 and 23, to insert before paragraph (b) the following new paragraph:
" (b) requiring prescribed documents to be used in a prescribed manner in relation to prescribed transactions concerning controlled drugs and requiring copies of such documents to be furnished to prescribed persons, or to persons of a prescribed class or description,".
This additional paragraph requires prescribed documents to be used in a prescribed manner in relation to prescribed transactions concerning controlled drugs and requiring copies of such documents to be furnished to prescribed persons, or to persons of a prescribed class or description. It is necessary to provide in the regulations for documentation of certain transactions involving controlled drugs. Where, say, a messenger is to be sent for such drugs it will be necessary that he have a signed order which the supplier can retain as proof that he has supplied him. In addition, the messenger will have to have documentation to establish his identity and, of course, his bona fides. I do not know whether or not that is sufficient. I may be entirely wrong about this but it is possible that, say, a young messenger could be waylaid and the drug or prescription taken from him. I do not know whether we should go so far as to provide for such a situation. It might be superfluous to provide for, say, a photograph of the messenger because many a thing could happen between the person who prescribes and the person who supplies. In any case, it would be necessary to include this to cover that particular circumstance.
The Minister is using the word " prescribed " here—" prescribed documents ". Is that wise wording to use here because, in the context of this Bill, prescription would have a particular medical meaning. I do not think it is intended in that context here.
Again, back to the definition section on page 4 where it is said " prescribed " means prescribed by regulations made by the Minister under this Act.
I recognise that. It is a small point but " prescription " has a certain medical connotation. That is not really what the Minister means here, I admit. He means requiring certain documents laid down.
Yes.
I move amendment No. 20:
In page 6, subsection (1), between lines 22 and 23, to insert:—
" (v) the showing in public or the broadcasting of any feature, film or play or the publication of any similar matter in connection with controlled drugs."
The Minister has laid down in paragraph (a) of subsection (1) a number of matters in regard to controlled drugs: the manufacture of them, the production of them, the preparation of them, the importation or exportation of them, the sale of them, the transportation of them. He proposes to give himself power to make regulations prohibiting the particular operation completely or permitting it subject to certain conditions. In my amendment I am seeking to include the broadcasting of any feature, film, play or publication in connection with controlled drugs. In other words, I propose that the broadcasting of films or plays about drugs would come within the general controls laid down in section 5. I should like to see the Minister in a position in pursuance of his general duties in regard to drugs able to prevent the showing on television or elsewhere of films or features if, in his opinion, showing them would be detrimental. If the Minister is going to take power in regard to the transportation of drugs surely it is even more important that he should take power in regard to the showing of films and such like about the use of drugs. I do not want to overstate the case but one can visualise films or plays glamourising the drug culture and I believe it would be wise of the Minister to take unto himself the power to control that sort of situation. I do not suppose any of us in this day and age would be advocates of censorship unless it were absolutely necessary but, if we have censorship of other types of publications, surely this is an area in which we should give the Minister for Health in the interest of the general welfare and general well-being a particular power of censorship in regard to these types of publications.
We frequently hear criticism of the extent of advertising in regard to alcohol and violence in films and so on. As the Minister is, I am sure, well aware there is a tremendous lobby for the drug culture and pressure with regard to certain drugs about which people know very little. It is argued that the penalties should not be so drastic and so on. There is the possibility of glamourising certain aspects of the drug culture, as Deputy Haughey has said, and I would certainly agree with everything he says.
I would not be inclined to agree with that proposition at all. We would be entering into a new field of censorship. There is general opposition to censorship and I believe that what we should aim at is enlightening people and it is the people who will be the best judges of what is good or what is bad. I would be slow to give the Minister this extra power because once you give such a power to one Minister, other Ministers will seek the same power in their particular areas. I believe the less interference there is the better it will be. As far as I am concerned, censorship is a negative attitude.
The whole Bill is negative.
Deputy Haughey surprises me. On one occasion he advocates the freer use of certain types of drugs and on the next occasion he advocates censorship.
We must keep things in context. I think Deputy O'Brien is becoming quite illiberal.
Deputy O'Brien is speaking to the particular amendment.
Good. I was confused for a moment.
We should let Deputy O'Brien elaborate on his point.
I am for a better educational programme. We should concentrate on an educational programme so that people will be enlightened of the dangers and, if we do that, I believe glamourisation will have very little impact. I could not support this amendment.
I agree with Deputy O'Brien that we need a better informed public and a more enlightened public. The better informed people are the better society will be. We must remember, however, that we always have within society a certain group who need protection from themselves and their particular weaknesses, weaknesses they may not recognise, and I believe some form of censorship is essential.
The power we will give the Minister here is power to make regulations under section 5 (1) (a) and I go along fully with what Deputy Haughey has said.
I remember being invited by a group interested in the drug problem to see a film they had made and they explained to me that they had to be very, very careful in the use of this film. Even though it was made for the purpose of being of assistance in regard to the drug problem, nevertheless it was not the sort of film that they would release at large. They said they would have to be very careful as to the type of persons to whom the film was shown. That is the sort of situation that prompted me to put down this amendment.
Does the Censorship Board not operate in the areas of books, periodicals and films?
I would be concerned very much with the actions of do-gooders, people who would produce what they considered to be helpful but which could be detrimental.
Deputy O'Brien referred to what he would consider the positive side of the question and he talked about the importance of education in this sphere. However, we must be concerned equally with the negative side of education in this respect and have regard to the type of situation to which Deputy Haughey has referred—that of the do-gooder producing a film which could result, for example, in young people daring one another and so on.
As Minister for Health, the Minister is responsible for the health of the nation and if his attention should be drawn to the fact that there is a film or a play which, according to the thinking of some, can contribute to the misuse of drugs, he should be in a position to appoint officers of his Department to investigate the matter and to report back to him. If the finding was that the allegation was true, the Minister could then report to the Minister for Justice. Regardless of who the Minister might antagonise his first priority should be the prevention of drug abuse. Various safeguards are needed in order to protect people from themselves. I do not wish to criticise the do-gooders but there are times when we need to be protected from such people. I do not consider Deputy Haughey's amendment to be dramatic in any way.
My personal reaction to this amendment is one of surprise. Very often a minority within a democracy may advocate a course of action that would not find favour with the majority in terms of social and cultural beliefs and practices, particularly in the physical and medical fields. Recently the Sunday Independent published an article which advocated a substantial liberalisation in regard to cannabis. Presumably, in the national interest that paper could be prohibited by the Minister from publishing an article of that kind.
Yes, if the Minister considered it to be dangerous.
The Sunday Independent is a responsible publication.
Not only are we faced with the situation of our internal media but as part of the English-speaking world it is possible for us to see, for example, BBC films or plays which may be contrary to the actions of society generally in the Republic in so far as drugs are concerned so that the Minister could find himself in the position of being requested by many councils and bodies in the country to prohibit the showing of such films in those parts of the country where BBC television is not received accidentally as it is on the eastern seaboard.
In regard to the question of health education I share Deputy Haughey's viewpoint to a limited extent but if at any time we should have a punitive or a reactionary Minister for Health—and I do not foresee any such eventuality—one could envisage a situation in which inspectors of the Department would be characterised every other week in the Abbey.
My amendment is confined strictly to the question of drug control.
Many magnificent plays and publications have evolved around the abuse and use of drugs.
One of the greatest books of all time was written by a man who was under the influence of opium.
In fairness, I could not support the amendment.
I should like to hear the Committee's views on this point but unfortunately we have a limited attendance today. However, I would point out that if the Minister is to be enabled to make regulations to do as Deputy Haughey suggests in his amendment, I or any future Minister for Health would be given very wide powers. It could be that the Minister would make a regulation prohibiting any reference to the control of drugs thereby preventing any public discussion on the effects, harmful or otherwise, of certain drugs. In regard to cannabis there is at least one person on this committee who says that the effects of this drug are quite harmless and that the consumption of it does not lead to addiction. I do not think any Minister for Health would wish to put himself in the position of censor whereby he would have to make regulations giving him the right to decide whether any film or publication was detrimental to the public at large. The views of Deputy O'Connell on the use of cannabis do not seem to be in accord with the majority view on this committee. I do not know how the censorship regulation could be operated in a general sort of way. In the first place one would have to vet all films in which there was a reference to the control of drugs and, secondly, there would be the question of what control could be exercised in regard to live public discussions. For example, what sanctions could be applied to " The Late, Late Show " in this respect?
I do not think this comes into it. The reference is to the showing, publishing or broadcasting of any feature film or play.
Broadcasting includes television.
One can defeat any legitimate proposal by drawing it to the ultimate extreme.
We must provide for the extreme, too. For example, some character from outside the country could make a reference on a programme such as " The Late, Late Show" to cannabis and so advocate its use, suggesting that it was harmless. This sort of situation could apply to matters other than drugs because there is no way by which one can prevent people talking on a live show.
This is peculiar since in later sections the Garda are to be given unprecedented powers to deal with this social evil, whereby every normal canon of normal justice will be allowed to be broken. The Minister is prepared to do this because of his being perturbed so seriously about the situation. The Minister is getting into an intellectual "tizzy" over a comparatively minor proposal of mine that would give him power to stop the publication of totally detrimental films if it was thought desirable to do so. I suggest that the Minister is being totally inconsistent in his attitude here if he wants to draw my proposal out to extreme lengths and makes it absurd by doing so. On the other hand, I suggest to him that there might be a situation in this city or elsewhere in the country where there might be a totally depraving and debauching film on public exhibition in regard to the control of drugs and nobody could do anything about it.
What is the role of the film censor?
It could be a play. A film censor is very restricted on the grounds on which he can act. He cannot act on the grounds of public health.
Why is there a features editor employed on a professional basis by a broadcasting authority?
There is a censorship in RTE itself.
With due respect, I would not leave any matter of public well-being to the discretion of RTE.
The people of the country voted in an opinion poll to give a second channel to the RTE Authority.
I should prefer to leave such matters in the hands of the Minister for Health in preference to leaving them in the hands of anyone at Montrose.
There is also the problem of the Press. We seem to be concentrating on films.
They have most impact.
Going down to Westport during the bye-election recently I read an Irish magazine and I was amazed at the comments made regarding one of those controlled drugs——
Was it in The Irish Times?
It was a magazine for teenagers. If there is to be a list of controlled drugs, there must be some way in which Deputy Haughey's ideals can be catered for. The Bill with this amendment states that the Minister may make regulations permitting the showing in public or the broadcasting——
He could also prohibit it.
At the present time many authorities are afraid to show educational films on drugs for fear of spreading the influence of such drugs. I should like the Minister to give some consideration to the provision. He may make regulations permitting the showing or the broadcasting of a film or play or the publication of such material, or he may prohibit the showing of such a play or film.
If it were a feature film or a discussion that was pre-recorded that advocated the use of controlled drugs it might be a different kettle of fish.
There are considerable powers available to the Minister for Posts and Telegraphs under the Broadcasting Acts to prohibit RTE from broadcasting——
Would all of us not agree that if we have to have censorship the Minister for Health, in pursuance of public health, should have that power? There is a valid reason for saying that the only person in the country who should have any powers of censorship is the Minister for Health.
There is still the problem of the newspapers. As far as I know there is no censorship of newspapers.
The Coalition Government have their own way with the newspapers——
Perhaps the Deputy would tell us which newspaper. With regard to censorship of the Press, this would be a very serious matter——
I did not have that in mind. Perhaps my amendment was inaccurately phrased.
The wording " the publication of any similar matter in connection with controlled drugs" is not directly related to films or plays.
It is meant to be a feature film or play or the publication of similar matter.
Would Deputy Haughey not agree that if it were brought to the attention of the Minister for Health that RTE were about to feature a programme that advocated it was desirable that everyone in the country should use heroin and if this were advocated in future programmes there is nothing to prevent the Minister contacting the Minister for Posts and Telegraphs who may issue an order under the existing Broadcasting Acts to desist showing the programmes?
I take it the Chair does not disagree with me in principle?
Yes, but I would be very loath to have every health inspector going into pubs inquiring if the proprietors had certain publications under the counter. To devolve on the Minister for Health a particular inspectorial responsibility in such matters is another form of censorship.
In the Chair's own words he has accepted the desirability of the proposal in principle. It appears that it is only a matter of getting it phrased properly and restricting it exactly to what all of us are agreed on.
I agree it should be done. Certainly I would have no hesitation in supporting the Deputy in the context of health education.
There is still the problem of live programmes over which there is no control.
No one could cavil if some material goes out before anyone knows about it but at least there is the power to stop it going out and that is important. I would agree with some of the Chairman's comments. If we give the Minister such powers in the context of health education, I would be quite satisfied.
That would be a positive matter through the Department of Health or the Health Education Bureau. However, the Deputy must appreciate the seriousness of what he is suggesting. It is tantamount to a major step so far as censorship is concerned. When it comes to the question of advocacy that is one thing but a sane and logical approach in discussion regarding controlled drugs is another thing. The newspapers have their standards and I do not think they would accept such a proposal.
The wording states that the Minister may make regulations. If he deems it necessary he may do so, but if he considers it unnecessary he need not make regulations.
It appears to me we are setting up another censorship board. The Department of Health will move into the area of censorship. We have a censorship board and, in the context of health education, they can be given a set of guidelines on what is expected and obviously they would operate within that. They have control with regard to films and publications and I would be happy to leave it with them provided the Department of Health might say that a certain procedure was what they expected to be operated. It seems wrong to set up a censorship board within the Department of Health.
That seems to be a totally indefensible position. Deputy O'Brien is prepared to give powers of censorship to a non-expert, non-health group and he is not prepared to give the same power of censorship to the Minister for Health who is responsible for this area. If the Deputy agrees with the principle of censorship in any context he cannot violently disagree with the amendment.
If we start to set up censorship boards all over the place then literally we will set up a chain of interference. I do not see any great problem in relation to this but, if there is, the censorship board can operate in relation to it. We have control in relation to the publication of periodicals. I am totally against Ministers getting into this area of censorship.
It is not proposed to set up a chain of censorship boards. I have been for a very long time dissatisfied with the standard of censorship that exists in regard to films. As far as I am concerned, sadistic violence portrayed in films is immoral and wrong. It has as bad an influence as the terror people used to have when they saw a naked lady on the screen.
That would have been censored 20 years ago.
There has been an emphasis on sadistic violence in some films which have been allowed through by the censor. I am not happy with the censorship in relation to this. The Minister, with the advice of his Department, is much better able to give advice on public health. I would put the whole matter of censorship under the Minister for Health. However, at the moment, we are speaking about prescribed drugs. There are many imported films and plays and there are probably hundreds of producing companies all over the world. Many of those people are attracted to the drug culture and participate in it. When the thing is underground there is a tendency to try to get more people involved and to share the guilt, make it acceptable. This is one of the pressures which one is under.
By writing into this Bill a section along the lines of Deputy Haughey's amendment the Minister will show a responsible attitude on the part of the Department of Health towards the health of young people in the country. As the Minister knows, doctors differ about the effects of cannabis. There is a report from John Hopkins Hospital, Baltimore, saying that cannabis is so dangerous that it causes defects in the next generation of children. There are others who say that cannabis has no such ill effects. It is an old saying that doctors differ and patients die. The Minister has a responsibility to see that irresponsible plays and films are not permitted. There is also a problem in relation to newspapers. We all know that many people are in this for what they can get out of it and that business is business with the newspaper world the same as with anybody else.
They never refuse an income.
That is right.
I have not any clear-cut views on this but I see all the snags. Censorship is a very emotive word in this country. Newspapers can certainly kick up a row in relation to it. If an editor felt strongly on the question of the use or the abuse of a certain drug he might be told: " You must not write such an editorial." In respect of the Wootton Report and the report from some of the organisations in the United Nations it is suggested that in some cases cannabis is not addictive, is not harmful. Should the publication of these reports be banned here?
No.
We know exactly the terms of Deputy Haughey's amendment. But this could be an implication because that would be tantamount to the consumption of cannabis.
Ideally, what I would like to see is total freedom of expression on the whole question of drugs, that everybody in the country should be free to express his views in relation to drugs anywhere and anytime he likes. I should like to see in the Minister's Department a group of wise, fully qualified, medical people who would be in a position to determine that some particular film—films have the most dramatic impact—play or feature of that sort was undoubtedly socially detrimental in the context of the control of drugs and that they would have the power to prevent the public broadcasting of such an item. That is all I am concerned about.
Does the Deputy visualise a situation where there could be a discussion on the control of drugs which could be one-sided? You could have people against the matter but if there is any sort of discussion there would be people who would take the opposite view.
There must be.
Such people could say that such and such a drug is not harmful. Deputy Haughey is an independently minded man. Suppose he had a public discussion and suggested that certain controlled drugs were not harmful, people would listen to the Deputy but they might not listen to Mr. X, Mr. Y or Mr. Z.
I could not possibly interfere with public discussion of any sort. I have confined my amendment to the broadcasting of the sort of things Deputy Briscoe referred to, things which are clearly identifiable in the view of the Minister's health advisers as being socially undesirable.
There are many people who have sent their children from the USA and Canada over here to have them educated because of the terror they have of their children getting involved in the drug culture. A brother of mine in Holland is terrified because of the increased use of drugs there. We have a relatively good record in comparison to some of these countries, but the use of drugs is spreading. The Minister should be in a position to take action if necessary. That is all we are asking for. There is money in this type of glamourisation, and where money is involved the use of drugs increases. The use of drugs is on the increase in other countries. It is not on the decrease at all. We owe all our people protection. The Minister has a team of advisers he can consult on any complaints he receives on films or——
I would have to see the film beforehand.
The Minister will have to rely on his advisers.
With respect to Deputy Haughey—I thoroughly share his liberal views—this discussion is very reminiscent of the Dáil debate on the background to the setting up of RTE and the censorship question of the 1930s. I also share his view that one should not have a situation where there would be advocacy which would be totally repugnant to medical and other aspects of health education. With respect to Deputy Haughey, I would ask him to reconsider his amendment.
In the light of the discussion and as the Minister will not come any nearer to meet me, I will withdraw the amendment.
We are a small group here and we are trying to do our best.
I do not mind withdrawing my amendment and bringing it in again on Report Stage.
Censorship operates in respect of films and books but not in respect of newspapers which are produced at night and we do not know what will be in them next day. Under the strict terms of Deputy Haughey's amendment, is it suggested that a regulation be made and if they are deemed to be in contempt of it, they will be prosecuted?
I did not have the newspapers in mind. If my amendment is unfortunately inaccurately drafted and could be taken to include newspapers, I will withdraw it.
But would the newspapers not have to be included?
Not necessarily. I am concerned with films on TV and in the cinemas, and with broadcasting on radio. I am only concerned with the situation where it is brought to the Minister's attention that something which is being shown or is on display continuously is doing irreparable harm, for example, where a drug addict is displayed as a heroic person in a television series——
Such as " The Man With the Golden Arm."
——and the Minister is powerless to prevent it.
Frank Sinatra was the hero in that picture. He was cured, incidentally.
We cannot help the expressions of modern society but we can be expected to deal with them.
How can you distinguish between television, plays and the media?
For once I am prepared to leave it to the wisdom of the occupant of the ministerial chair at the given moment.
I would be strong on the term "advocacy" as used in the amendment. I think we should concentrate on that rather than on anything that might happen. I am still concerned about the Press and the freedom of the Press. For that reason, it would be good to try to embody Deputy Haughey's amendment in terms which would make it an offence to advocate. There are subtle ways of advocating, such as, by opinion, quotations and so on.
There have been agreements with RTE in respect of drink which should be advertised only in certain circumstances and during certain hours. There has been agreement between the manufacturers and distributors on the use of cigarettes. It is possible that, in consultation with RTE, the Censorship Board and the media, we might agree on a formula which would do exactly what we want. We do not want to ban completely any discussion on these subjects nor do we want to encourage making a hero of a drug addict or anything like that. The regulation will need to be worded very carefully. I will not commit myself on the principle of advocacy until I have had some discussions with the media, including the Press.
Fair enough.
I move amendment No. 21:
In page 6, subsection (1), paragraph (c), lines 29 and 30, to delete "to the Minister" and substitute " in such circumstances and in such manner as may be prescribed".
Section 5 (c) requires prescribed records to be kept in relation to controlled drugs and regulations to ensure that they will be kept and maintained in a certain manner and the regulations also provide for the furnishing of information to the Minister. I propose to delete " to the Minister " and substitute instead " in such circumstances and in such manner as may be prescribed ". I believe other agencies, specifically the qualified professions, should have access to the information described in subsection (2). It would be very valuable if that information were to be given to an inspector of the Pharmaceutical Society, as part of their function. This has been discussed with the Pharmaceutical Society and they believe that this should be so, so that they might, in their present capacity, be allowed to ensure that the records are properly kept.
We would have to be careful that the information would not be given to competitors. Paragraph (c) deals with prescribed records being kept in relation to controlled drugs and now it will be possible to give this information to persons other than the Minister. I am not suggesting for a moment that there is a very real danger here but it should be kept in mind. Nobody minds giving the necessary information to a Government Department but it is a different thing to give it to private businesses outside the Department.
These professions have standards, particularly in respect of misdemeanours. It would be desirable in the making of these regulations that such qualified persons be consulted.
Outside bodies do not have the same degree of confidentiality or inspire the same public trust and confidence as a Government Department. There is some danger involved in private firms having to give information about their business to outside bodies. That is the caveat I wanted to mention.
I think we can go further than qualified persons. Probably the industry and distributors themselves could be consulted.
I move amendment No. 22:
In page 6, subsection (1), between lines 30 and 31, to insert the following new paragraph before paragraph (d):
"(d) providing for the inspection by prescribed persons of precautions taken or records kept in pursuance of regulations under this section,".
As you can see under section 5 (1) the Minister is given power to make regulations:
(b) requiring prescribed precautions to be taken for the purpose of ensuring the safe custody of controlled drugs,
(c) requiring prescribed records to be kept in relation to controlled drugs and regulations under this section may specify the manner in which the records are to be kept and maintained and such regulations may also provide for the furnishing of information relating to such records to the Minister.
It was agreed in amendment 21 that the words " to the Minister " should be deleted and the words " in such circumstances and in such manner as may be prescribed " substituted. Whilst (b) and (c) would require prescribed precautions to be taken and require prescribed records to be kept, there is no power in the Bill as it stands for inspection of these records in respect of 5 (1) (c), and of safe custody precautions in respect of section 5 (1) (b). This amendment provides for inspection to ensure that the regulations are adhered to.
Amendments Nos. 23 and 47 are related and may be discussed together if that is satisfactory.
I move amendment No. 23:
In page 6, subsection (1), line 34, to add after "prescription"" and without prejudice to the generality of the foregoing requiring that all prescriptions for controlled drugs be in standard form, having an identifiable serial number and counterfoil and supplied by the Minister".
I am told by some of the people involved in this area that this would be a very valuable item of control, that if these drugs could only be handled on the basis of prescription which would be known and have a serial number and be issued from a central authority, preferably from the Minister's Department, this would be a very effective mechanism for making sure that there were no weaknesses in the machinery we are trying to construct. My amendment would visualise a situation where these controlled drugs could only be prescribed on a certain official form supplied from a central source and having a serial number so that they could always be tracked down and the whole transaction identified. I am told by people in the business that it is practicable to do this and that it would be a very effective piece of machinery. Perhaps Deputy Byrne would have something to say on this.
This would be of tremendous advantage if we were able to do it and also if the prescription form had some identification mark of the prescriber and if it were mandatory for the age and sex of the patient to be included. It is high time that a deeper look was taken at the multiplicity of prescription forms available. The law at present does not prohibit a doctor from picking up an envelope and writing his name and address on it and the name and address of the patient nor is there much technical difficulty in a lay person getting forms printed; I have never been asked for my certificate of medical qualification when I go to get prescription pads printed. This is another way in which there could be abuse. I would be in favour of Deputy Haughey's amendment. The wording is very similar to that of the amendment I put down. I would like to see the Minister introducing the thin edge of the wedge here by prescribing standardisation. This Bill could be the vehicle by which this could be achieved. Therefore, even though it may involve the Minister in a certain amount of initial expense, and the general practitioner, dentist and veterinary surgeon may also have to pay for this, I think it would be of tremendous importance as regards the degree of control it would give over retail prescribing, and perhaps one of the best improvements we have attempted to make in this Bill to date.
There is one thing that worries me about this. I do not know how many controlled drugs there are. I know what is intended here and it is a good idea if it can be worked, but there seems to be a large number of controlled drugs. Would the practitioner remember that the particular drug he is prescribing, which may have a proprietary name, is one of these controlled drugs?
He would have to.
This is a difficulty, because an emergency may arise in that a drug may have to be got and the doctor may not have the forms with him when out on call. I am just instancing that as just one difficulty. Is there any way in which we could get over that? Very often the doctor may have to prescribe on the back of a cigarette packet or a piece of paper. If it has to be on a prescribed form and if it is an essential drug for some urgent condition, what is going to happen?
The whole theory behind this legislation is that people will have to be careful about these drugs.
I appreciate that, but I am thinking of an emergency situation. I do not know whether any of these controlled drugs would be used in an emergency situation where a doctor might not have the special type of form with him.
A prescription pad will just have to become as important as a hypodermic.
I understand this amendment is directed at a special form of prescription pad to be used. Is that the spirit of the amendment? That is what is worrying me.
Naturally there would be emergencies and one doctor could lend another doctor ampoules, or a chemist could do so. There would be a practical way out of emergencies. I may have gone into too much detail on my amendment. I am sure members of the Committee are aware of the new free flow of medical practitioners there will be between European countries under the new regulations. I feel we should incorporate in this Bill some limitation, or some control, or some way in which we could keep an eye on, say, a doctor coming here for holidays, or for six months, or for a year, and moving from one area to another. What I have in mind is that, if possible, he should be issued with a stamp something similar to the stamp issued by the health boards to practitioners in the GMS.
I did not follow the Deputy. Does he mean instead of a prescribed form?
He would have a prescribed form. Under the GMS, if a doctor wants to prescribe penicillin his stamp must be on the prescription form before the chemist will fill it, except in extreme emergencies. I suggest that, when a doctor comes here, or when a doctor is registered as a practitioner of medicine, he should be issued by the Department with a stamp which would last him for one year or two years. This stamp would be changed periodically at the doctor's own expense. I do not wish to involve the Department in any extra expenditure. A doctor could come here from a foreign country and go down to a western seaboard area and then go up to a north western area. It would be difficult to keep track of him. At present there is no way in which an Irish chemist can know officially who is practising medicine in an immediate catchment area, apart from the doctors in the GMS. Nor is there a way of controlling the local flow of doctors. We are going to the trouble of bringing in a standardised prescription form and this could possibly be abused if we overlook providing a further mark of identification. We are identifying a drug and a prescription form. The doctor himself should have some means by which the chemist could recognise him.
Is the Deputy saying that, in an emergency situation, the doctor's time would be wasted because how would the chemist at the far end know there was an emergency situation?
The doctor would be visiting the chemist to get the drug.
The doctor would be dealing with an emergency situation.
May I suggest that it would not be all that much of an emergency because the issuing of the prescription means that the person has to go down to the chemist to get the drug?
The doctor might have given him a carrying dose to start off with. Many doctors have to travel a number of miles. He might have travelled ten miles before he realised he had forgtten something. He would not be back until the evening. He might give an injection to carry the patient over.
Once a prescription enters into the situation it cannot be all that urgent. The idea of a prescription is that one goes to the chemist, or sends a relative. The doctor himself could go to the chemist.
The doctor could be out all day doing his rounds.
For example, in the case of the train crash I am sure many prescriptions were issued there and then.
I would say in that case they brought all the stocks they could lay their hands on.
A prescription suggests that you take a document and go up to the chemist.
If it is a pain-killer it will have to be on a prescribed form.
It is the drugs which would be urgently needed, not the prescription for drugs.
You would not be able to get a drug unless you had a prescribed form.
I think the Bill will have to be stretched a little. I am just throwing out an idea in my amendment. I support Deputy Haughey's amendment because it is similar to mine. I should like to see more details on the prescribed form with, of course, a counterfoil.
I have power to include the special prescription forms in section 5 (1) (d). It does not say that specifically but it is wide enough to enable me to require a special form to be provided. I can see many merits in the proposal. First, it would make forgery much more difficult. Secondly, there would be tighter monitoring in order that we would know the prescribing pattern of controlled drugs. As I say, I can do this under section 5 (1) (d). There is a practical difficulty. I am sorry. I was out of the room for a short time and perhaps somebody mentioned it. The practical difficulties will have to be discussed with the professions. At present doctors have two prescription pads. They have a prescription form in respect of public patients who participate in the GMS, those in the lower income groups. They also have another pad for private patients. If there were to be a special prescription form for controlled drugs that would entail another pad for the GMS and another pad for private patients. In effect, this would mean a doctor would be required to have four pads.
I am sure that with a little ingenuity we could combine the last two pads.
I am talking about the practical difficulties. The medical profession might have reservations on this or refuse to implement it.
Could I ask this question? Do practitioners have a registration number that would be known to every chemist?
Only in the GMS.
Almost every doctor is engaged in GMS work.
They have a special stamp for the GMS work.
I suggest that when a doctor is prescribing a controlled drug he should put his number on the prescription before signing it. It would then be possible to check back on the doctor.
The doctor would do that in the case of the first two I mentioned.
I suggest that something of that nature be introduced in order to avoid all this complexity.
The approach of Deputy Byrne and myself is different. We want any transaction relating to a controlled drug on a special standardised form.
The Deputy wants doctors to have another two pads.
A bit of ingenuity would combine the two.
Would the Deputy give us inspiration?
I will act as consultant to the Department at any time.
I suggest a special numbered form for controlled drugs purposes so that a check can be made if necessary.
I should like to see a special standardised form, of a particular colour, centrally issued and numbered from one to infinity, so that any prescription can be traced back to source.
They will be stolen and used just as drugs are stolen.
This would be an additional measure to prevent drugs getting into the wrong hands. It is easy for anyone to scribble out a prescription and sign the name of a doctor in order to obtain drugs.
Does the Deputy mean illegally?
I am sure that is being done.
Does Deputy Haughey envisage that such a form would apply to public and private patients?
The governing factor would be the controlled drug and not the type of patient.
There has to be a distinction. Two pads would have to be used because one would be for recoupment.
I would be interested to know if the medical profession would wish to deal with another pad.
The medical profession would welcome any help from the Department.
Particularly if the Department supplied them free of charge.
They are getting enough out of the Department.
Would the medical profession be pleased to know that a prescription in relation to a controlled drug given to a private patient could be traced back by the State?
We are all human and they could make a few mistakes. It is easy to distinguish between two forms but four is a different matter, although Deputy Haughey has suggested that a different colour should be used.
All these controlled drugs could be supplied through the Department, or the health boards.
Surely the question of confidentiality arises?
It is not often one would prescribe controlled drugs to a patient in general practice.
As things stand a doctor can write a prescription on any paper.
Even if we make the regulation this will not happen for some time but eventually doctors will carry these pads with them.
These could be stolen and that is why I suggested that regulations be made requiring that every prescription be stamped.
That is another reason for my amendment. If my amendment was accepted it would be an offence to steal one of these which would be immediately identifiable.
Exactly. I presume the counterfoil would be retained by the chemist and the top page would go to the health board for payment. I should like to see two counterfoils in operation, one to be retained by the doctor and the other to go to the chemist. The doctor could put his counterfoil into the patient's chart and he would be in a position to ascertain, at any time, the amount and quantity he prescribed for a patient. A patient could not alter the amount on a prescription as happens in this city.
Is everybody satisfied that the doctor will be able to remember the 125 controlled drugs when prescribing for a patient?
The doctor will have to; that is what this Act is all about.
It is the doctor's duty to prescribe a drug for a patient and he cannot remember the category all drugs come into. To ask him to be able to remember that is placing an unreasonable burden on a doctor.
If the doctor has any doubt he can write on the form.
I will undertake, as I did in respect of the making of other regulations, to talk to the medical profession to see if a system can be devised to ensure some segregation to make forgery less easy and to tighten the monitoring of these controlled drugs.
Could we include amendment No. 23a?
If Deputies Haughey and Byrne were prepared to withdraw their amendments on the basis of the Minister's statement we will have made considerable progress.
I am prepared to withdraw amendment No. 23.
That is considerable progress.
I move amendment No. 23a:
In page 6, subsection (1), after line 34 to insert the following paragraph:
" (e) requiring all controlled drugs to be prescribed in the empirical formula of the drug ".
As I have already indicated, I am prepared to withdraw this amendment from the point of view of the general consideration that will be given to it in conjunction with the previous amendments.
On the basis of the pharmacists.
