I move amendment No. 23b in the name of Deputy Byrne:
In page 6, subsection (1), after line 49 to insert the following paragraph:
" (h) providing for the withdrawal, of a prescribed amount of controlled drugs from any person, who, in the opinion of the Minister has an excessive quantity of such controlled drugs in his possession ".
I do not think it would be acceptable for various reasons. As far as the different categories are controlled, the practitioners, the importers, manufacturers and so on, there are adequate provisions here for importers and manufacturers. The quantity they would be allowed to import and to manufacture would be included in the original licence that would be given to them. As far as the practitioners, the doctors, the vets, the dentists and the pharmacists are concerned, it is not likely that they would hold excessive stocks. In this particular case we would have to rely on their professional integrity. There would be practitioners, for example, in the remote areas in the west of Ireland who would carry stocks over and above what would be carried in the cities and in the provincial towns. It would be extremely difficult for anybody to say whether or not they were excessive. Again this would be a matter for the doctors. I am not talking about the prescribing of drugs. I am talking about the amount of drugs that they would have in their possession. Generally in respect of the importers and the manufacturers this would be governed by the licences that would be issued to them. As far as the other professions are concerned we must depend on their professional integrity. As far as the individual is concerned, of course, it could be determined whether or not he had an excessive quantity of the controlled drugs in his possession and he could be dealt with under section 5. Therefore, I do not think this amendment would add anything to the Bill.
Is the Minister's argument that it is not necessary because if a likely situation arose persons who would have controlled drugs in their possession would have undue amounts?
Manufacturers and importers. The manufacturers would have to be covered by the type of licence that would be given to them. As far as the professions are concerned it would be very difficult to challenge a doctor and say that he had an excessive amount. We will have to leave that to the doctor himself. In remote parts of the country it would be necessary for him to have over and above what a doctor or a pharmacist might have in a city or any town. You can only depend on their professional integrity.
What safeguards or precautions are taken with regard to the quantities held by wholesalers and manufacturers? Is there a very strict control over this at the present time?
I could not say that. It depends on the needs in medical practices.
Is there control at source, at manufacturer level or wholesaling? Do the regulations in this Bill aim to further tighten up on this?
There will be control.
The licence will determine the amount of any particular drug made by a manufacturer. As far as the importers are concerned the licence would specify the amount and the type of drug that they would import.
What machinery is there built into this that will enable it to be monitored? There are controls at the moment but is there enough monitoring of this?
There would be under this proposal an inspection to see what they had.
There are all sorts of records.
It is just that I ordered a whole list of narcotics, and no one came to me after giving me a double supply. There has been no check up on it. This, to me, seems puzzling and a bit worrying. No one has checked with the manufacturers or the wholesalers as the case may be. When I wrote the prescription for one supply double supplies were given.
Did they charge for the whole lot?
They did, but that is not the point.
Was there a bonus?
No bonus. In two years nobody has asked me about it. If that can happen what is to stop anyone having access to supplies within the wholesalers' stores? This is where I can see there might be a loophole, that you would not have this control. This is the real source. It might not be stealing a doctor's prescription or forging a doctor's prescription. It could be the actual wholesaler or manufacturer. If there were not sufficient built in safeguards about that this Bill could be in vain.
Does subsection (1) (a) and (c) not cover this?
Section 5 (1) (a) and (c) covers both.
That is already there. Could somebody tell me what is an excessive quantity?
We have to come back to the amendment.
It is already there in paragraph 1 (a) and 5 (1) (c).
This is the gist of the Minister's argument.
I would like to make a distinction between a doctor and a chemist. A doctor can also be a pedlar.
Yes. When we are talking about excessive quantities we are not talking about any one of the particular professions. We are talking about the lot, the pharmacists, the manufacturers and the importers as well.
Yes. The Minister has mentioned in his statement that it would be hard to control the doctor's stock.
It would. Right, so we will only write prescriptions.
Can we write anything in? He can have an excessive quantity.
There are exceptional cases.
Does the Deputy mean an offender as one who overprescribes for his own use?
Yes, or he could be a pedlar.
It would be discovered by the law that he was a pedlar.
I think the Minister has correctly pointed out, if the amendment is put down in the context of section 5, that a careful perusal of that section will clearly show that restrictions are there already in relation to any possibility of excessive quantities.
Also, in other sections the question of a practitioner or any sort of professional person who is guilty of any sort of offence can be dealt with in the machinery in the Bill.
As well as the other machinery that is available to deal with them.
It is all set out.
Deputy Byrne, your amendment having been formally moved, do you wish to press it?
I did not think the controls were sufficient to take into account the death of a chemist who might have quantities in his shop. I wanted to give the Minister power whereby he could have some vehicle to control the possession of these drugs. There could be a case where a large amount of a controlled drug was available to the family following the death of a chemist, in similar circumstances following the death of a general practitioner, and also in the hands of a relative following the death of a patient who might have a certain amount of these drugs. My amendment would enable the Minister to have some means whereby he could seize these drugs. That is the bones of it.
Again, I wish to point out in relation to section 5, first of all, the Minister may make regulations ensuring the safe custody of drugs. He may make regulations regarding the method of the keeping of records and so on and the method by which these records are maintained. He may make regulations regarding the destruction and disposal of prescribed drugs in a prescribed manner under (g) in section 5, so that presumably if the chemist dies and these regulations are in force the Minister may order the destruction or disposal of these drugs.
What would the withdrawal procedure be? Would the Minister seize the drugs and destroy them?
There could be an insistence. I do not know what the machinery might be that in the event of a practitioner, a pharmacist or a dentist dying there would be an obligation on the next of kin to notify the death and that in those circumstances the drugs would be removed from the premises.
Could the Minister make regulations under 5 (b) covering that?
It is quite easy for the Minister to do that.
Deputy Gibbons referred to 5 (b). This states:
. . . requiring prescribed precautions to be taken for the purpose of ensuring the safe custody of controlled drugs.
If there is no qualified person having control of these drugs, then I presume that they will be seized and taken away from the premises, unless of course there was somebody else in the establishment that was of the profession or a pharmacist.
Section 5 (g) takes care of it.
It can be disposed of. It may mean that the executor of the estate would have to hand back probably several thousand pounds worth which would be the value of the deceased chemist's estate.
Not any more, after this budget.
They would have to be handed back to the manufacturing chemists.
I wanted to put in a proviso whereby the Minister could compensate the relatives. He could say: " Look, you have £500 worth of controlled drugs there, the chemist shop is closing up ".
The value of the man's estate goes into probate. If the chemist is dead this is part of his estate and the executor will make arrangements for the distributing manufacturing chemists to take back the stock and a certificate will be given to the solicitor. Otherwise the Minister would have to go around chasing chemists for the rest of his life.
You will not get a lot for the Minister to get near when the Revenue Commissioners are finished.
It appears, in any case, as pointed out by Deputy O'Connell and Deputy Hugh Gibbons, that (b) and (g) would adequately take care of that sort of a situation. I just want the Committee to be satisfied on this. Maybe Deputy Byrne would like to make a comment on it. I refer to the possibility of qualified persons having in their possession, as he says in the amendment, an excessive amount of drugs.
Yes.
I may be out of order.
Deputy Byrne has a point here. Take a doctor who has a receptionist and a housekeeper. There are many other areas where he has not safe control or is not liable to the same check as the pharmacist.
There are regulations which could take care of that situation whereby they would not be allowed to handle them or would be allowed to handle them under certain circumstances.
I would be worried about the application of this to the pharmacists and doctors. I would be worried about an excessive supply of this to a doctor without question.
On the other hand, if you come from an area like mine where there are no chemists within miles doctors must—Deputy Gibbons will know of this—carry the stock.
I assume we can strike an average.
You would want to. It is not the same problem in Dublin or Cork with plenty of chemists shops.
We are suggesting that any situation visualised by Deputy Wyse is already covered by the other provisions.
Yes, I think we can pass on.
I move amendment No. 24:
In subsection (1), page 6, between lines 49 and 50, to insert the following paragraphs:—
" (h) requiring any registered medical practitioner who attends a person who he considers, or has reasonable grounds to suspect, is addicted (within the meaning of the regulations) to controlled drugs of any description to furnish to the prescribed authority such particulars with respect to that person as may be prescribed;
(i) prohibiting any registered medical practitioner from administering, supplying and authorising the administration and supply to persons so addicted, and from prescribing for such persons, such controlled drugs as may be prescribed, except under and in accordance with the terms of a licence issued by the Minister in pursuance of the regulations."
There are two things here. Firstly, there is a requirement that the medical practitioner would report to, the prescribed authority, a patient whom he considered to be a drug addict. Secondly, Deputy O'Connell proposes that there be a special doctor practitioner appointed in an area or for an area who would have the sole responsibility of prescribing for drug addicts and for their treatment. I can see that what is in Deputy O'Connell's mind, if I can interpret it properly, is a voluntary arrangement—possibly voluntary is not enough in this case —for notification of addicts to the National Drugs Advisory Centre. We have to distinguish between that and the National Drugs Advisory Board. The profession are asked to notify people whom they consider to be drug addicts. My information is that it is not working satisfactorily, that it is not done in all cases. There are some doctors who are co-operating in this proposal by Deputy O'Connell but a minority are not, and, of course, we cannot ignore the minority.
It appears that the staff of the National Drugs Advisory Centre are not getting sufficient information. They are not getting the full facts as to the extent of the drug problem. The minority can, of course, do quite an amount of damage. The argument in favour—I do not want to anticipate Deputy O'Connell's argument—is that compulsory notification would not alone give the full picture of drug addiction but the trend, say, in respect of the use of different drugs over different periods. The system of compulsory notification has its merits. It is not a very good analogy but there is an obligation on a doctor to report in the case of an infectious disease. It would probably not be a pertinent matter with an allergy because that is not a disease in the field of public health generally. When we are talking about drugs we are talking about individuals as far as the consumption of drugs is concerned. I would be under an obligation, hence I would be favourably disposed under this amendment, to have a talk to the medical profession about it.
As far as licensing is concerned that would certainly be a matter that would also have to be discussed with the medical profession. If I can interpret Deputy O'Connell's mind properly it would mean that there would be one man in a particular area. I do not know what extent the area would be in respect of the whole country. It appears to me that it would be easier to control irresponsible prescribing, maybe unconsciously. This is not a great problem now, it is a relatively small problem but it is still a real one. As the law stands and as is envisaged in the Bill, any doctor can prescribe for addicts. This can, of course, create a certain amount of abuse by the addict who could probably go to several doctors and get the various prescriptions for his own use and, if you like, for the sake of peddling because doctors can abuse this system by prescribing excessive doses of drugs. There are cases where a doctor finds it necessary to prescribe some of these controlled drugs in severe cases in order to get an addict over a period during which he can decide to go for treatment.
The idea of licensing one doctor in a particular area would mean that he would be enabled to, more or less, specialise in the treatment. Again, in this respect I think it would be necessary to talk to the medical profession so that we could find out their reaction. What their reaction would be I do not know. That would be what we intend to do. I am thinking merely in terms of inviting licensed doctors to Dublin. As I said before that is a problem in various parts of the country.
However, I would be in favour of the amendment with a proviso that the medical profession would be consulted. What their attitude would be I do not know, what the ethics of it would be I do not know, what the system of the appointment of a licensed doctor would be I do not know, but we must remember that all of us are here in order to try to ensure not alone that drugs are not abused but also—and this is the most important thing—that drug addicts are cured. We should distinguish between the drugs and get consideration for an idea that a doctor through a licence would be allowed to prescribe in respect of what would be considered hard drugs, the really dangerous ones.
The Minister has put very well what I have in mind. The point is that, first, we should have a register of drug addicts in so far as we would know exactly what the situation is like. We should also have information on the individuals who are addicts and who, because they are addicts, will seek the treatment anywhere and the drugs anywhere. There could be a check-up on them to see that they do not get excessive amounts of drugs. In this way there would be information as to the extent of the problem in the country and also we would be able to have a feedback on the individuals themselves by virtue of having the register.
This can only be done by means of compulsory registration and notification. We could never keep it by voluntary means as is happening at Jervis Street Drug Centre. They are not getting the information because there is no basic system. Doctors cannot be aware of the extent of the problem and they are not able to help because of that. It is not that they do not want to help but there is no feedback to them.
The second point is an important one. Unfortunately I am one of those who was caught by drug addicts doing the rounds of doctors in their area. They call to one doctor and then another. Each doctor with a good heart might mean the best but I do not think it is a family doctor's place to treat drug addiction. It is a specialised status and it should be confined to those who are expert in treating addiction. It has put an unnecessary onus on the family doctor to take this on, always remembering that one doctor may be treating an addict and that two hours later the family doctor up the road may be seeing that same addict without the other doctor's knowledge. That is a very dangerous thing. It is leaving the matter wide open to abuse because there is not that liaison between family doctors in an area that they would know who is going in to them and to neighbouring doctors. The same addict can call to three or four doctors in an area, getting treated regularly by each with a controlled drug.
I would not agree with one doctor in an area. I think you have to have specialised treatment centres. Where you have notified a case of a registered drug addict, he attends for his treatment and he will get withdrawal treatment in a registered centre by doctors who are specialised in this form of treatment and which would help him. Asking the family doctor to do this is an intolerable burden. He would be open to great abuse. We are not trying to deny doctors their right to treat addicts. It is not a question of that.
There will be a certain measure of concern among the profession that we might be trying to curtail a doctor's right to treat drug addicts. A doctor might say: " Why should I not, I am qualified "? This is an argument that might be put forward by the doctors. You could also argue that 80 per cent of doctors are qualified to take out an appendix and they would. Of course, that does not hold water because they should have it done in a specialised centre—a hospital, under hospital treatment.
This is more open to abuses. The family doctor has not the time because it is a time consuming process to treat drug addicts. You cannot just see a fellow shaking and write out a prescription. It requires a lot of care and attention and psycho-therapy besides the actual drugs and that is not within the ambit of family doctors' work.
Only if this amendment is incorporated in the Bill will you discourage drug addicts from prevailing on doctors to give them supplies of controlled drugs. You make the doctor's burden all the less because the doctor can say: " I am sorry I would like to but I have not been given the power to treat addicts". The fact that such a provision is not there means drug abusers can exercise a certain amount of pressure on the doctor to do it and prevail upon his weakness in so far as he is sympathetic towards them. The doctor can tell an addict that he can get him all the facilities immediately in the centre. I do not think that that is curtailing his right to treat addiction, but this is an unusual condition.
I am surprised that this amendment has been down for seven months and that this was not submitted by the Department to the medical profession long before now. We should have from the profession some indication as to their reaction to it. We should have asked the profession through their representative bodies to consider this.
As a layman I want to put this point. Where a doctor in the course of treatment creates an addict because of the treatment he has prescribed—and there are thousands of addicts, people who become dependent on drugs—suppose that person has been reported to the central authority. The central authority have to satisfy themselves that the doctor is giving the right treatment. Suppose they consult another doctor who says: " I do not consider this is the right treatment", I would like to know what would happen in that situation. Say the doctor who is treating the person dies and the person goes to another doctor, the doctor can carry on the treatment as before or say: " No, I am not going to treat you the way you were treated before ". What happens to the person whose addiction has been created because of the treatment in the past and who is now to report to the central authority? Who is going to assess whether the doctor was correct or not? This is a dilemma the Minister could find himself in in consulting with the medical profession.
If it were only a suspect or the doctor was not certain, there would be an assessment when he would be referred to the licensed doctor.
I would not like the idea of the licensed doctor to go out. This would not be right.
Is it not in the Deputy's amendment?
In accordance with the terms of a licence. The licence need not necessarily be issued to him. It is a licence for a centre. In regard to the point raised by Deputy Briscoe, it must be a doctor who created that problem, created the addiction in the first place. We would not want that drug addict to continue the treatment with that doctor. Secondly, it still does not detract from the doctor to say that he should refer the case to a specialised centre because the treatment of drug addiction is not necessarily giving small doses of their drug of addiction. There is a lot more involved. There are social workers involved and so on to try to rehabilitate that person. It is a specialised business and that is why I am emphasising specialised treatment centres.
First, Deputy O'Connell is dealing with two situations. One is the person under the influence of addiction at the time the doctor sees him. This is a case that is rightfully referred to a specialist. The other situation will arise when the patient is discharged from the care of the specialist. There must be somebody at local level who has some responsibility for the patient, even to the extent perhaps of giving him drugs sometimes. This would involve some guarantee of immunity from prosecution. Perhaps this could be got over by notifying the case by number, as is supposed to be done under venereal diseases regulations. The other point where the patient can go from one doctor to another might be covered by issuing a book to the patient. Where a patient gets drugs, whether in hospital or outside, this book must be signed and authenticated by the person who gave them the drugs. The ideal kind of book may not be acceptable, but under the regulations there are people with diabetes and various other people who can get free drugs but they must present a book at the chemist on each occasion. The only difficulty I see with the addict is that he may not carry his book with him from one place to another.
I suppose there are such things as wayward doctors. It is possible that no matter what regulations are made, people will be able to escape the net and get those drugs from doctors at times. While accepting the notification grounds, it is going too far, in particular the second one, prohibiting anybody from prescribing drugs except under the terms of a ministerial licence. That is going a bit too far.
If they are registered drug addicts.
Thank God I have no trouble with them, but if they react like the alcoholics react at times, and the hours they call you, you will be disturbed and you might be dealing with them at the most awkward hours. If they do you cannot decide then to send them to a specialist without giving them any treatment locally.
From a lay person's point of view, it seems to me that we are looking at it from a purely legal point of view rather than from the patient's point of view, and these are the people we are supposed to be most anxious to help. If a patient was certain that by attending the family doctor he would then be reported and possibly prosecuted, he would not seek help and I would be afraid of that, particularly in the case of the young when they need help very early. I would be inclined to designate a few doctors in each area so that they would have a choice of specialists.
We are saying that. Of course there would not be only one specialist in the country.
Not in the whole country but there might be only one in Country Galway, for instance.
The danger of being prosecuted is not in that. That is the drug treatment centre.
I want to follow up Deputy Hogan O'Higgins on the private personal aspects. I believe that Deputy O'Connell's proposal would constitute fundamental interference with the rights of individual citizens. We must be very alert to any such interference. We are dealing with abuse, we are dealing with a social problem, but in so dealing we have to be careful that we do not trample on individual rights and freedoms. I would resist any question of individuals being compulsorily put into some central roll. This is getting very near the Big Brother type of society which we do not want. But one hears suggestions, particularly about the United States where a whole population is going to be put on a computer.
It is already here.
It is getting very near a totalitarian type of society. This amendment is touching on that. Why is this necessary? Why would addicts have to be registered at some central register? As the Minister pointed out, even though he was trying to use the analogy, it is not like an infectious disease. Drug addiction only affects that particular person. It is only relevant to his particular well-being and there is no question of his infecting society with addiction. Therefore, why should there be a central register? Is it not better to leave this matter of addiction to the good sense, wisdom, skill, knowledge and experience of the practitioners? Drug addiction is just a disease, I suppose, probably a much more tragic disease than some others, but it is still only a disease. Therefore, it comes within the competence of the medical man to deal with it.
Deputy Gibbons has put forward a few very sensible suggestions about the way in which the situation could be dealt with so that addicts could be prevented from doing themselves harm by misusing the medical profession and the facilities provided. Something on those lines might be evolved. Again, I would prefer to see that evolved by the medical profession itself, by most of its members, as a way of handling the particular problems of the addict going from doctor to doctor. I fully agree with Deputy O'Connell that what we should be discussing here, more than anything else, is the establishment of treatment centres and rehabilitation centres. That is basically what this problem is all about and what we should be concerned with in regard to this problem.
There is something completely different involved in this amendment. It is simply a question of establishing treatment centres and trying to ensure that addicts get suitable treatment. I would like to know what advantage there is to anybody, the medical profession or addicts, in being registered on some central register. If it is only statistics you want, then Deputy Gibbons has suggested a very simple way in which these statistics could be compiled without actually registering an individual and all the breach of confidentiality that involves. This addiction is just another disease, a serious and tragic one, one with many implications. We do not register other killer diseases. Why do we not have a central register for people who are suffering from cancer or tuberculosis or any of these other diseases?
We do.
Not until they got the free allowance.
I do not know that you are put on some central register because you have a particular disease. You may go on the register for some other reason, maybe to get treatment. I am certainly against paragraph (h) of this amendment in principle. Purely on the technical side I think this amendment, paragraph (i) is already covered and dealt with under paragraph (d) of the existing subsection (1) of section 5.
We are talking about a register. There is many an unfortunate addict in need of help. Sometimes they want help but I cannot see an unfortunate addict coming in to a doctor for help knowing that he will be registered. I am totally against the register in that case. If the abuser comes in and he is convicted by a court that is register enough. Those are the type of people we are looking for. I understand that any family doctor can treat a person. He may have to seek psychiatric opinion. That is the specialist that is needed here. I believe from inquiries from a number of doctors that a family doctor can treat an addict, but he may seek the advice of a psychiatric specialist or something of that kind.
Let us not make it difficult for people. We are here to help people, as the Minister said. To my mind compiling a register of people of that kind is driving people away from help. I am totally against any kind of central register for that reason. I am convinced that the family doctor can treat them but may need the assistance of psychiatric opinion.
We had quite a considerable discussion. Deputy O'Connell, do you wish to press the amendment.
I just want to point out this. I am fully qualified to treat a drug addict. But, say, a drug addict had been to a doctor 100 yards down the road ten minutes earlier and he has got a shot of morphia from that doctor and he comes up to me before the injection has worked on him, and I give him a shot of morphia—I give him a half a grain—he could be dead three minutes later. We are both qualified to treat the same man. I am speaking from experience of this. A fellow came into my surgery who had already got treatment but he could have died with an overdose.
Could it not work the other way around? If the Deputy was prevented from treating him could it work the other way round?
I always have to try to see into rural Ireland. Sometimes it is not so easy for a city based Deputy to see the difficulties that arise in rural Ireland, including Wexford.
With regard to the central register I accept what Deputy Haughey said and I am very much in agreement with it. I am always afraid of this Big Brother thing, but where it is to help a person it could do a lot of good. We have got to have some idea of the extent of this problem. It is not like many of the medical and surgical conditions we have where you cannot speak openly about it. There is something furtive about this. I accept that it can militate against the person coming to a doctor. But if we can impose all the other restrictions on the illicit availability of these drugs, a drug addict will seek medical advice irrespective of whether or not there is a central register. If all the other regulations are put into force that will not prevent a drug addict. Depending on voluntary registration is ludicrous. You can help people. You know he is on the register and therefore he can, from then on, get his registered supply of the drugs. You can ensure he gets his proper supply at regular intervals because he is on that register and there is no danger of anything going wrong.
It can help others in knowing the extent of the problem. It can help the medical authorities and the public health authorities. It can help legislators in knowing the extent of the problem in the country. I recognise the breach of confidentiality but it can be done with certain built-in safeguards. Everyone who goes to a psychiatric clinic in Dublin under the health board is on a register. These people are already on a register and their full psychiatric history, which is very, very serious because it affects many more people is on the register. This is on a computer now. If anybody goes to see the psychiatrist at the local health centre the full history of the person's anxiety or depression is on a computer and it is available to civil servants.
Everybody is on the doctors' register.
I am talking about the central register for the psychiatric cases. It is on a computer. I am not asking for this to go on a computer. If it goes on a central register, which is a register set up by the Drug Advisory Centre, which is controlled by doctors, you have the confidentiality of it controlled. That is not the case with the psychiatric matter. When a person goes up to the psychiatric clinic of a health centre his name automatically goes on to a computer. This, to me, is a very serious matter. I fought this for a long time because you then take the control out of the doctor's hands and the confidentiality is lost. It is gone on to a computer where public officials can have access to this information. That is very serious because it could be used against that person.
It could be used against Ministers.
It could indeed. The other thing is that I argued against the family doctor treating these because he would not know—he would not necessarily abuse it—that his colleague was treating him at the same time. We are protecting the patient, not just the doctor, from abusing it.
There is definitely a need for a central register where information as regards the type of drug that a person is addicted to is available, particularly in the casualty department of hospitals, where people come in complaining of a particular pain—they are quite skilled in this—and the houseman or some other person gives them an injection of some painkiller or other. I know from my experience of working in casualty departments that this is a great defect in the efficiency of treatment. I also have experience of people coming in and presenting themselves as patients and wishing to have a prescription for perhaps two weeks' supply of a particular drug. There is nothing at all to stop them travelling to another ten doctors and getting a supply.
I do not agree with all of this. My amendment, No. 90, requests the Minister to set up a treatment centre in each health board area where all addicts should be treated, that is a central area under specialist care and the doctors should be taken out of the picture. The idea of addicts going around trying to find drugs is something we should try to prevent or at least limit it to the optimum. We know that one of the ways addiction can be spread is by handing around tablets.
The last part of this is adequately covered in section 7 (1) and also paragraph (d) of section 5. There is a need for registration. If it is not compulsory it will not be efficient. If you want it to be efficient it will have to be compulsory. There is the ethical problem of whether you are giving out too much information. I do not think so. Information about the people who are dependent upon drugs, whether or not it is done by number, as Deputy Gibbons suggested, must be available to general practitioners to know whether the person presenting himself is genuinely ill or is merely feigning. The secrecy aspect is a problem. We have to weigh up the two. Every time I suspect somebody I have to ring the drug squad and ask if the person is known to them.
Will some of the doctors here be able to tell me is it difficult or easy to determine whether or not the patient is a drug addict?
It is very difficult at times because they can feign any complaint. One fellow came in to me with an acute kidney stone. He had actually thrown water on his face and, so on, and he gave me full details of what instructions he got from Jervis Street Hospital, that I was to give him the shot—he knew the exact amount of pethidine—and have him admitted to hospital. He knew the name of the surgeon in Jervis Street. When I rang Jervis Street they said "yes" but the communication was wrong. They offered a bed but of course he had gone.
Is diagnosis simple?
It is not simple.
Sometimes it is and sometimes it is not.
They can mimic having any trouble. They can say they have a kidney stone and give all the descriptions.
Two other Deputies wish to contribute. I think we should bear in mind we have spent a lot of time on this amendment.
The main point was made by Deputy Haughey when he spoke of the infringment of the fundamental rights of the citizen. Deputy O'Connell may be expecting higher things from members of his own persuasion than we as lay men would. In regard to a central register and requiring a doctor to do this and prohibiting him from doing that we cannot write all that into legislation. The medical profession should be able to make regulations and administer codes and standards of conduct in relation to drug addicts without the sanction of legislation. How are you going to require a medical practitioner——
They do this in Britain, by the way, and in the United State.
What sanction do you use? Do you strike him off the register if he does not disclose the information?
There is compulsory registration of venereal disease. Admittedly it is not used that much.
The Deputy could have fooled me.
There is compulsory registration. What measures do you take against them if they do not register? Well, you cannot. It is in the doctor's interests because by having the register you have full details of what kind of drugs this person is on. If an addict comes in to me I could get on to that register and they could say, " Well, do not give him more than one-eighth of morphia", or something like that.
If I go to a doctor, voluntarily as a citizen, looking for treatment, or if I go to a clinic or a hospital, that is my voluntary act and I do not mind my being registered because I have done it of my own volition. I do not want some person to whom I go in my private capacity having an obligation to register that fact with some clinic, hospital, organisation or institute which I have not consulted and of which I know nothing.
The Deputy will have to elaborate a little more.
Deputy O'Connell suggested that there would be centres and that doctors would report drug addict patients to those centres. If I go to that centre it is perfectly legitimate for that centre to record me, register me and keep me on their files and records. Unless I do I do not think somebody else should submit my name to a body, institute or centre which I personally have not consulted or about which I know nothing.
The second part of my amendment will show that all I have in mind is that they attend the centre from the beginning. Where a person is a drug addict I am in favour of a specialised programme of treatment. It is not just a one off situation. A drug addict is not cured in a month. It may be a life-long cure.
Is there a cure?
This is the point. There are many of them who may not be. It necessitates regular attendance at a centre and a full programme of rehabilitation for that person. That is why I am advocating the idea of a treatment centre, a full record on him, what drugs and the quantity he is getting. That is the whole purpose of the registration. The doctor who has control of that also knows what the trends are. Then they can come back to us and say: " We need sterner measures. The situation has got worse ". They would have some way of finding out. With the present system we could have drug addicts in abundance going from doctor to doctor. There is no liaison between us. There is no check up on the amount of drugs given out. Naturally, we do not want any restrictions. I would prefer no restrictions but you are helping the person and you are helping a whole community. It is a programme of treatment we want to see for them, not just in and out from one doctor to another.
I think we are clear now.
People may be surprised that I am in full support of Deputy O'Connell in this matter. We have compulsory notifiable diseases. We are supposed to be concerned with the mis-use of drugs here. Deputy O'Connell, in his last statement, has highlighted a fact that could occur. If a patient was getting treatment, a certain minimum amount of a controlled drug because he was an addict and could not be taken off it, another GP could find himself the innocent cause of completely upsetting that course of treatment and control. We are concerned with the patients who are subject to drugs. I can fully understand Deputy O'Connell's concern in the matter. Twenty people could wreck a lifetime's work.
There is nothing to stop me, if I want to be treated as a private patient, going to Deputy Byrne, Deputy O'Connell, Deputy Gibbons or Dr. X, Y or Z, doing the rounds, getting a selection of pills and building up my little bundle of nuts, like the squirrel, and then going on a good trip. There was no control on that, but this measure does control it. If the GP is bright enough to spot what is happening he can at least notify some central authority so that a warning can be sent to other GPs.
We are dealing with a person who is suffering from a disease in this case. I do not care about Big Brother. When a person is suffering from a disease he may not be able to control himself or his urge for the drug. Deputy Haughey rightly commented that a person goes along of his own volition. But a person who is an addict is not in complete control of himself. He has a drive to get this drug. We have all seen plays, films and so on describing what happens to a person hooked on a drug. We are trying to treat that person. Let us try to devise some method where these people can be treated and their urge for drugs controlled.
As has been said by the doctors, it is very difficult sometimes to discover which drug a person is on or what is the nature of his addiction. This will not cause any trouble, it will probably be rarely availed of, but there will be the odd case that can be saved or improved if this provision is in the Act. It is up to the Minister, on the advice of his Department, the health boards and the medical profession, as to the rules and regulations required. That can be dealt with quite confidentially. A matter like this does not need to be booted around; it is more the preservation of doctors from making mistakes and being the innocent contributors to further addiction. This is the important thing to remember about Big Brother fear. We may be all afraid of that but we are dealing with something which must be dealt with.
I will make one personal comment on this, which is a very important issue. Deputy O'Connell has raised a serious issue and one which shows that it is virtually impossible to cater for drug addiction in a private enterprise medical system, whereby each medical doctor acts in such isolation internally that public assistance, in the best sense of that word, to a drug addict becomes virtually impossible. Certainly, it exposes, in the discussion we have had, the total lack of internal liaison within the private enterprise medical system in this country which results in private treatment on a voluntary basis with no liaison between the medical profession and——
Having said that, it seems to me that the amendment in Deputy O'Connell's name is a veritable by-product of that system. I think Deputy O'Connell would agree that it would be wise to give the Minister an opportunity of seeing if a system could be devised which would meet the general feeling of the Committee.
What this Bill sets out to do is to stop young people abusing drugs, to stop the growing cult of drug abuse. There are, I am quite sure and without having checked on it, elderly drug addicts who are not even aware that they are addicts due to treatment given by doctors over the years for all sorts of conditions. What happens to these people who have been turned into drug addicts by their doctors under a provision like this, where they have been attending a private doctor and taking a particular drug? First of all, they have confidence in their family doctor: whichever drug their doctor recommended they took. Has a situation now been created where a whole section of the community—if a survey was carried out on doctors it would probably be found that they have created more drug addicts among elderly people—will have to go on a central register because they have become dependent on a particular drug? What I am concerned about is the misuse of drugs by young people; the misuse of LSD, cannabis and all the other various drugs. The Medical Council should be well able to redirect their members as to the dangers of prescribing such drugs. There are probably more addicts over the age of 30 in the country but these people would not describe themselves as addicts. I would ask any doctor to say that this is not so.
If a doctor has made an addict of a patient then he should not continue to treat that person, because no doctor has the right to continue treating a patient with hard drugs such as pethidine or morphine except in a case of advanced cancer where pain-relieving drugs are administered in the terminal interest. There should be no practice of continuing hard drugs.
On the question of records, I quote paragraph (c) of section 5, lines 28 to 30:
Such regulations may also provide the furnishing of information relating to such records to the Minister,
These regulations will go a long way towards covering the problems raised by Dr. O'Connell, in other words, providing information to the Minister and his Department as to the amount of drug abuse related to the amount of people taking drugs.
Does that deal with individual patients? People talk about professional secrecy. This is the problem we must face. I do not think that provision goes far enough.
We cannot argue on the question of professional secrecy, but there are a lot more things which doctors try to keep to. Then we give this away by notification of infectious diseases, other diseases and evidence in court. In one way or another, our ideals are circumscribed so we can not really make a case——
It is entirely defensible that there should be—I would advocate it—within each health board area and maintained by public funds, an entirely confidential system whereby medical practitioners would have some opportunity of consulting with one another on some kind of central record system whereby they would be prevented from falling into pitfalls which would be horrific; these pitfalls could occur in a system with absolutely no liaison or perhaps with very thin liaison wherein the Minister has admitted in relation to the National Drugs Advisory and Treatment Centre that it is rather ineffective. There is need for that kind of public co-ordination.
Deputy O'Connell has suggested that because the amendment was put down seven months ago we might have consulted with the medical profession. I take the point, and in some cases we have taken that precaution in respects of other parts of the Bill. My view on this particular amendment was that I should get the views of this very representative Committee before I would approach the profession. It is important that we should——
We are on the Committee Stage now. We are either going to pass the provision or not.
As I suggested in respect of other amendments, I would consider it for Report Stage. It appears to me from the information I have that the vast majority of doctors have entered into a voluntary agreement whereby they would notify addicts to the National Drug Advisory Centre. This seems to indicate that the doctors are very anxious to keep some sort of a register and to try to determine what drugs are in use now and what the trend generally is.
We are all concerned with the individual rights, and it would be a mistake to think just in terms of the patient himself as an addict, because we all agree that he does himself a tremendous amount of harm and the function in framing legislation is to try to help him but there are social effects as well. Social effects are as dangerous as the spread of infectious diseases. We do not know what the family life is, we do not know whether these people who are collecting drugs are going to collect an undue quantity of drugs for peddling or for distribution to young children. Therefore, we must tighten this as tight as we possibly can have it in trying to ensure that the fullest information possible is collected and that there is satisfactory treatment.
I could not say whether average general practitioners would be capable of the absolute ultimate treatment for drug addiction, and the idea in the second part of the amendment is to the effect that there would be someone who would be reasonably specialised in the treatment of a drug addict and that a person would be referred back to him. Deputy Briscoe talked about drug addiction as a result of prescribing certain sedatives——
Particularly elderly people living alone and various cases like that.
There is something we have to consider, and that is not necessarily notification of an addict on, say, soft drugs—whether you could call librium and valium soft drugs or not I do not know, I suppose they would be regarded as soft drugs—but for the other drugs like morphine and heroin we could possibly do something in that direction and maybe add on a few more. But we still have not got over this idea where, as Deputy O'Connell suggests, somebody who is addicted to drugs goes to two, three, four or five different doctors to get an undue quantity. That would be the merit in the proposal as I see it, that there would be an obligation on a doctor to notify addiction and that that particular person would be referred to somebody who would be very well specialised in withdrawal and general treatment. It would be necessary to have a discussion with the medical profession to see what type of formula they could come up with or whether they would go along with this amendment. I propose to do that.
There is one question I should like to ask. Under this Bill, if a person is moving from doctor to doctor and it is proved that he is doing so, is that considered abuse and subject to prosecution?
No. He is a sick person.
In all cases he would be getting drugs on prescription. It could be considered that he is legally entitled to them. This is my information. We have three doctors here and they may be able to help us in that respect. Deputy O'Connell suggests that this is so, but it may not happen in some rural areas.
We are getting into a dangerous area, because if the doctor is aware that his patient has moved from another doctor to him then he is subject to prosecution, I would think.
If the doctor is so aware, then he is guilty of over-prescribing and he could be charged under the Act.
What I am getting at is the person who is codding the doctor. I have been in a house where a patient went up to the one practice and it so happened that there were two locums in succession in the practice and a principal. I accidentally had to go into the house about another matter and I knew that one doctor had prescribed and when I went in I saw with the same patient treble doses of the drug. I asked how all the pills came in and I was told what had happened. They had been up three times to the same practice to three different doctors who had written prescriptions and they had treble doses of drugs and only needed one dose.
Controlled drugs?
No, but this can happen with controlled drugs.
What precisely is the Minister proposing? He is to consult the medical profession and if they agree he is going to accept this amendment?
Not necessarily. I said I would have to consult them and then make up my own mind.
On Report Stage.
We understood some of us were objecting to the amendment on principle even if the doctors agree to it.
Would Deputy O'Connell be agreeable to withdraw his amendment?
There are two elements in this recording business as I understand it. Number one is the recording for the information of the Minister and his Department on matters of general policy, and the second one is the one which Deputy O'Connell is emphasising at the moment, the recording of the personal treatment for the benefit of doctors. There are really two problems in recording. I suggest that the first one is covered by subsection (1) (c) of the section.
It is the second one I am concerned about.
It is a very dangerous one. It involves the specific licensing of doctors.
Paragraph (c) is concerned with drugs only and not persons so paragraph (c) would not cover what Deputy O'Connell wants to achieve.
I accept that, but at the same time it is for the Minister's information and the information of the Department. Information could be extracted but it would not cover the main point Deputy O'Connell made.
The medical profession will be aware of the discussion through the reports.
It is amazing how various bodies concerned are totally uninformed about our discussions here. I still find people writing to me demanding that things be put into the Bill which have already been discussed by the Committee.
We can go on record that the verbatim reports of these discussions are fully available to all.
It might be like the Savoy Hotel in London—available to all but not accessible to all.
There is only one newspaper reporting these proceedings.
As far as the professions are concerned, I am sure they are following the discussions. We will undertake to ensure they will.
I move amendment No. 25:
In subsection (1), page 6, between lines 49 and 50 to insert the following paragraph:
" (h) prohibiting absolutely, any qualified person from supplying or authorising the supply of controlled drugs to any person under the age of eighteen years, unless such controlled drugs have been prescribed for such person by a registered medical practitioner."
I have tabled this amendment because of the possibility of young people taking prescriptions to chemists for controlled drugs, perhaps for their parents. The ones in particular I have in mind are valium, librium and so on, the white tranquiliser pills, the white sleeping tablets—the mother sending the child out to the chemist with the prescription and the chemist giving the tablets then to the under-18 year old. The mother sends the child to the chemist with the prescription and he gives the child the tablets. I inserted 18 years in the amendment so that the committee could discuss it if they think it worthwhile. There is a risk of young children using drugs, having seen their parents taking them. They may have easy access to them. I tabled the amendment so that the committee might consider it and if they thought it wise it could be inserted into the Bill, that an age limit be imposed upon those who can have controlled drugs in their possession for a temporary period as messengers going to and from chemists' shops. Chemists could be advised not to fill prescriptions for people under a certain age.
There are a number of things about that. It would mean scrutinising every single prescription. When I go to see a patient who urgently needs certain drugs I will send one of her children down fast to the chemist's shop. It would impose tremendous difficulties because a doctor would have to see what portion of a prescription related to controlled drugs. A painkiller might be prescribed plus specific treatment for the patient's condition. If a child was sent to the chemist he might only be able to get half of the prescription. I see the logic behind the amendment. We would certainly like to stop children being sent for drugs. The chemist could exercise a certain amount of responsibility. He is the best person to assess the situation. He usually parcels up the prescription carefully and the child does not know what it contains whether it is aspirin or a diarrhoea mixture. This amendment would impose many difficulties on households.
Particularly because prescriptions are normally used and if an adult is sick he cannot get out to the chemist himself.
That is the problem. In 90 per cent of cases prescriptions do not include controlled drugs. They are for an antibiotic or something like that. You could have a controlled drug as part of the prescription, so what happens?
The committee are taking a funny view of this. I am not thinking of infants but a 14 or 15 year old child going to a chemist and taking maybe 40 valium tablets out of a container before bringing it back to his or her parents——
That is not a controlled drug.
I am speaking broadly. At the present time the position should be looked at.
The amendment refers to controlled drugs whereas valium, librium and many tranquillisers are not controlled drugs and the amendment would not apply to them. There is nothing to prevent a child, when the drugs reach the household, from doing the same thing. He could get up in the middle of the night and take some valium.
All we want now is for a patient to die in the middle of this.
We would be imposing severe restrictions on a family if we inserted this amendment. The child on the way back with the valium could steal them. He could also steal them as soon as he got home.
Are the committee happy with the present position? A doctor writes a prescription for drugs and a 14-year-old boy is sent to the chemist's shop.
How does he know what the prescription consists of? He would not be able to read it. Doctors' prescriptions are almost indecipherable. Pethidine is a white, uncoated tablet and it could be one of a million tablets. How will a child be able to read a prescription, which is generally indecipherable except to a chemist? There may be two different types of tablets on the prescription. He would have to know which was which. I agree with the reasoning but it does not apply here.
Hold on. Of course it applies here.
The Minister has to sit and listen to this. He wants to hear about this.
What Deputy Byrne suggests, I have power to do under section 5 (1) (a). We will be able to make regulations to control manufacture, supply, transportation and so on. For obvious practical reasons it would be difficult to make regulations to decide whether or not a boy or girl of 14, 15, 16 or 17 years of age should, in effect, convey something that has been prescribed by a doctor from a chemist's shop to a household. It is all very well to say that the young person might not know what the package contained, to him it is just a prescription. There could be a smart fellow who knows damn well that his mother is on pethidine or something like that. The person carrying the drug home could be waylaid and have it taken from him.
Why cannot they go into the chemist's shop and take them the same way?
There is the possibility that the person might take half the tablets and say the chemist only gave him half the prescription. A young fellow can buy a bottle of cider in a supermarket. If we are trying to stop that for those under 18 years of age why allow a child to go to a doctor and tell him that his mother wants a repeat of her prescription?
I am sure if a woman wanted a message from a chemist's shop and a young fellow was passing by she could not ask him to produce a certificate——
We should refer here to the chiseller, because it is always the chiseller who is sent for the messages.
Is it envisaged that controlled drugs will be given out to anybody otherwise than on a prescription?
No, it is on prescription only.
If a drug is being handed out on prescription only, is it not immaterial what the age of the person is? If the person is over 18 he must have a prescription for the controlled drug just the same as if he is under 18.
That is for consumption. Deputy Byrne is referring to deliveries.
Assuming it is for delivery it would be on a prescription for a particular person.
He is saying that the deliverer, the messenger, could steal them.
That can happen whether he is under or over 18 years of age.
Yes, that is true.
What about the chemist who employs a messenger?
These messengers are usually under 18 and they are often employed for about six months and then they are sacked.
Is Deputy Byrne withdrawing his amendment?
I do not have to put in this amendment. If I decide to do what Deputy Byrne wishes I have the power to do so.
Do not stop the chiseller running down to the chemist.
Deputy O'Connell spoke about a youngster getting up in the middle of the night. He substituted chiseller afterwards but it might be more than a chiseller. I do not know how many recall that in England some years ago a mother who was getting the pill discovered after some months that her daughter was substituting aspirin for it. The aspirin did not work for the mother, I am afraid.
I move amendment No. 26.
In page 6, subsection (1), between lines 49 and 50 to insert the following:—
" (h) requiring any manufacturer, manufacturer's agent or wholesaler who wishes to withdraw a controlled drug from public sale to give six months' notice of such proposed withdrawal unless the Minister is satisfied that it is in the public interest that such controlled drug should be withdrawn at such shorter notice as the Minister may determine."
This amendment proposes to add another paragraph to the existing paragraphs included in subsection (1) of section 5 to the effect that any manufacturer, manufacturer's agent or wholesaler who wishes to withdraw a controlled drug from public sale to give six months' notice that they propose to withdraw unless the Minister is satisfied that it is in the public interest that such controlled drug should be withdrawn at such shorter notice as the Minister may determine.
I think the reason why I put down this amendment should be obvious. I am told by practitioners that it sometimes happens that they are prescribing a certain drug and, without any notice to them, the manufacturer of the drug or the wholesaler choose to withdraw it from the market and they are, to say the least of it, inconvenienced, and the best interests of the patients that they look after in this process are not served.
In so far as controlled drugs are concerned I want to give the Minister the power to make this provision, that if a manufacturer wants to take a drug off the market he will have to give due notice to everybody concerned that it will be available in future. I think it is reasonable that the manufacturer would have to give this notice, but I go on then to make provision that in the event of some emergency situation arising where a controlled drug must be got off the market without delay because of some danger involved in it, that there would be a good medical reason, that then the Minister could dispense with this provision.
I do not think the amendment is unreasonable.
I am just trying to see what is intended in it.
As Deputy Haughey said, a drug company could withdraw tomorrow morning a particular drug that the medical profession generally would regard as being absolutely necessary, say some pain killing drug, for example, because it was not profitable. It is possible that they might decide tomorrow morning that because it was not profitable that they would withdraw it from the market. I think somebody should be able to decide whether there was a proper substitute for it and possibly a substitute at the right price. This is not a reflection on the drug companies or anything like that, but notice of withdrawal, I think, would be necessary in order to ensure that there would be a substitute or, as Deputy Haughey has said, the Minister for Health could be given power to take it off the market immediately. We have examples of where it might have been done—there could be a drug that could be deemed to be dangerous and it might be necessary to take it off the market within 24 hours.
With regard to this amendment I want to indict the Department of Health for their failure to act.
I think Deputy O'Connell should indict the Minister for Health.
I said " the Department of Health ". I can indict whom I like. I am indicting the Department of Health.
What, about summary conviction?
I am talking about the drug thalidomide. The six months' notice applied in that case. The Department of Health had the power to do it but they did nothing about it. I am wondering about that. If a manufacturer wanted to withdraw a drug in the normal way you have to give six months' notice. Say the drug is dangerous——
Had the Minister the power?
He had and he took six, seven, eight months to think about it. I agree that on that point of view it is——
Our Department of Health was not unique in Europe in that particular case.
It was unique in Europe. Every other Department of Health went to trouble but the Department of Health here were satisfied to say that the company sent around the circular. I have to say this because it is relevant to this.
It does not affect the validity of it.
It does because they are being asked to give six months' notice and then leave it to the Minister.
If it seemed to be a dangerous drug it should be withdrawn from the market within 12 to 24 hours.
You are leaving it to the Department of Health.
The Drugs Advisory Board.
Is this relevant on misuse of drugs? I do not think this arises under the Bill at all.
It does. Say this drug is also causing massive deformity.
Leave out the " massive ".
Say this causes massive deformity in babies and the mother is taking it and it has been found out. Under this amendment this drug company would give six months' notice of withdrawal.
That is a different matter. The provision for dangerous drugs comes into operation then and it is the Minister's duty to get that drug off the market immediately. That is a different situation.
You are saying that they might want to withdraw a drug for their own personal reasons. It does not say that. The same amendment could apply if the drug company wanted to withdraw a drug because of its dangerous effects.
The point here, and I think it is right—you mentioned it accidentally—is that if it is a drug of addiction and you had to give a miniscule amount of it to keep the patient right then it would be wrong for the manufacturer to withdraw that particular drug.
It is a permissive amendment in that the Minister may make regulations requiring a manufacturer rather than that he shall make such regulations.
I move amendment No. 27:
In page 6, subsection (2), to delete " a qualified person " from line 52.
Amendments Nos. 27, 28 and 29 are consequential on amendment No. 16 and are therefore governed by the decision on No. 16.
I move amendment No. 28:
In page 6, subsection (2), lines 53 and 54, to delete " in case such person is a registered medical practitioner, registered dentist or registered veterinary surgeon " and substitute " a practitioner ".
I move amendment No. 29:
In page 7, subsection (2), in line 1 to delete " in any other case" and insert " a pharmacist ".
I move amendment No. 30:
In page 7, subsection 2 (b), line 2, before " manufacture " to insert " import, export, transport,".
This is not of any great significance but it seemed to me to be some help in the drafting of the Bill. On page 7, paragraph (b) the existing wording is:
in any other case, for the purpose of his profession or business, to manufacture, compound or supply a controlled drug,
I think it would be desirable to put in there the words " import, export or transport ". It would be necessary in order to sound out the various reasons. " Import, export or transport " would not be covered either by a manufacturer or by compounding. It is really only a drafting amendment.
Would " supply " not cover it?
The purpose of section 5 (2) is to ensure that the Minister makes regulations to enable practitioners, dentists, doctors and pharmacists to carry out their normal professional duties. In the case of section 5 (2) (c) their normal professional duties are manufacturing, compounding and supplying controlled drugs. Importing and transporting would not normally come under the duties of a pharmacist. Deputy Haughey's amendment——
These are not pharmacists; they are more manufacturers, agents and wholesalers.
Section 5 (2) (b) deals only with pharmacists.
Compounding and supplying drugs.
Deputy Haughey wants to include import, export and transport. This would not be the normal practice of pharmacists. If a particular pharmacist wanted to get a special import licence that could be provided for as well, but import and export would not normally be the function of the pharmacist.
Under subsection (1) the Minister has power to make all sorts of regulations for the control of drugs. There is a safety valve in subsection (2).
It is specified: " a practitioner, dentist or veterinary surgeon ". The ones which are left are pharmacists within the definition of a qualified person.
With regard to whoever is covered by paragraph (b) if it is wanted to cover manufacturing it is reasonable to cover importing, exporting and transporting a particular substance.
It is not just manufacturing. It could be importing.
No. Manufacturing might necessarily lead to importing.
I think the Deputy is referring to the previous amendment, amendment No. 29. We have deleted " in any other case " and inserted " a pharmacist".
When we talk about qualified persons we are talking about doctors, dentists, pharmacists who are already covered. Section 5 (2) says:
" the Minister shall exercise his power to make regulations under this section so as to secure that it is not unlawful under this Act for a qualified person in case . . . to prescribed, administer, manufacture, compound or supply a controlled drug."
Section 5 (b) states: " in any other case". That again is related to a qualified person. He may do it for the purpose of his professional business to manufacture, compound or supply but that would be normal. It would not be his normal function to import, export or transport. In the case of importation, I do not want to give him a global permission to import, but if there is a special case the person might be issued with a licence.
That is all my amendment wants to ensure.
The Deputy is making it mandatory on the Minister to give that licence to all pharmacists. What I am saying is that in a particular case it would be all right.
Again, the Minister shall exercise his power to make regulations.
The Minister at paragraph (b), subsection (2), because of the amendments which he has already made, can only cover pharmacists?
That is all.
Even granting that, if a pharmacist is put in a position where the Minister cannot make a regulation making it unlawful for him to manufacture and it precludes him from extending that even in the case of importing or exporting what he manufactures.
In the case of what he manufactures, what we visualise here is a pharmacist who would be actually manufacturing the drug.
Antigen?
Yes.
Surely they would be able to import and export the products once they can manufacture them and transport them.
As far as manufacturers would be concerned there would be general regulations governing the manufacturer and the type of person who could handle them. What I am saying now applies to (b), that is the pharmacist in the manufacturing industry would be able to manufacture. I would not envisage that every pharmacist's shop would have the power to import, export or transport.
The Minister would not be doing that because it would still be constructed under the terms of paragraph (b) for the purposes of his professional business. He would only be allowed this for the purposes of his professional business. Maybe we will leave it over and the Minister will consider it.
It is a difficult case because one could have every pharmacist importing and exporting.
I do not think it would be right to give the pharmacist the power to import.
That is not really what is involved. What is involved is putting a prohibition on the Minister not to make regulations, to make it unlawful for a pharmacist for the purpose of his business to manufacture a particular drug. He cannot do that. I think it is equally valid to put the same prohibition on the Minister in regard to regulations governing import and export.
I see the point. Perhaps before we adjourn we could take a further amendment from Deputy Byrne. We would then be in a position to dispose of section 5 altogether.
The Chairman cannot do that because I want my amendment to remain extant until the Minister has time to consider it. I am not withdrawing it.
We will leave the matter until this day fortnight if that is agreeable.
