was our heroin problem necessary?

Addirrion Xesrarch. 1997. Vul. 5 ( 2 ) pp.79-82 Reprints available directly from the puhllrher Photocopy permittcd hy license nnly

Editorial

0 1997 OPA lOverseas Puhlishera Aswciauan) Amsterdam B V Published under liccnse hy

Harwnod Academic Puhli\hers Printcd i n Muleysie

WAS OUR HEROIN PROBLEM NECESSARY?

Looking back at one’s own previous life can be a depressing as well as an illuminating experience. Around thirty years ago, a number of letters from me on the subject of the developing British drug culture were given prominent position in The Times (1). Partly due to the work done by the late Bing Spear, former Chief Inspector of the Home Office Drugs Branch, who was inter afia exploring the relationship between media attention and government policy in the 1960s, and partly for personal rea- sons, I have been re-reading one letter which appeared almost exactly thirty years ago, on 9th November 1966, the first anniversary of the Second Brain Report.

I asked the question: what has happened since the report? At one level, the answer was: nothing at all. There had been a good deal of talk and an increase in writing about drug abuse. Treatment facilities remained inade- quate, and no action as a result of the report’s recommendations had been taken. There had been a statement about treatment centres by the Minister of Health in the House of Commons on 2nd August 1966. ‘There are already centres for the treatment of drug addiction’, he claimed, ‘and more beds could be made available if the demand increases (2). I was puzzled by this statement and wrote for clarification to the Ministry of Health who replied saying that the Minister ‘was not referring to any action that had been taken following the second report of the Brain committee’ but rather to some ‘specialised units’ which had existed for some time (3).

In my letter in The Times I said that the Minister’s statement had been received by workers i n the field with ‘cynical laughter or with despair’. I described our experience:

Those who daily face the problems of the young drug taker are finding the obstacles almost insurmountable: hours and days spent ringing round hospitals for admissions;

79

Add

ict R

es T

heor

y D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y Q

UT

Que

ensl

and

Uni

vers

ity o

f T

ech

on 1

1/22

/14

For

pers

onal

use

onl

y.

8 0 R. SANDOVER etoI.

refusals, evasions and interminable delays; addicts whose condition deteriorates and parents whose hearts are broken; doctors who refuse to prescribe, and doctors who pre- scribe with almost criminal irresponsibility; and an overwhelming sense of hopeless- ness and despair among those who know the drug scene closest.

I went on to identify three areas where there had been significant changes during that significant year of 1966. First, the increased resistance of GPs to prescribe heroin and cocaine for addicts, even under carefully controlled conditions. From the end of the 1950s there had been a small group of gen- eral practitioners, known as the ‘junkies’ doctors’, who had played a critical role in the management of addiction in Britain (4). Although they had a bad press, and were undoubtedly a mixed blessing, they did help to keep the criminal market at bay and the ‘grey’ market under control. But by 1966 the number of doctors willing to take on addict patients was diminishing. This was hardly surprising since, not unlike the present day, there was consider- able official prejudice, hostility and venom directed against them.

The second change had been the escalation of the illicit market, itself in part the result of the withdrawal of the doctors. The 1965 report from the Home Office to the United Nations had noted ‘the significant increase. . . . . in the numbers of addicts who have obtained their drugs entirely from unknown sources’ (5). This was a more significant staterrlent than perhaps even the authors realised, for by 1966 there was evidence that criminal syndicates had moved in on the heroin market. I lived within a few yards of Gerrard Street in Soh0 during these years and saw the entry of the Chinese Triads into the traf- fic. Ironically, the first reliable news report noting the arrival of illegally imported heroin appeared in The Times on 26th March 1969, and its author was Norman Fowler, later to have some responsibility in this area in the Government. But powder heroin had begun to appear as early as 1966.

Thirdly, there had, during 1966, been a shift in the character of the ‘drug subculture’ itself, and this was to change even more dramatically during the Methedrine crisis of 1968. While E M Schur in 1963 had noted the total absence of any addict subculture in Britain, and David Downes in a study published in 1966 (though based on research from 1960) claimed that drugs played a negligible role in urban working class delinquency (6), by 1966 both these claims were being falsiified. The division between the kids on the pep pill fringe and the intravenous users was becoming blurred, and the addict subculture was spreading to embrace a wider range of young people. Again, while 1968 was the major year of change in terms of the spread of intravenous drug use, the process was well under way by 1966.

Add

ict R

es T

heor

y D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y Q

UT

Que

ensl

and

Uni

vers

ity o

f T

ech

on 1

1/22

/14

For

pers

onal

use

onl

y.

HARM MINIMISATION STRATEGIES 81

I ended my letter with these words:

The situation can be exaggerated and distorted, but it is serious enough. What is to be feared is that official reaction will be repressive and negative. So far the results of the Brain report have been almost entirely negative and bad. Since Brain, the situation has got worse, not better. And, perhaps most frightening of all, is the fact that many of our best workers in the areas of infection are coming to feel that they are banging their heads against a brick wall. Paralysis, like addiction itself, grows like a cancer, and destroys.

Could any of this have been avoided? Was our heroin problem necessary? It is difficult to be certain thirty years on, but my suspicion is that, had there been encouragement rather than calumny towards those doctors who were willing to treat addict patients, both the concentration of prescribing in the hands of such a small number and the reluctance of most GPs to have any- thing to do with addicts, could have been avoided. There was certainly a direct relationship between the rapid reduction in heroin prescribing and the escalation of the criminal market. What happened was predictable, and was indeed predicted.

But the most dramatic change has been in the whole economic and polit- ical climate, the environment for the growing drug culture. Just as the inventor of the glazed ceramic sewage pipe did more for the health of 19th Century London than all the charitable endeavours of dedicated social workers, so the spread of the drug economy is more likely to be halted or controlled by changes way beyond the field of drug use. But we cannot ignore the damage done by ill-conceived policy changes. Whereas in the 1950s, the pattern of addiction in Britain was the reverse of that in the USA, by the 1980s we were moving more and more in an American direction: the increasing correlation between addiction and high unemployment, poverty and youth hopelessness, but also the unintelligent following of American approaches to many areas of urban policy and penal affairs. It could be said that Britain has followed American practice in the field of drug abuse in all those areas where they have most conspicuously failed.

I currently chair a small drug prevention project in the East End of London which, like most voluntary projects, struggles for survival within the sea of rhetoric. It is, of course, cheering that, after thirty years or more, the government has finally come round to a recognition of the importance of preventive work. How much this is due to persistent and exhausting pres- sure from the voluntary sector, and how much to the fact that increasingly their own children and friends are affected, is hard to tell. But it is far too late now to prevent the escalation of serious drug problems which has

Add

ict R

es T

heor

y D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y Q

UT

Que

ensl

and

Uni

vers

ity o

f T

ech

on 1

1/22

/14

For

pers

onal

use

onl

y.

82 R. SANDOVER ettrl.

occurred over these years, and so much outreach work now, and for the foreseeable future, is bound to be in the area of picking up the pieces, casu- alty work, ‘crisis intervention’ (to revert to 1960s jargon), and so on. Governments never apologise, so it is left to the voluntary agencies to point out that many of the disasters of the last few decades could have been avoided, and that much of the mess that we now deal with -not least the escalation of the criminal market in heroin and cocaine- is the direct result of ill-thought out policy. Yet, as an earlier editorial in this journal pointed out, there was a rational control of drug use in this country from 1920 to 1971 and it still survives in isolated areas (7).

Replying to my letter of 9th November, that remarkable London GP, the late Dr A J Hawes, in The Times of 15th November 1966, made the same point in a more direct way:

The most threatening portent is that addicts are telling me that there is plenty of the stuff to be had on the black market even though the source from over-prescribing doctors is drying up, It looks as if big business, which has been waiting in the wings for so long has now hken over the stage and is playing the lead. So we may look for an explosion in the teenage addict population as the months go by. One can only write to the press, which most of us ‘junkies’ doctors’ are always doing. What else can pull the public ostrich head out of the sand? It could never happen to my children! Oh, couldn’t i t? Just wait.

Kenneth Leech Community Theologian,

St Botolph ’s Church, Aldgate, East London

References

( 1 ) See The Times, 2nd December 1965,25th July 1966,9th November 1966,4th March 1967,

(2) The Times, 3rd August 1966. (3) Ministry of Health to K. Leech, 19th August 1966. (4) Kenneth Leech (199 I ) , ‘The junkies’ doctors and the London drug scene in the 1960s:

some remembered fragments’ in D. K. Whynes and P. T. Bean (ed), Policing und Presc,ribing: the British svstem of’tlrrrg umtrol, Macmillan. pp 35-59.

( 5 ) Report to tho United Ncrtions by H M Governrnent. . . . . on the Working ofthe Internnriontrl Trearie.r on Narrotin Dnrgs. 1965. para 37.

(6) E. M. Schur (l963), N W H J ~ ~ C Addicrion in Brittrin urzd Aniericw. Tavistock, pp 144-146; David M. Downes (1966). The De/inyrrenr Solutimi, Routledge, p 135.

(7) John Marks ( I 996), ‘Accidy, addiction and the prohibition’, Addiction Reseurch 4:2, pp i-v.

27th June 1967, 28th July 1967, 2nd 16th July 1968.

Add

ict R

es T

heor

y D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y Q

UT

Que

ensl

and

Uni

vers

ity o

f T

ech

on 1

1/22

/14

For

pers

onal

use

onl

y.