Drug History Canada

Musings on the history of drugs in Canada.

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Whose control is it, anyway?

So those upstart pharmacists and nurse practitioners want to edge in on doctors’ business!

Recently, across the country, various health practitioners have been seeking to expand their scope of practice. This is the legally defined range of activities they are allowed do. In the health system, especially, it is a highly contentious issue. Because unlike other professionals, whose work is also restricted and protected by law, when health professionals do stuff, it affects people’s health.  And just ask any health ethicist. Unlike buying a car, or getting your house painted, or even renovating your bathroom, the transaction you have with your health professional affects you in a way that can affect your well being,  quality of life, and sense of self.

We can understand scopes of practice by looking at history.

The scopes of practice for health professionals have been developed over decades, if not centuries.  In Ontario, in the middle of the nineteenth century, doctors and pharmacists, argued over what activities should be their specific areas of authorities.  Generally physicians won these arguments, since the pharmacy laws which gave pharmacists legal right to compound and distributed a specifically listed set of substances, normally exempted physicians from those rules (docs often carried drugs with them and it was often, in a rural country as ours was, much more efficient for them to sell or give drugs during treatment then to require a patient to head to the local pharmacy).

Some physicians exploited this loophole.  Some opened their own pharmacies, finding these were much more lucrative than a medical practice. A pharmacy could sell other goods that it might not be so expedient for a physician to carry in his saddle bags, so if you could build a good solid mercantile business, you were in the money.

At the same time, some pharmacists also infringed on the physicians’ domain. A customer comes in and has a cough and is looking for  a remedy.  What do you do?  Send them to a doctor to get a ‘scrip for a cough medicine? Or compound some simple syrup, cherry flavour and opium and voila, cough medicine (this would probably be what the doc would prescribe anyway)?  Well, to the docs, this was a violation of the legal scope of practice. To the pharmacists, it was just serving their customer. The courts were divided, but most saw selling something to a patient to deal with a simple symptom was not the same as diagnosing and prescribing.

There were other issues of intersection, and I’m currently exploring them in more detail.  I’ll try to post more information and thoughts when I find more great examples.

The point, though, in respect to current debates about scope of practice, is complex.  

Scopes of practice were contested, debated, lobbied for, and not always established with 100% control.  When doctors in Ontario saw the legislation passed that gave them professional status and control over who would be allowed to practice medicine, they had to share this responsibility with homeopaths and practitioners of a few other types of alternative modalities.  Homeopathy was popular, especially among elites, and the idea of an absolute monopoly over any single occupation rubbed our laissez faire-ist ancestors the wrong way.

So these current debates are part of a process of evolution and change

But when it comes to drugs, there is another historical process at work: the construction of danger embedded in the prescription.

When pharmacy laws were passed they had two purposes. The first was to control access to “poisons” which were being used purposely or mistakenly to kill.

Suicides, murders, accidents. These were sometimes linked to drugs.

Strychnine, arsenic, opium. These were the poisons.

Taken in high enough doses, they’ll kill you. But they were also medicines.  

So the pharmacy law was designed to place control over highly dangerous drugs in the hands of professionals who knew how to use them. And since usually pharmacists were also compounding remedies (a doctor would send a recipe and the pharmacists would mix it) there was some skill in the actual process of assembling, measuring, etc. 

But what happens when something becomes controlled? Well, the idea that medicines should be controlled by professionals expands the scope of that control. By the end of the century, there were more arguments for more control over substances that, while not poisonous, might in some ways cause some damage to a patient.  The range of “controlled substances” expanded as the pharmacopoeia did. Why is an antibiotic a prescription drug?  It’s not likely going to kill you. But if you take it too often, it will become ineffective. How about oxycontin?  Well, it is an opiate, so it might kill you, but it will more likely addict you.  Both of these, of course, carry their own dangers, and some very significant ones, but they are not poison in the traditional sense. They are, however, controlled.

So when docs, nurses, pharmacists and others begin to talk about who should control the prescription and administration of certain drugs, pay attention to the way the idea of danger emerges.  What is dangerous?  How dangerous? How much risk is there in a different professional administering an antibiotic or a vaccine?  And is that danger so severe that the practice should be strictly controlled to one professional? And should one profession have that much authority?

It’s worth considering.  Because these ideas of danger, control, abuse, misuse, and professional authority are infused with complex meanings. The meanings are historically grounded, and evolve and even transmogrify. As these debates continue, ask what is really being discussed.

And then look to an historian to unpack it for you.

(c) 2014, Dan Malleck

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Big thinking in London

I was at a conference in London on drug and alcohol history.  I go to these quite a bit.  But this time they caught me on video.  

To avoid seeming entirely self-promoting, I encourage you to follow the links to other interesting presentations at that conference.  And just in case you’re wondering, the “James” to whom I refer in the paper, is James Kneale, who presented his paper immediately before mine.  His presentation is also on this site, as are many others, and all better than mine, I’m sure. 

http://www.fead.org.uk/video718/Dan-Malleck:-Habitual-risk:-Insurance,-professional-authority-and-the-medicalization-of-addiction-in-the-19th-century.html

Finding historical newspapers and their locations

Once in a while we need to get off our butts and get to the archives.  I was in the University of Toronto’s Robarts Library yesterday and had the blissful feeling of going through actual real documents, coming out covered with the detritus of over 100 years of deteriorating paper, glue and leather bindings.

But after getting through all of those documents (I was deep in historical provincial legislative records) I wanted to look at some of the newspapers for the provinces I’ve been working on.  The problem is: I didn’t know which papers existed for the period I was researching.  Searching “Halifax newspaper” for example was a poor approach, and yielded weak results.

How do you find which newspapers existed, when, and where they are located?  It may be a newbie dilemma, but since I mostly did Ontario history for the past 15 years, it wasn’t a big problem for me recently.

But there is an easy solution.

One of our history librarians at Brock pointed me to this good list at the Library and Archives Canada:

http://www.collectionscanada.gc.ca/newspapers-at-lac/index-e.html

Although it lists what the LAC has in its holdings, it is possible also to find where some or all of a particular newspaper is located in other university libraries and public archives.

Follow these easy steps:

1) Use the search field in the top right of the page and search on the specific name of the newspaper.

You will likely get many results, because that search pulls of mention of that title as a phrase in everything. But if you then do an advanced search, search with the name of the paper as a title, and then maybe add a few more limits [for example, date or language or Library vs Archive] you should be able to find a listing for that newspaper.

Now, here is the awesome bit:

2)  Click on that title and it will go to an old skool looking Courier font listing for the paper.

3)  Click the “Locations” button near the top left edge of the page, it will show you which libraries and archives hold it, and the ranges.  These libraries and archives are listed by an obscure code (hint: word beginning with “O” = Ontario, “Q”= Quebec, etc. This is normally what is available through Inter Library Loans, so there may be more stuff at the actual library itself.

4) Click on the location in the left column and it will tell you which institution has this paper.

It is a very useful source for planning research trips, not only to the LAC, but elsewhere, too.  Have fun

(c) 2013 Dan Malleck

The dangers of relying upon scanned text searches

With all of the on-line documents out there, it is tempting to avoid the sitting-in-a-library-and-reading-miles-of-microfilms approach to newspaper research, and replace it with using text searches on digital newspapers, texts and other scanned material.

There is some merit to that: saves time, microfilms readers can be annoying to use, and you can do your research at home in your underwear.

But lest you rely too heavily upon the scanned text,  remember one thing: character recognition software can be deeply flawed, especially when it is trying to recognize characters from texts printed over a hundred years ago.

Case in point: I’m reading through  legislation discussions as reproduced in the British Colonist online.  (You can find a link to it on the Digital Newspapers page, above)

On 18 March, 1881 the BC legislature had a brief discussion of amendments to the 1881 Poison Act.

Here is what it looked like in the paper:

British Colonist, 19 March 1881, p. 3

Here is how the character recognition software read it:

House wont Into Committee on silo of
Poisons Regulation Bill , 1ItW . Ucown
in the cir
,
Olauso 1 was altered by suhstitutin
” medical practitioner
” instead of ” apothecary
.
” ‘
.
Clause 5 , for mixing colored fluid with
poison , was struck out . ,
Schedule A was slightly amended tniljo :
: )
third line so as to road\ : Strychnine nnd1’
all ; poisonous vegetable alkaloids and their
511.ItsJan striking out aconite :
\ and its
preparations ,

. ‘
Sohodulo B calls for name and address
of 1sttichiasor.atsddata of sale in addition \

to name and quantity of poison , purpose
for wJi.lyh.iiaiuliHU

,
; \
.
qitilRigiiilt.IfIii \
, ;
;
! of put
l

I-
.t
; ”
.chMe\
‘ .l\l1d of person introducing it.
, .
f Committee ! rose and reported Bill com¬
plete with amendments

 

 

A more permanent home for newspaper listings

With corrections pouring in for my digital newspaper post the other day (okay, not “pouring in” but I have had a few additions and changes) I’ve decided it will be best to make the digital newspaper listing a separate page.  I will update that page (you can see pages under the main blog headline) when I can. The original post will remain unchanged.

Oops

Okay, so the corrections on the newspaper post have begun already.  

Apparently the “New Brunswick”newspaper links I received (and reproduced) are for the city in New Jersey, not the province in Canada.

I’ll fix them soon.

Where did the dangers of drugs come from?

In the next little while I’ll be musing on the origins of the idea that drugs, and especially drug addiction, is a problem.  there has been a lot of work on this, so I am going over very charted territory.

My concern is that the work on the idea of the “discovery of addiction” as Harry Levine named it, has focused generally upon official discussions, medical discussions, and those of commentators.  But not, from what I’ve read, on how policies and professional lobbying affected ideas of the meaning of drug consumption

In my dissertation, I took this back to basics, looking at the emergence not of prohibitory drug laws of the early 20th century, but rather of the first attempts to control in any systematic way the access to drugs: pharmacy laws of the mid- to late- nineteenth.  Here we have the idea of a substance that can kill you being labelled a poison and duly controlled.  After that, within a few decades, the idea of 1) controlling the public’s access to certain substances for their own good and 2) controlling what a person takes into their body under the idea that the damage, while not death, could undermine the individual’s physical capabilities really took off.  It was a constellation of influences.  I’ve discussed it somewhat in my 1997 article “Its Baneful Influences are too well known” published in the Canadian Bulletin of Medical History.  I also published, a few years later, an article on the development of the idea of addiction in asylum treatment, and then also on the tension between physicians and pharmacists over the control of access to drugs.

These are merely a few of the many influences over the shifting perceptions of habitual drug use.  From a simple habit to a complex socially problematic condition or even “disease,” drugs, their habitual use, and the multifaceted impact this behaviour has on society have deep and interwoven roots.  The process of deracination is long and difficult.

I’ll try to make it straightforward in subsequent posts, but if you’re really interested, I can post a reading list.  I promise it won’t be all my work; I don’t have that kind of ego!

 

(c) Dan Malleck, 2012.

Why the harsh new criminalization is dumb

I was recently asked why the federal Conservatives are so hell bent on pushing criminal legislation that includes 1980s era penalties for selling drugs.  More specifically, the new legislation will make mandatory minimum sentences for possession of moderate amounts of drugs like marijuana.  I guess having six plants makes you a trafficker, and there is no room for. er. judicious judicial judgement. (Sorry).

I’m not going to get into the history here, though if you wanted to, you could read some stuff by Marcel Martel, Catherine Carstairs, or Neil Boyd (there are others, too, like the book Panic and Indifference).  But since I have been asked about current policy changes, I’m going to reflect on why this policy is so out of place today.

Much of the negative commentary upon this legislation notes that it flies in the face of much of the last few decades approach to addressing what can be really problematic drug use.  For example, harm reduction to decouple the use of hard drugs like heroin from the criminal industrial complex and often gang-driven drug distribution networks, which also provide clean needles and social support for people who use hard drugs.

Historian David Courtwright wrote a brilliant book about a decade ago now called Forces of Habit in which, among other things, he asks the reader to consider the drug distribution industry as a business like any other.

Consider it: Legitimate businesses advertise, provide incentives (like “loss leaders,” coupons, buy one get one free deals, etc etc).  Drug dealers offer things like giving away some product, and then upping the price for more.  The first is considered normal business pracice, the second is considered heinous.

Legitimate businesses need to protect their product, usually through patent and copyright legislation.  Drug dealers have to protect their turf, expand their market through gang violence and other violent means, because they don’t have things like normal court system to use to protect their product.

It continues.  Legitimate businesses establish networks of distribution, work with border agencies to expedite transportation, deal with supply and demand problems, deal with the problem of “dumping” by competitor countries, or other businesses simply trying to undercut their hold on the market.

Think carefully about all of the things you hear about the illegitimate drug trade, and you’ll realize that much of what they do is precisely what legitimate businesses do, but the drug dealers do it in an environment where they are not only competing with other dealers, but they are trying to keep it out of the eyes of the police.  Their dealings are not with the border agencies and transportation companies, but with other criminal networks that can get product through borders and into the hands of distributors (aka: pushers).  These groups are criminals, they protect their turf with guns and violence, and often expand their market with other illegal or shady dealings.

It is, therefore, the outcome of the illegality of the product, not some sort of inherent character of drugs that make people do things illegal, violent or otherwise anti social.

But there is something else, and it is the way we locate certain behaviours culturally.  Historian John Burnham wrote a book entitled “Bad Habits” where he looked at the historical connections between different “minor vices” at the beginning of the twentieth century.  He referred to the relationships between, say, smoking, drinking, prostitution and gambling as a “constellation of minor vices.”  We see in the criminal gangs and different networks these same connections. It is a business system built upon what Courtwright calls “limbic capitalism,” the marketing of pleasure substances.  Some of those, say, for example prostitution in Las Vegas, might be legal in some places and therefore while considered immoral, might be severed from other illegal activities.  But they are still connected culturally to “misbehaving.”

I could go on, but my point is this: some people, usually more politically conservative, see drugs as inherently dangerous because of the way they see it altering people’s behaviour.  In this view, it is the substance that is dangerous, regardless of its social context or legal status.  Our esteemed prime minister at one point said something like “harm reduction is ridiculous because taking drugs is going to harm you.”

He is wrong.

It is not the drug that has some inherent danger.  It is the political, legal and social ecosystem created by its criminality, which then creates and expands criminality.  I am not denying that some people take drugs and end up with some serious problems.  But many people take drugs and end up with no problems–except that they’re breaking the law, so have to mingle with some unsavoury characters, and pay into a criminal network that could get them into trouble.  A number of tremendously talented people were drug addicts or alcoholics, and still functioned well, and were remarkably successful.  Think of surgeon and co-founder of Johns Hopkins University, William Halsted, for example. Coke head.  Brilliant innovative surgeon.  Or any number of drunken authors who penned remarkable works.  Or, while we’re at it, any philosopher of merit, if you believe Monty Python.

All this brings us back to the new, harsh legislation.  By creating minimum sentences for drug dealers, and ramping up the punitive measures on similar behaviour, the government is building up on and propagating a perception of the substance being bad. Increased criminalization is not the answer.  If pot were not illegal, it would be no more of a problem, and no less manageable than alcohol.

(c) Dan Malleck, 2012

the first one’s free

Welcome to Drug History Canada.  I have created this blog as a forum (or maybe a monologue) about the history of drugs in Canada.

In contrast to my other blogs, which relate little to my academic work, this blog will be focused upon my current, upcoming and at times previous research in the history of drugs in Canada.  This topic is broad, the limits being mostly set by how you define the word “drug.” Does that include alcohol? Medical drugs or only “illicit” ones? Addictive or non-addictive.  Etc., etc., etc.

I guess I come about this topic honestly: I have researched both the history of drug control and prohibition in Canada, and liquor regulation in Ontario.  I am also currently the editor in chief of the Social History of Alcohol and Drugs: An Interdisciplinary Journal.  So I try to take a fairly pluralistic approach to the topic.

Having just completed a book on the regulation of public drinking in post-prohibition Ontario, (which you can find listed here and which will come out in paperback–and thus will be cheaper–in six months, and which will also be available for purchase on Google books) I am now beginning to revisit research I did years ago that looked at the decades leading up to the creation of prohibitory drug laws in Canada at the beginning of the twentieth century.  I hope to turn that research into a book over the next year or so.

That’s enough from me.  With this blog, I begin a new meandering journey. Hopefully these thoughts will be able to compete with my musings on brewing and cheese making

(c) Dan Malleck, 2012