Of all the millions of words that have been written and spoken in the past five years on the subject of drug abuse, only four have undisputed validity. The words are: we do not know.

We can recognize trends; we can make estimates that appear to be developing some sophistication. But, on the basis of current information and methods by which the information is secured, we can only conclude that we are trying to deal with a condition, the limits of which we do not know.

L'usage de drogues à des fins non médicales présente au moins deux caractéristiques justifiant les recherches dont cette communication rend compte:

• — II se situe d'abord dons la zone frontière entre déviance criminelle et déviance relevant de formes de controle social autres que celle mise en œuvre par le système de justice criminelle;

• — II comprend des formes ≪ traditionnelles ≫ dons les sociétés d'Europe de l'Ouest et d'Amerique du Nord, l'alcool notamment, mais aussi des toxicomanies qui paraissent relativement recentes dons ces sociétés.

C'est un plaisir pour moi d'être ici. Je vous remercie de votre cordiale invitation.

In contrast to some of our earlier speakers, my paper is less dramatic but is probably representative of the smaller inland Canadian cities. I say probably as similar statistical data from other cities is not available. The Ottawa Civic Hospital Poison Information Centre situated in a 1,000 bed general hospital has kept data on all poisonings since 1966 and from this statistical data we first saw the appearance of Drug Abuse in 1968. The Poison Centre has continued to maintain statistics on all poisonings including Drug Abuse, so I shall present our experience at our centre over the last four years.

Since the passage of the Narcotic Rehabilitation Act of 1966, the number of agencies for treating drug addiction, both public and private, have multiplied rapidly. The experience of these treatment centers has developed numerous treatment modalities; but no “one best way” or truly effective solution for treating the complex drug-using population has been found. The different treatment modalities have been moving gradually from the criminal approach to addicts to a purely clinical approach, and, in some areas, to a social and psychological approach to the patient in this entire human and environmental ecology.

The City of Philadelphia had a population slightly under 2,000,000 persons in 1970. It was estimated that, as of August 1971, there were 15,000 to 20,000 heroin addicts and 30,000 to 40,000 other drug addicts. In addition there were an estimated 60,00C to 80,000 alcoholics. These addicted persons made up approximately 5 % of the total population. An estimated 5 % of these addicted persons were in treatment.

As of January 1972 al least sixty-four public and private agencies or groups had been established to provide some form of drug referral, treatment and/or education. Some of these agencies had been in existence for many years, while others were in the initial stage of organization. Facilities for the treatment of alcoholics are not currently receiving the same emphasis.

There has been a paucity of information about illicit drug use in Australia up to date. Available figures refer either to persons admitted to mental health and other treatment facilities (Krupinski and Stoller, 1964-1971, Ma and Edmonds, 1969; Wheeler and Edmonds, 1969; Whitlock and Lourey, 1967), to drug offenders (Davis and Milte, 1970; Kyte-Powell, 1968), or both (Le Fevre, 1971).

Although these data cannot be regarded reliably as even the tip of an iceberg, they are indicative of a recent growth in illicit drug usage. Thus, the number of drug offenders in Victoria increased from 60 in 1965 to 160 in 1967 (Kyte-Powell, 1968). A survey carried out in New South Wales (le Fevre, 1971} identified 2,182 drug offenders born after 1939 who were recorded during the period 1965-1969. Since May 1969, the Central Crime Intelligence Bureau of the Commonwealth Police Force has been systematically collecting information on drug offenders throughout Australia (Davis and Milte, 1970) and, within a year, they gathered 5000 files on persons convicted or charged with an offence relating to drugs in Australia.

Il n'est pas dans notre intention d'effectuer un recensement statistique très précis, ayant une réelle valeur scientifique, des toxicomanies dans la région lyonnaise.

En effet, comme pour toutes les conduites deviantes, ii est extremement difficile d'accomplir un tel travail exhaustif. D'autre part, de tout temps, la region lyonnaise s'est trouvée un peu à l'écart des points de consommation de drogue, et on peut dire que, même actuellement, elle conserve dons une certaine mesure ce privilège. Cela a permis d'observer, avec une distance suffisanle, le déroulement chronologique de lous les faits et réactions sociales concernant ce problème de toxicomanie, sans être d'emblée submergés par la demande, comme cela paraît s'être produit dons d'autres régions, comme Paris et Marseille.

Drugs have played an important role in man's life for thousands of years. Man has always used “substance” in relation to spiritual or ritualistic experience or for secular reasons in order to change mood, feelings or perception. Only the choice of which substance depended on its availability and the nature of change desired.

The idea, in fact, behind many pharmacologically unrelated substances is one: to induce an artificial sense of satisfaction of some sort, a satisfaction derived from feeling up or down or bringing about a change of perception.

Nous n'aborderons ici que la toxicomanie provoquée par l'usage de stupéfiants, naturels ou synthétiques, c'est-à-dire un état caractérisé par la réunion des trois éléments retenus par l'Organisation mondiale de la santé : désir invincible de se procurer de la drogue, tendance à augmenter les doses et dépendance psychique ou même physique.

La définition elle-même de la toxicomanie n'est d'ailleurs pas essentielle sur le plan policier, étant donné que le principal critère est celui de la détention de stupéfiants, que celle-ci soit destinée à l'usage ou au trafic illicite.

Certains « usagers de la drogue », utilisateurs épisodiques des dérivés du chanvre indien, ou même du L.S.D., poussés par la curiosité et le prosélytisme, n'ayant aucune dépendance à l‘égard de ces produits et n‘étant donc pas de véritables toxicomanes, posent surtout des problèmes sociaux en raison du rôle de « vecteur de germe » qu'ils sont susceptibles de jouer dans la propagation des habitudes toxicomaniaques; mais ils soulèvent également parfois des problèmes médico-psychologiques : ces sujets ont en effet assez fréquemment des troubles psychopathologiques qui nécessitent une prise en charge psychothérapique ambulatoire, tant sur le plan de leur réadaptation sociale qu'en raison du risque d'escalade qui n'est pas négligeable, même chez ceux qui n'utilisent les drogues mineures que de façon occasionnelle.

The United Kingdom has recently clarified its drug legislation with regard to addictive drugs under a single Act, The Misuse of Drugs Act 1970. The various statutory regulations with regard to the many pharmacological preparations on which patients may become dependent and which they should not be allowed to purchase freely such as barbiturates, tranquilizers, etc., are unaffected by this Act. The purpose of this paper is to describe the main provisions of The Misuse of Drugs Act and to mention a few of the anxieties that may be caused to the medical profession with regard to its operation.

Un titre plus adéquat serait : « Quelle propriété doit avoir une substance pour tomber sous le coup d'une des nombreuses lois ou conventions pour le contrôle des stupéfiants ou psychotropes? ». Cependant une telle manière de voir serait aussi plus vague, étant donné la variabilité considérable des textes légaux. Même en se bornant aux traités internationaux on se trouve en face d'une multiplicité de critères. Toutefois, elle laisse apparaître une certaine tendance vers un concept qui pourrait correspondre aux besoins de la situation telle qu'elle se présente dans le monde d'aujourd'hui.

Qu'est-ce que la toxicamanie?

La toxicomanie est un état d'intoxication périodique ou chronique, nocif pour l'individu et pour la société, résultant de l'usage répété d'une drogue naturelle ou synthétique. Voici ses caractéristiques

A system of controlled prescribing of opiates for addicts was instituted in Tennessee in 1913 with a rigidly guarded permit system and a specified druggist for each addict. (“The Tennessee System”?). Although this system was abused in a few cases its good results appeared to far outweigh its defects and it led to the collection of a considerable mass of data about drug addiction which could not otherwise have been easily obtained (Brown L.P. 1915). Uncontrolled prescribing of heroin (“The British System”?) led to a marked increase in the number of known opiate addicts in the United Kingdom and an Interdepartmental Committee (1965) recommended changes to deal with this. These were implemented in 1968 following changes in the Dangerous Drugs Act (1967). Notification of addiction to controlled drugs became compulsory and the prescribing of heroin or cocaine to an addict could only be carried out by a specially licensed doctor. At this time the Department of Health set up a number of special clinics [the majority in London) to treat opiate addicts. In evaluating the effectiveness of such clinics, since abstinence as a goal is unlikely to be achieved in any but a small minority of cases, it is necessary to try and evaluate how patients function. Better overall control of drugs available should be reflected in a reduced incidence rate.