british drug policies in the 1980s: a preliminary analysis and suggestions for research

British Journal of Addiction (1987) 82, 477-488

British Drug Policies in the 1980s: a preliminaryanalysis and suggestions for research

GERRY V. STIMSON

Sociology Department, University of London Goldsmiths' College, New Cross,London SE14 6NW, U.K.

SummaryFirst, this paper attempts an assessment of recent developments in British drug policies. In the 1980s Britishdrug policies are in a state of transformation in which it appears that medicine is being displaced from a centralrole, and being replaced by a more extensive and dijfuse response involving a broader range of agencies andideas about drug problems. A more active role is being played by central government, the debate on drugs isbecoming politicized, and there is a new emphasis on law enforcement, and legal and penal control. It is nowquestionable whether the British approach to drug problems is as distinctive as it once was. Given that researchon contemporary drug policy is negligible, the second task of this paper is to identify a number of areas andissues worthy of policy analysis.

An immense gulf seems to separate the understand-ing of addict as a 'sick person' in the 1960s, from theunderstanding in the 1980s of the 'problem drugtaker'. When we read reports from the two periods,it is as though their authors are seeing anddescribing very different phenomena. In 1965,during a time of considerable public concern aboutthe relatively new drug problems then being en-countered in Britain, the Interdepartmental Com-mittee on Drug Addiction' described the problem inthe foUowing terms:

" . . . addiction is after all a socially infectiouscondition and its notification may offer a meansfor epidemiological assessment and control. Weuse the term deliberately to refiect certain prin-ciples which we regard as important, viz. that theaddict is a sick person and that addiction is adisease which (if aUowed to spread unchecked)wUl become a menace to the community." (p. 8)

Seventeen years later the Advisory Council on theMisuse of Drugs in its 1982 Report on Treatment

and Rehabilitation'^ chose very different terms todescribe the drug problems of the day:

"Most authorities from a range of disciplineswould agree that not aU individuals with drugproblems suffer from a disease of drug depen-dence. While many drug misusers do incurmedical problems through their use of drugs somedo not. The majority are relatively stable indivi-duals who have more in common with the generalpopulation than with any essentially pathologicalsub-group." (p. 31)

The report went on to describe the 'problem drug-taker' as someone who experiences social, psycholo-gical, physical or legal problems associated withdrug use.

These two reports epitomize the different con-ceptions of drug problems in the 1960s and the1980s. But if we look further at the 20 years or sothat have passed since the major policy changes inthe late sixties, it is not just the conceptualization ofproblems that has changed. There have been both

477

478 Gerry V. Stimson

major changes in the scale of the misuse of drugs inthe United Kingdom, and marked developments inthe British response to drug problems at a nationaland local level. In the 1980s British drug policiesappear to be undergoing a major transformation.

The purpose of this paper is twofold. First, it willseek to identify some of the main themes of theserecent policy developments. A preliminary assess-ment is that whilst in the 1960s and 1970s drugproblems were discussed at the policy level andresponded to mainly within the sphere of medici-ne—what in this paper will be referred to as a'medico-centric' approach—the 1980s saw a morediffuse understanding of the 'problem drug taker',with medicine taking a much less central position inthe response. Central government is now moreprominent in debate and policy, drugs are now apolitical issue, and much of the debate has beenaround law enforcement and legal and penal aspectsof control. It is probable that there is now little thatuniquely distinguishes the British approach fromthat of other countries. Given the lack of researchon contemporary British drug policies, the secondtask of the paper is to identify a number of questionsthat might be pursued for a fuller understanding ofthose policies. The paper will focus mainly onheroin not because its use is the only drug problemin the U.K., but because it is around the issue ofheroin and other opiates that the major strands ofBritish policy have been framed and discussed.British drug policies have often been synonymouswith policies for opiates.

The 'British system' for Dealing with DrugProblemsThe special features of British drug policy have beenthe attention of a number of writers (e.g. references5. 9, 18, 19, 20, 21, 22, 23, 24, 26. 28, 30, 31. 32, 36, 47, 48, 66) J j

was the idea that there was a unique 'British system'for dealing with opiate problems that was the subjectof many of these accounts. In particular some U.S.observers thought that Britain had a system that wasspecial and preferable to other approaches. Theterm was probably first used incidentally by E. W.Adams in 1937." Adams had served on the RoUes-ton Committee^'' and referred to the medicalprescribing of opiates to addicts as a 'system oflegalized purveying' (p. 65). The idea was devel-oped by Lindesmith" in the late 1940s and 1950s inhis arguments against the American penal approachand in favour of a more medical one. Certainly by1954 the Federal Bureau of Narcotics put out a

refutation of the 'British Narcotic System' that wasclearly aimed at Lindesmith (Lindesmith,'^ p. 163;King,*' p. 199). Other prominent commentatorsincluded Schur,"** who argued that the Britishapproach prevented the development of a drugsblackmarket; Judson, whose book Heroin Addictionin Britain^^ is subtitled 'What Americans can learnfrom the English experience'; and Trebach who inthe Heroin Solution^* also argued that the U.S. couldlearn from Britain.

Notwithstanding differences in interpretation,many commentaries on the 'British system' havetended to indicate that two things distinguished theBritish response. First, that the balance swung moreto the medical side—both in rhetoric and practi-ce—rather than to the legal and penal, and was thusbenign rather than punitive. The essence of theBritish approach was that the interests of treatmentand prevention were best served by regarding theaddict as a patient.-^" Some observers" have sug-gested that it was not just Britain's medico-centricapproach that distinguished it from other countries,but that it had a particular type of medical approachthat allowed for the prescription of opiate drugs toaddicts. This has been a key differentiating practicesince the 1920s, and perhaps one that has enableddoctors to remain central to debate and policy.Secondly, the British medical approach, as well ashelping the individual, was thought to limit thesocial problems of addiction, for example by pre-venting the spread of addiction, and reducing thefinancial and criminal problems often associatedwith it. It was early realized that medical treatmenthad benefits for society as well as (and sometimesinstead of) the individual addict. (The analysistended to ignore the fact that non-medical use ofopiates was subject to strict legal penalty; that acontinuing part of the British response has beenthrough policing, the courts and the prison system;and that a wide range of controlled drugs wereoutside of the medico-centric domain.) (For otherinterpretations see, e.g. Smarf".)

Many British observers, although accepting thatour approach was distinctive, claimed that there wasnot a 'system', and indeed it is clear that even inperiods of major policy change the legal andinstitutional framework has involved 'only looseguidelines from the centre about treatment'." Thispoint may be difficult for U.S. observers to grasp,familiar as they are with the voluminous regulationsthat surround methadone clinics in the U.S. Stateintervention in drugs in the U.K. has often givenonly broad guidelines from central government.

British Drug Policies in the 1980s 479

leaving vast room for inerpretation and discretion inlocal practice.

There have been several transformations of theBritish approach since its basic form was establishedunder the 1920 Dangerous Drugs Act and thesubsequent RoUeston Committee Report." Mostreaders will be familiar with the major changeswhich established the Drug Treatment Centres (the'Clinics') in 1968. A brief recapitulation of theperiod since then will set the scene for discussingthe present position. As is now well-known, rapidchanges in patterns of drug use in the 1960s—theappearance of young, recreational heroin addicts—led to questions about the effectiveness of thethen British policy that allowed any medical practi-tioner to prescribe for addicts. Evidence given to theSecond Interdepartmental Committee on Drug Ad-diction' (known after its chairman as the BrainCommittee) suggested that the system which hadallowed any practitioner to prescribe for addictsappeared (in 1965) to be a pohcy that actuallyfacilitated the spread of addiction. It must be madeclear to those who do not have experience of thattime, that the vast bulk of heroin and cocaineavailable illicitly in London in the 1960s waspharmaceutical heroin that had been legitimatelysupplied to addict patients by doctors and thenresold. There was no illicit market in smuggledheroin and cocaine.

The Brain Committee saw addiction as a 'sociallyinfectious condition' and believed that control of thedrug problem could be exercised through control oftreatment. In this new formulation, medicine wasseen in functional relation with the blackmarket—ifdoctors could get the right balance then addictswould come for treatment, be prescribed just theright amount to prevent them having recourse to theblackmarket, and so the development of a majorblackmarket would be curtailed. Thus was born thenotion of 'competitive prescribing' or, prescribing to'keep out the Mafia'. This task was given tospecialist hospital doctors (mainly psychiatrists),who would have more colleague-support and overwhom some (subtle) oversight could be exercised.

The ensuing period was dominated, at the level ofdebate and to a large extent in practice, by a clinic-based medical response, supplemented by someagencies in the non-statutory (i.e. outside the NHS)sector, such as 'concept' houses (e.g. PhoenixHouse) and a handful of drop-in centres. One majorpreoccupation for clinic workers in this period wasthe social control of the drug problem.' Many clinicworkers were concerned to limit the spread of

addiction through the treatment given to individualpatients.

There was considerable variety in methods oftreatment and treatment aims in the clinics, whichincluded heroin maintenance, in- and out-patientwithdrawal, therapeutic wards, and methadone sub-stitution. The principles that generally emergedwere first that patients should, where possible, betransferred from heroin to methadone, and sec-ondly, that doses should go down (and almost neverup). The main switch from heroin to methadoneoccurred from the first year or two of the Clinics.There was eclectic borrowing from the experienceof others. Significant here was the British experiencewith methadone, which was sometimes used to weanpeople from heroin, sometimes to maintain them ondrugs, and sometimes as part of an abstinenceprogramme. At first it was quite common forinjectable methadone to be prescribed. At this time,as in later years, there were few studies of treatmentor good descriptions of treatment practice. Review-ing the first ten years of the clinics Druglink^'remarked on the "almost overwhelming silence onwhat actually happens in a clinic...".

Around the mid-1970s there were some misgiv-ings within clinics and a change of treatmentphilosophies. The HartnoU-Mitcheson"'''' workcompared the outcome for patients offered injecta-ble heroin versus oral methadone. Despite theauthors' reservations about the results, the studywas widely taken to show that oral methadonetreatment was preferable. This study coincided witha new version of methadone treatment in clinics: itwas now to be given on a short-term, contract basis,in a confrontational therapeutic climate. The majortreatment philosophy was now abstinence ori-ented." This policy shift was not dictated fromcentral government, nor was not adopted wholesaleby all clinics for all patients. Clinic consultants havean extremely high level of autonomy in decidingtheir clinic practices.

This move from social control to treatment hadseveral impetuses. First was the feeling of greatersafety about the nature of the drugs problem. Thenumber of addicts grew only slightly between 1973and 1976 and there was a feeling that things wereunder control, and therapists could therefore bemore energetic. Second was the growing disillusion-ment regarding the lack of success of maintenanceprescribing—the continued multiple drugtaking,high morbidity and mortality among long-termpatients." Third was criticism about the limits ofsocial control through competitive prescribing.^'


Fourth, the clinics were beginning to be filled withaging addicts and long-term patients. The shorterterm contract treatment enabled a faster throughputwithout an increase in resources.''-'' By the mid-1970s most ofthe clinics had switched most of theirpatients to some sort of methadone (IV or oral).

A survey of clinics in 1982^' showed that mostwere restricted by a lack of staff, few had consul-tants working on a full-time basis, they lackedsupport services, and the majority did not comeclose to the guidelines on staffing policy andresources in the Advisory Council on the Misuse ofDrugs report on Treatment and Rehabilitation.^Many were still based in the cramped accommoda-tion in which they had been established.'' Withisolated exceptions (e.g. 38-42), there has been amarked lack of research on treatment, then and now.Treatment policies proceed largely without empiri-cal investigation.

Edwards gave a good assessment ofthe time whenhe wrote'" in 1979 that "The anxieties of a decadeago are no longer so acutely felt, and it is easy topersuade ourselves that the epidemic has beencontained and that not much more need now bedone". But he continued "Unemployment in gen-eral, youth unemployment in particular, and unre-solved difficulties in racial integration provideexactly the social setting which could lead to arapidly developing instability in drug ecology".Writing in 1982, Trebach'* noted that the drug-abuse situation in England had changed for theworse, "but not to the extent of believing, as domany English and American commentators, that thevenerable British system has been destroyed or thatthe differences between the English and Americanapproaches are now insignificant".

Changes in the Character of Drug ProblemsThis account of the British approach, emphasizingthe medico-centric debate and practice, sets thescene for understanding developments in the 1980s.First it is necessary to review changes in thecharacteristics of drug problems. Despite the rela-tive complacency and security felt by many workersin the late seventies, a longer term view indicatesconsiderable alterations in the size and pattern ofdrug use since the 1960s, with major changesoccurring since the end of the 1970s. We havelimited information to work from, and our basic datastill come primarily from the Home Office, supple-mented by information from DHSS, surveys andmore anecdotal reports. Despite the known short-

comings of the official statistics'"' the changes thatare indicated are so massive that few could deny thatwe now face a problem of a new magnitude.

(a) Number of Regular UsersIn the 1960s there were few regular users. By 1966,after what was then seen as a major increase in theextent of heroin addiction, the total number ofaddicts known to the Home Office was only1349.5,72 ^^jjgjj fjjg Ygja Institute of New Yorkestimated in 1967 that Britain would have 11,000addicts by 1972'" this was dismissed by manyBritish observers as belonging to the realms offantasy rather than scientific projection.

By 1984 the number of addicts known to theHome Office was 12,489."''2 Notifications to theHome Office rose by 20 to 30% a year from 1980,more steeply than at any time since the 1960s.Estimating a notional 'real' number of regular users(i.e. both those known and unknown to the HomeOffice) is a matter of guesswork, but refinementsintroduced by drug indicators projects," suggestthat official notifications may be multiplied byfive to give an approximation of the number ofregular users.''' This would give an estimated60,000 regular users. Some drug workers estimatethat as many again may use opiates on an occasionalbasis."*

(b) SeizuresIn the 1960s seizures of illicitly imported heroinwere insignificant, and the major heroin market wasin prescribed pharmaceutical heroin. The first majorseizure of smuggled heroin came in 1971 when 1.14kg was seized. In 1984, the customs seized 312 kgand the police seized a further 49 kg.

(c) ConvictionsIn 1966 there were 2613 convictions for drugoffences (1119 for cannabis, the rest for otherdrugs). By 1984 the total number of convictions fordrug offences was 25,022. Most of these were forcannabis offences (20,529), but convictions con-cerning heroin, at 2446, were almost as great as thetotal for all drug offences in 1966.

(d) PriceIn the 1960s pharmaceutical heroin was sold at £1for 60 mg (the standard retail unit of one pharma-


ceutical grain made up of six 10 mg pills). Pricesrose after 1968, stabilized in the mid-1970s anddropped from 1978. IUicitly imported heroin nowretails at about £80 for a gram. Relative to infiation,the real price of heroin on the iUicit market hashalved since 1978."''"''" Retail purity is high ataround 45 to 55%'^ though there have been somerecent local reports of a drop in purity.'*

(e) Geographical SpreadIn the 1960s heroin use was mainly concentrated inLondon and the South East, with a handful of usersin other major cities. In the 1980s heroin use can befound in most parts of the country and is no longerconfined to urban environments.

(f) Changes in Mode of AdministrationIn the 1960s most regular heroin users injected thedrug. In the 1980s, it is probably true that themajority use various methods of inhalation such as'chasing the dragon' (inhaling the fumes of heroinheated on tinfoil), 'snorting' (sniffing) or smokingwith tobacco.

After many years of relative silence in the media,1984 was the year that Britain heard again aboutheroin. Press and TV began running stories on new,young heroin users, often, but not always, living inrun-down parts of large cities. The changed patternof use has led some researchers to hypothesize a'normalization' of drug use.'"'"'" This thesis pro-poses that heroin use is now a commonplace activitythat many young people will encounter, and which isno longer at the extreme end of a self-consciousyouth culture. Barker'" commenting on drug use inSouth London, noted that there is no longer a 'drugscene' but a 'local scene' where iUicit drug use hasbecome part of the character of the community. Inparts of London " . . . it is impossible to grow upwithout being exposed to or involved in iUicit drugsand substance abuse". Some commentators havesuggested that the reaction has also been normal-ized. As Banks & Waller put it: "In the days of theBrain Committees the country panicked over anincrease in known addicts from 470 in 1961 to 631in 1963—now we shrug off what is probably a 20-fold increase."*' In other words, whUst heroin is notaccepted and tolerated, there is scepticism aboutmeasures to control its spread.

Identifying the Themes of ContemporaryBritish PolicyAccompanying these changes in the extent andpattern of drug use have come numerous changes inthe perception of drug problems and the nature andlevel of response. Indeed in the last three years therehave been more initiatives and more debate aboutdrugs than at any previous time. This section of thepaper attempts to identify a number of themes thatcharacterise this new response. GivSn the lack ofresearch on contemporary drug policy these shouldbe viewed as working hypotheses about the newdirections being taken by British policy.

Theme 1: the decline of the clinicAs was indicated at the beginning of this paper, amajor trend appears to be a shift from a medico-centric to a more diffuse response. The first changeis that clinics appear to be less central than inprevious years. This was anticipated in a succinctreview of the clinic system in Druglink^^ whichargued that "To an extent the clinics (not aU ofthem) have become a backwater of our socialresponse to drug abuse dealing with a problem thatno longer reaches the heart of the U.K. drug scene".An indication of this is that notifications of newaddicts from clinics now (1984 figures) make uponly 30% of the total, the rest come from generalpractice (independent and NHS) (55%) and prisons(15%). Many others are seen outside the medical-notification system. This is not to suggest thatclinics no longer see large numbers of patients. Theycertainly do, and although good data on NHSresources and services are hard to come by' staffingand patient loads probably continue at the samelevels as in recent years. Specialist doctors are stillprominent, if not always dominant, in some socialnetworks of policy making, and on infiuentialcommittees. What is suggested is that from beingseen as a central hub of the response to drugproblems, doctors in clinics are now but one ofnumerous groups working in the field, and theirviews are among many different—sometimes com-plementary and sometimes confiicting—views.

Theme 2: the discovery of the 'problem drug taker'Some support for this hypothesis about the diffusionof response is found in a redefinition of the problem.Earlier discussions of the 'addict' or the 'drugdependent' have been replaced by the 'problem drugtaker'. This term received its official warrant in the


ACMD Report on Treatment and Rehabilitation^(p. 34) which defined a problem drug taker as "anyperson who experiences social, psychological, physi-cal or legal problems related to intoxication and/orregular excessive consumption and/or dependenceas a consequence of his own use of drugs or otherchemical substances (excluding alcohol or to-bacco)". This definition broadens the scope ofconcern for treatment and rehabilitation servicesand suggests that drug problems are wide-ranging,and do not always involve dependence and a medicalresponse. The conceptual move is similar to thatwhich occurred with alcohol, with a shift in focusfrom the 'alcoholic' (someone with an alcoholdependency), to the problem drinker, who may ormay not be dependent on alcohol. (Observers fromthe U.S., where the disease concept of addiction ismore strongly held than it is here, may wish tospeculate on these cultural differences in percep-tions of problems).

Theme 3: the rise of the 'community'A third theme, also linked to the suggestion that theclinics are becoming less central, is the 'community'response to drug problems. The focus is changing,as one commentary put it, as " . . . non-statutory andcommunity resources outside the clinic system havereplaced heroin maintenance inside...". This re-sponse is also linked to a demedicalization of drugproblems."" This is a change in perception of theproblem, but one that is related to real problems ofresources: "With the spread of drug use and drugproblems and the consequent overloading of specia-list services, these (community/voluntary) andother non-specialist services are likely to becomeincreasingly important in the response to drugproblems.'"" In this context 'community' meansfirst the voluntary sector. The voluntary agencieshave been present to a greater or lesser extent sincethe 1960s but rarely figured prominently in policydebate. They are now seen as a crucial part of theresponse. They include residential rehabilitationprojects; advice, information and counselling agen-cies; and self-help and community groups. Thissector has, for example, 400 residential places,^'compared with the 86 NHS beds in special in-patient units set aside solely for the treatment ofdrug addiction'O-'^ (though it is to be noted thatgeneral psychiatric beds are used for detoxificationin many Health Districts). Their status is given newrecognition in policy documents,"''^ and in govern-ment publicity and educational campaigns.'' A

considerable proportion of the £17 million shortterm 'pump-priming' funds from the DHSS centralinitiative has gone to these projects." In England,162 projects were funded by February 1986, rangingfrom clinics, drug screening equipment, nursetraining courses, counselling services, telephonehelp lines, rehabilitation hostels, and therapy ser-vices for drug takers and their families. A recentlisting of projects is given added kudos with aforward by the Princess of Wales.'"*

Theme 4: the shift from specialists to generalistsThe fourth linked trend is the shift of emphasisfrom specialists to generalists in recent DHSScirculars.'' This seems to be based on an assessmentthat the spread of drug problems has overloadedspecialist services, and that many such services areinappropriate for the treatment of the problem drugtaker. It is argued that the response should shiftaway from specialist services to the development ofgeneric services in the community. Thus 'commu-nity' means not only the voluntary agencies, but alsothe enrollment of many non-specialist workers.Many different groups of workers come into contactwith people with drug problems (e.g. social workers,community and youth workers, general practition-ers, general medical workers and psychiatrists in theNHS, health visitors, clergy, teachers, probationofficers) and an increasing proportion of their workis concerned with such clients. In some cases clients'major problems might be with drugs, or drugs can beincidental to other welfare and health problems.

In a community based response, the role of theexisting specialist services becomes a service of lastresort for problems that cannot be dealt withelsewhere, and training and support for generalistservices." The aim is to deal, in the first instance,with drug problems at a community/generalist levelorganized around Drug Advisory Committees orCommunity Drug Teams.""'"'"

'Community' has yet a third meaning. There hasbeen greater attention to the role of families andparents. This is indicated in the recent anti-heroinmedia campaigns (see below) which were targettedat parents as well as young people. The DHSSleaflets What Every Parent Should Know aboutDrugs and Drugs: what parents can do" gavevignettes of young people in trouble with drugs,advice on sources of help, and suggest that parentsshould be involved in responding to drugs. It is alsoreported that the Central Office of Informationdescribed one campaign objective being to help con-


vince the public that heroin should be their concernand that the government is taking action."

Theme 5: a role for the "responsible' general practi-tionerAnother shift from specialists is the encouragementgiven to the 'responsible' general practitioner tobecome involved in the treatment of addiction. Thelast 20 years has of course seen the continuation ofthe private prescribing practitioner, an attempt bysuch practitioners to improve their status throughthe Association of Independent Doctors, and con-tinued controversy about their role."-"

Recently it has been argued that the general NHSpractitioner has a new and important role to play.This reverse of earlier policy has come about in partbecause of the limitations of specialist resources inthe face of high levels of drug misuse. Encourage-ment has come in the form of various localguidelines for GPs"' '" and in the national Guide-lines of Good Clinical Practice in the Treatment ofDrug Abuse^^ issued by the DHSS and sent in 1984to every general practitioner and hospital doctor inthe country, and subsequent DHSS circulars." AllGPs of course have a responsibility for the generalmedical care of patients, including those who areaddicts. It is now suggested that GPs take someresponsibility for their drug-related problems, in-cluding detoxification. Doctors are advised in theguidelines not to undertake long-term prescriptionof opiates to addicts unless in conjunction withspecialist support. This encouragement has hap-pened without much information available on theextent of GP involvement in drug problems.

Theme 6: a new role for central governmentA marked feature of state intervention in drugs inthis country has been the lack of detailed centraldirection. But since 1984 this government has taken

, a new major interest in drug problems. The level ofgovernment involvement is greater than has hithertobeen seen in this country. This is the first govern-ment to have seriously considered the problem ofdrug-taking at many levels; it has set up inter-Ministerial collaborative machinery at ministeriallevel (a recognition that the issues concern and cutacross government departments). Drugs are nolonger the concern of just the Home Office and theDHSS, but also Customs and Excise, Department ofEducation and Science, Foreign and CommonwealthOffice, Overseas Development Administration, De-

partment of the Environment, Scottish Office,Welsh Office, DHSS Northern Ireland." ThisMinisterial Group on the Misuse of Drugs hasdeveloped a strategy for Tackling Drug Misuse andthe government has put money into numerous lawenforcement, educational, preventive and treatmentprojects.

There are five elements to the present govern-ment strategy, which are, in the order they appear ingovernment strategy documents:"''^ (a) reducingsupplies from abroad (b) tightening controls ondrugs produced and prescribed here (c) makingpolicing more effective (d) strengthening deter-rance (e) improving prevention, treatment andrehabilitation.

(a) Reducing Supplies from Abroad. Inter-nationally, the U.K. government is providing assis-tance to producer and transit countries for cropreduction, strengthening policing, and improvingcollaboration with the U.K. Nationally, the govern-ment has reassigned customs investigators to in-crease the numbers who work on drugs.

(b) Tightening Controls on Drugs Produced andPrescribed Here. Since April 1984 Diconal has beensubject to the same prescribing restrictions asheroin. Baribiturates have been brought under thecontrol of the Misuse of Drugs Act.

(c) Making Policing More Effective. Every policeforce in the country (bar one in Scotland) now has adrugs squad, which, with the CID deal with moreserious cases; and Regional Crime Squads coverdrugs cases crossing more than one police area. Onaverage, half the activity of the Regional CrimeSquads is now concerned with the investigation ofdrug offences or drug related crime. There are over1000 police officers in force drugs squads and in theRegional Crime Squads with a major commitment todrugs work. Intelligence for these activities isprovided at New Scotland Yard by the recentlycreated National Drugs Intelligence Unit, whichreplaces the Central Drugs Intelligence Unit, and isstaffed by both police and customs.

(d) Strengthening Deterrance. Parole has beenremoved for major drug traffickers, and the maxi-mum penalty for trafficking in Class A drugs hasbeen increased from 14 years to life imprisonment.Sequestration of assets of drug traffickers hasrecently been approved by Parliament. It is hopedthat this will take some of the profit out oftrafficking.


(e) Prevention, Treatment and Rehabilitation.The main focus of the prevention strategy is the£2m anti-heroin campaign aimed at young peopleand parents. The campaign, launched in February1985, used TV commercials, posters, magazineadvertisements, and leaflets.'^'" Evaluation of thecampaign indicates that it has reached its targetaudience, but that there is little evidence of majorshifts in attitudes and knowledge.*"*''"* A funher £1million has been allocated in 1986. The secondpreventive strategy is a £4m fund from the Depart-ment of Education and Science to appoint a drugtrainer in each local education authority to coordi-nate and stimulate anti-drugs activity in education.New funding from DHSS for treatment and rehabil-itation amounts to £17 million (discussed above).

Theme 7: the debate on law enforcement and controlA further indication of the changes that are occuringis in the character of the new debate on drugs.Whilst professional debate has focused on treatmentand rehabilitation, this country has continued avigorous legal and penal approach to drugs. We senda lot of drug users to prison, to the extent that somecommentators speculate that in terms of numbersand costs, imprisonment is one of our majorresponses to drug problems." It is as if this side ofthe British response has been hidden from the viewof those professionals centrally involved in policydiscussions and debate (despite occasional remin-ders of its existence).^* For example, the maingovernment advisory body, the Advisory Council onthe Misuse of Drugs, has paid much more attentionto treatment, rehabilitation and prevention, than ithas to legal and penal issues.

But as can be seen in the description of thegovernment strategy, discussions about controlthrough legal and penal measures have recentlybecome prominent. This debate has emerged fromcentral government and Parliament rather than thecaring professions. 1985 saw this shift in debate. It istypified by the report of the Home Affairs SelectCommittee" which argued for the Royal Navy andthe Royal Air Force to help the customs and thepolice. The committee called for intensified lawenforcement efforts, sequestration of the assets ofdrug traffickers, extradition of suppliers from othercountries, a reform of the banking laws to trace drugmoney, more efforts for crop substitution anderadication, and an increase in the penalty forsystematic dealing in drugs to "no less than thepenalty for premeditated murder". The new ap-

proach to drugs—the Home Affairs Committeereport described the problem as "the most seriouspeacetime threat to our national well-being"—wasechoed in Prime Minister Margaret Thatcher'svisits to the Customs at Heathrow and to theCentral Drugs Intelligence Unit at Scotland Yard.She made it clear that there was now a war ontraffickers and smugglers, and warned "We are afteryou. The pursuit will be relentless. We shall makeyour life not worth living". The new approach todrug issues has been called the 'war on drugs'."

Theme 8: the politicisation of drugsIn seeing the emergence of this new debate, we areseeing the politicisation of drug problems. TheMinisterial Group on the Misuse of Drugs, thePrime Minister's interest, numerous ministerialstatements, a government hosted international con-ference of foreign ministers, reports from the Houseof Commons Home Affairs and Social ServicesSelect Committees - all these indicate that the arenafor debate is no longer confined to professional andadvisory committees, but that centre stage may forthe moment be taken by central government andParliament. Along with prominent statements frompoliticians in other parties (e.g. Owen"), it appearsthat drugs are now on the agenda as a political issue.The next election is likely to be the first where eachof the major parties has a drug strategy to offer theelectorate.

A Preliminary Assessment of the New PoliciesInsofar as we can make some preliminary assess-ment of what has happened, it appears that theBritish approach to drugs is in the process ofundergoing a marked transformation. It may be tooearly to fully identify these changes or summarisetheir implications. And given the lack of policyresearch, we are unlikely to be able to assess theimpact of these changes. But what does the newapproach look like? Let's return to those earlierdiscussions about the 'British system'. It is likelythat if our previous visitors returned they mightdiscern some traces of that 'system' and concludethat there is still something recognisably distinctiveabout the British approach to drug problems. Tosome extent that would be a reasonable assessment,for a visit to many clinics might suggest that the'British system' is alive, if not too healthy. After all,doctors still prescribe drugs to addicts. But suchvisitors might be viewing survivals of earlier prac-


tices. True, the tnedical involvemetit is still a majorand utidiminished otie in absolute terms. Butcompared with other developments, the medicaltreatment of drug problems is now but one aspect ofthe British response. Our visitors would find adiversificatioti of ideas about the nature of drugproblems, and an involvement of a greater numberand range of people and agencies. A provisionalview is that responsibility for dealing with drugs hasbeen spread out. Where once medicine was centralto debate and practice, there is now no clear centre.The response has diversified and includes a moreprominent place for government, law enforcement,the legal and penal system, and the community. Inthis, the British response is unlikely to appearunique, or so different from the response in manyother countries with longstanding drug problems.

Prospects for Policy ResearchThe policy analyst faces difficult problems. We lackthe data for a thorough examination of British drugpolicies. The analyst is left to piece together whathas happened from numerous sources of material,published and unpublished articles, memoranda,interviews and gossip. A lot of this is filled in andinterpreted with good hunches. In trying to ask whatthe 'system' was like at different times we try hardto find something solid to grasp. We risk exaggerat-ing our models, misunderstanding trends, and over-interpreting our data, in what is a rather shifting andmurky reality. We also risk confusing rhetoric andpractice because so often the information on what ishappening is just not available. Further, given themore diverse character of the recent British re-sponse, the task of policy commentary is morecomplicated than at any other period in the historyof British drugs policies. Such problems point to theurgent need for good research in the policy field.The second and final task of this paper is to identifya number of issues and areas worthy of analysis.These questions have emerged in writing thispreliminary review and could set the agenda forfuture analysis:

The Character of the DebateHow can we identify the main themes in debate?What drugs are identified as problems? Why aresome drugs (such as the opiates) prominent indebate, whilst others that are similarly controlledand widely misused, are neglected? Why is drugmisuse currently receiving so much more attention

(and resources) than tobacco and alcohol prob-lems?^'

The Character of Policy-makingDoes policy develop from reasoned analysis ofpolicy options (e.g. Mayer & Greenwood'^), or doesmuch of it develop from good 'guesses' and pastinheritances?" Does it take the overview, or can itbe characterised as 'disjointed incrementalism'—ofresponding to problems rather than setting up planswhich reform whole areas?'"

Policy 'Makers' and the Policy-making ProcessWhich individuals, in which institutional positions,help to shape policy? What are the social networksof policy making? In earlier periods major policychanges emerged after formal consultations betweenthe state and professional workers. It would appearthat the new policy initiatives have emerged withfew such consultations (or perhaps the advisorycircle has shifted away from professional workers).

The Relationship Between Policy Debate and Re-source AllocationIs the apparent emphasis on law enforcement andpenal and legal measures refiected in governmentexpenditure? Part of the analysis is to sum theallocation of state resources to different areas ofactivity.

The Mechanisms for Policy ImplementationRecent changes in British drugs policy have oc-curred without major changes in legislation.What isthe relative importance of financial, legal andexhortatory measures in shaping policy?

The Effect of the Politicisation of PolicyHow do political exigencies affect the scale andcharacter of the response? What is the new relationbetween government and professional workers, andbetween the centre and local practice?

The Place of Monitoring, Evaluation and AssessmentBritain has missed some good opportunities forpolicy assessment. The clinic system may be passingbefore it has been properly examined; data for


routine monitoring of the clinics and other initia-tives, let alone evaluation, are missing. Little isknown about treatment, and even less about theeffectiveness and efficiency of customs and policework.

Policy Implementation and Practice at the LocalLevelWhat features enable and hinder local policy andpractice? What is the relationship between centralpolicy and local practice?

International and National PolicyWhat is the relation between national and interna-tional policy? Of special interest here would bepolicy differences between European countries.Relevant also is the place within national policy ofinternational diplomacy and other efforts aimed atproducer countries.

ConclusionFrom this lengthy list it is apparent that what is notknown far exceeds what is. In the long term, thecontribution of policy studies is not just through ananalysis of past events, and of the gradual transfor-mation from the British 'system' to some newpattern of response. The aim must be to raise thelevel of policy debate and contribute to improvingpractice in the field. Perhaps the key question isWhat are the policy options for the future? Are weable to develop new measures for controlling drugsand reducing the social and health costs of their useand control? What package of policies offers thebest buy? Such questions require examination ofpolicies directed at the whole range of drugs capableof misuse, and of the relationship between policiesfor drug misuse, and policies for alcohol, tobaccoand prescribed drugs. Given scarce resources forresponding to drug problems, policy studies are notan optional extra, but an esssential part of planningthe response. The task has barely begun.

Postscript: AIDS and intravenous drug useThis article was written before the issue of AIDSand intravenous drug use came to prominence.Several studies, mainly from Scotland,'""*" showsamples of intravenous drug users with high levelsof HIV seropositivity. Evidence from NorthAmerica and Europe shows similar findings. One

immediate response from government, statutory andvoluntary agencies, has been to develop ways ofreducing the spread of HIV infection among intra-venous drug users by measures which includeeducation, counselling in safe drug and safe sexpractices, and the provision of syringes. AIDS hasraised some problematic issues for drug policy: theprovision of syringes might be seen to contradict thegovernment prevention campaign, and runs counterto a therapeutic climate which is unfavourable tocontinued drug use. What seems certain is that if theprevention of AIDS is given higher priority than theprevention of drug abuse, British drug policies areabout to change once again.

AcknowledgementsI would like to thank the numerous people who gavetime to talk to me when compiling this review; thelibrary staff at the Institute for the Study of DrugDependence; and Goldsmiths' College ResearchFund for providing financial assistance. Part of thisreview has developed from a position paper pre-pared for the 1986 Drug Addiction ResearchInitiative. Geoff Harding, Martin Mitcheson, MikeAshton, and Griffith Edwards gave helpful adviceon an earlier draft.

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british drug policies in the 1980s: a preliminary analysis and suggestions for research

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