THE non-medical use of drugs today is an example of how society, supported by the medical profession, constructs 'problems' and invents 'diseases' for which they then find 'treatments'. Some pharmacological substances, for example alcohol and tobacco, are major causes of death, yet are permitted to be sold and even advertised, and are a major source of government revenue. Others are regarded as 'ethical', and require a doctor's prescription. Some of the less harmful drugs, for example cannabis and heroin,[1] are made dangerous by myth, politics, illegality, and other social factors. Governments and doctors capitalize on collective fantasies. They publicize the drugs in a way to induce horror and fear. This policy costs governments and nations dearly, but it provides other political benefits, including to the medical profession. The dangers of these substances are both created and emphasized with zeal rather than evidence. Such evidence as exists is liable to be concocted and financed in order to exaggerate their dangers.
Illegal drugs are the subject of a 'phoney war', waged by governments for their own purposes that certainly have nothing to do with the 'dangers' of these substances. Governments who capitalize on public shock-horror have a splendid means of diverting public attention and anger from real issues and for interfering in the affairs of other nations, even to the extent of sending spies and troops. This situation is a major cause of crime all over the world and the criminal drug industry is second only to the arms trade in wealth, power, and influence. Whole economies now depend upon the production and sale of illegal drugs and the people who would least like to see the trade decriminalized or legalized are the criminal traders themselves. In no other way could they have so much power or make so much money. This raises a question. How far are governments who purport to make 'war on drugs' actually encouraging, profiting from, and involved in the illegal trade? The same question can be asked of the doctors who support those government policies.
There is little or no evidence that these drugs are in themselves seriously harmful until a political situation leads to the creation of genuinely harmful forms- crack, ecstasy- but there is ample evidence that the harm they do is actually done by the policies constructed round them. Yet few politicians, and only one British politician, have yet admitted this in public. The medical profession accepts and supports government policies and goes along with the idea that drugs, rather than fantasies and policies about drugs, are harming society and must be 'fought'.
For individuals whose fears and fantasies have been stimulated by governments and doctors, the so-called 'drugs crisis' and the 'War on Drugs' is largely a product of what Freud called primary process thinking, i.e. the thinking of fantasy and dreams, unfettered by fact (at least, by fact in context), unimpeded by logic, highly symbolic, and dominated by anomalies and mysteries. My own part in the history of the drugs problem has been largely as a participant and I got into deep trouble as a result, being prosecuted three times by the General Medical Council. This experience has not produced any evidence against my views but it has shown how entrenched are current beliefs about the drugs war and how deeply involved is the medical profession in supporting those beliefs.
The 'War on Drugs' in its many manifestations is being acted by doctors, politicians, and public servants who have their own motives, and often behave in ways that are specious, scary, or bizarre. There are few things in the world that damage the quality of life more than present drug policies. These have become so destructive that I suspect that, in the foreseeable future, only historians could sort it out. The present situation depends on people not understanding the situation and on maintaining their misbeliefs and prejudices. Much energy and public money is spent on ensuring that this ignorance and misunderstanding continues, along with the shock-horror fantasies that provide essential support for western drug policies.
An historian who starts with a reasonably open mind and a moderate acceptance of the conventional wisdom in the subject is likely to assume that heroin is dangerous, that addiction means inevitable deterioration, that doctors are as honourable towards drug addicts as they are towards other patients, and that America or Britain, or any other country, is reducing or containing the problem rather than causing it. Such an historian who looks at the evidence is in for a shock, but it will be a constructive shock.
My interest in drugs was initially clinical, as a practising doctor. I stumbled by chance on something that took me into deep waters. I began to explore further and came across a situation that certain powerful people did not wish to be explored. They wanted me out of the field, and in the end they got what they wanted, though not, I think, in the way they had intended.
The 'something' on which I stumbled was the discovery that our present situation regarding illegal drugs, including its medical 'treatment', is political and without scientific foundation. Even after thirty years as a practising doctor, I was so shocked by what I found that it destroyed in me last remnants of the youthful idealism that took me into medicine in the first place, when the National Health Service was about to begin and seemed to be a dream come true.
I realized that in scarcely any field is so-called 'truth about drugs' backed by valid evidence. The cooperation of doctors is vital to the politicians and vice versa. In the medical field the evidence for what is done and imposed on others is so feeble as to be virtually non-existent. But important factors are at stake, including the political careers of important people, ambitious doctors, high up civil servants, powerful moralists, and those exploiting less powerful moralists, and, of course, the whole of the world's illegal drugs industry. It is a conspiracy only in the sense that many people and institutions have become involved and now share the need to avoid the truth. It is a dangerous field for an unsuspecting doctor who is simply trying to help patients.
In this situation addicts, whether or not they are also patients, are mostly unable to help themselves. Their self-esteem is low, which is not surprising if one considers how society and the medical profession treat them. It means that they are unable to form a pressure group, even for simply providing information. They still feel they have to play the part of the degraded, dying creatures that society wants them to be. One might say, they are invented like that. It is a sad background to the 'War on Drugs' which must be one of the most phoney (or invented) wars ever devised or fought. Like many wars, it is based on false information and misinformation, and is basically not really concerned with drugs or drug users.
The first anomaly I am going to mention was actually invented by an historian, Virginia Berridge. With Professor Edwards she wrote a splendid book on opium use in the nineteenth century,[2] published in 1981, when the present so-called 'drugs crisis' was causing concern. There was a visible problem in London and other big cities at the time, due to a sudden change of policy on the part of certain powerful doctors. As a result, addicts, unable to find any help from doctors or anyone else, were congregating in Piccadilly and roaming the streets. Any doctor who was remotely sympathetic was inundated with potential addict patients begging for help, and was under threat from the medical establishment. The media were full of shock-horror stories about drugs. There was a strong need for sensible historical background information. Yet, in the very first sentence of Berridge and Edwards' Introduction, we read: 'The most acute anxieties of the 1960s "drug epidemic" have quietened. Drug stories appear less often, and more prosaically, in the newspapers.' That statement seems to be a provocative denial of reality. The rest of the book, about the nineteenth century, seems to be a model of learning and good sense.
Some of the anomalies in the field of illegal drugs are frankly absurd. A few months ago I was invited to talk at a provincial medical school and teaching hospital. I chose the title Untruths about Heroin are Damaging Civilization. Notices of the meeting were posted all over the hospital and university. Mysteriously these spelled the title of my talk as one word, and they spelled it wrong. It stated that I would talk on
UntruthsaboutHeroinareDamagingCivilization (sic)
This word has forty-two letters. Perhaps only the subject of illegal drugs could produce so absurd a word. No one offered any explanation or even mentioned it. In matters of drugs, if it is mysterious and incomprehensible, anything goes!
That was not the end of it. I had been particularly careful to make my talk historical and not to advocate any changes except to call for more honesty and clarity in the definition of terms. I believe that until we agree what we are talking about and as long as everyone is talking about different things, it is impossible to have a reasonable discussion about drug use, drug dependence, and/or the war on drugs. But as soon as I had finished I saw that many people had heard a different lecture. Even the chairman, a retired Professor of Psychiatry, said in his summing up that I had advocated a free market in heroin. I had not, but he seemed to find the idea of striving for truth and clarity so threatening that, so far as he was concerned, I already had heroin on the supermarket shelves. One person criticized me for, as he put it, 'saying that heroin should be available to expectant mothers'. I had not mentioned either availability or expectant mothers. Had we been at the same meeting? I was reassured when several intelligent and relevant comments and questions made me realize that I was witnessing just another manifestation of the effect that this extraordinary subject has on some people.
I told this story while delivering a similar paper at a Wellcome symposium and again, a member of the audience rose angrily to his feet and accused me of wishing to put heroin on the supermarket shelves! I have given versions of that paper on several occasions since. The only time it did not elicit a hostile and misheard response was in a small group of sociologists. It seems that the subject of drugs elicits feelings so powerful that some people will always hear falsely. To mishear and distort what is said is the norm in this subject.
The anomalies include the term narcotic. The word traditionally refers to drugs named because they aid sleep (though it comes from the Greek narke, meaning stiffness or numbness). Yet in illegal drugs, 'narcotics' came to include substances such as amphetamines and cocaine, which are stimulants, have the opposite effect and actually prevent sleep. Even heroin and cannabis are not true narcotics. This has led to confusion. The word 'narcotic' acquired pejorative connotations about substances that were illegal or of which moralists disapproved. It really came to be used to mean 'nasty', 'dangerous', or simply 'illegal'. There are now many different meanings of the word and few attempts to sort them out.
Some drugs, for example opium and its derivatives such as morphine, nepenthe, heroin, were at one time regarded as beneficial to mankind and people kept them and used them rather as they might use aspirin or Valium now. It is interesting that today the image of Valium is beginning to change to something dangerous and sinister. I wonder, will the cycle be repeated?
Somehow the myth arose that so-called 'soft' drugs (whatever those are) are also dangerous. In the term 'soft', most people think of cannabis, which is also illegal but about as harmless as a drug can be for none are totally harmless. It was put about not only that cannabis is dangerous (and all kinds of phoney research was done to 'prove' it) but that it leads to 'hard' drugs such as heroin and cocaine. This must be one of the most politically astute myths of all because it leads to fear, mostly in parents who know nothing about the subject. Yet the connection between 'hard' and 'soft' drugs is that they are both illegal and the Dutch have now demonstrated this by separating them in law and showing that the connection no longer exists. I personally asked several hundred heroin addicts what was the connection between cannabis and heroin and their only answer was that if the police seize the available cannabis, dealers offer heroin instead. That was how some of them had become addicted.
Other anomalies: a common Victorian habit, taking a so-called 'narcotic'—opium or cocaine—to relax, which in many could be compared to a couple of pints of beer or a gin and tonic, came to be regarded as a sin and a crime. Addicts, formerly objects of mild disapproval, rather like drunks or smokers today, were gradually turned into criminals and outcasts. This was demonstrated recently in a clever cartoon. The addict Samuel Taylor Coleridge is sitting at his desk writing poetry and smoking opium. Enter the man from Porlock, bowler-hatted, flashing a card. He announces, 'Porlock Drug Squad! You're nicked, Coleridge!'
The virtually universal and fairly harmless custom of taking opium for pain, also came to be regarded as a sin and a crime. Heroin is banned altogether in the US and I have come across some tragic cases in Britain in recent years where people who are dying or have had serious accidents are denied the incomparable benefit of heroin or morphine on the grounds that they might become addicted.
The Harrison Narcotic Act of 1914 in the United States set the scene for the prohibition that has been America's policy ever since. It both reflected and created a climate in which the addict could be reclassified as criminal and morally evil. Britain, or rather British doctors, stood out against American and Home Office efforts to extend the process to Britain. The Rolleston Committee, which reported in 1926, created a liberal, medical, attitude towards drug addiction in what was then a small and largely middle-class problem. This lasted for nearly forty years and enabled many respectable addicts to live normal lives, as they had always been able to do. Some, such as the writer Enid Bagnold, were able to lead prosperous and creative lives while on opiate drugs for as long as sixty years. This gave the lie to the idea that addiction inevitably leads to deterioration, but the evidence, as with other evidence, was ignored or kept secret.
Then, in the 1960s, the system was challenged by an increase in addiction and its extension to that dangerous body, the working class. Newspapers began the shock-horror tactics that we know so well. The medical profession changed its attitude and joined the word-abusers and concept-manipulators, even to the extent of allowing, and initiating, shock horror. How did this happen? That is an interesting question and is, I think, important in the history of the medical profession in the twentieth century, though there is no time to explore it here.
In recent years illegal drug use has been given such morally condemnatory labels as 'drug abuse' and 'drug misuse'. These are now regarded as medical diagnoses. They appear in official documents and in the names of official bodies—the Advisory Council on the Misuse of Drugs is powerful in forming government policy- and incidentally drugs are one of the few subjects about which the two main parties are in complete agreement. There is another government-funded body, the Standing Conference on Drug Abuse. Ironically and typically, a new government document emphasizes the importance of not being moralistic about 'drug abuse'![3]
This is the only example I can think of where a moral judgement is used as a medical diagnosis. How did this come about? Why does no one, or at least no one with influence, protest? Another way of putting it may be to ask, In whose interest is this situation maintained? The idea of 'drug abuse' as a medical diagnosis, and the attitude it reflects, have produced a language of their own. I call it Drugspeak. In George Orwell's 1984 the language Newspeak, the origin of all the modern so-called 'speaks', was designed in order to make it impossible to think in any way other than the party line. That's how it is with Drugspeak. Corruption of language is probably inevitable where there are strong reasons for suppressing, confusing, or simply avoiding the truth. It seems that the phrase 'drug abuse', used to mean 'illegal drug use', was first used in the United States to express disapproval of the use of cocaine by Southern blacks. As so often happens, the phrase was, and is, used to condemn the user and his group rather than the drug itself.
The World Health Organization has also tended to attack the user rather than the use of drugs. For instance, one committee said that certain drugspossess a particular attraction for certain psychologically and socially maladjusted persons who have difficulty in conforming to the usual social norms. These include 'arty' people such as struggling writers, painters, and musicians; frustrated non-conformists; and curious, thrill-seeking adolescents and young adults.
You can work out the details of Drugspeak by looking and listening to the use of such words as 'consensus', 'specialty', 'flexibility', and 'maintenance'. They are all used by drugspeakers in special ways that maintain the status quo.
Now another anomaly. In June 1983 the British Medical Journal published an article on the treatment of drug addiction that must have broken several barriers or records.[4] For instance, there has long been debate about the scientific value of asking patients about treatment they have had. But data in this article were based on asking patients about the treatment that other patients had had. I do not think that had ever been done before. Moreover the statistics were absurd or nonexistent and the conclusions were non sequitur. A lively correspondence followed.[5] One distinguished psychiatrist wrote asking how it was that sixteen and a half addicts had done such and such and said that the article was unworthy of the journal.[6] Another wrote that during his experience of the clinic system which had come into being in 1968, the treatment of addicts became not treatment but a competition between doctors to see who could prescribe the least heroin.[7]
It is a mystery to me that this article was published in the British Medical Journal. In 1990, when Peter Bartrip's splendid history of the journal[8] was published, I looked through it for clues. Of course the article was not mentioned, nor was the interesting question about what information can usefully be obtained from patients or from patients talking about other patients. On page 321 the then editor describes how, after 1975, there was 'increased rigour in vetting original articles for publication... Initially this means good, unprejudiced and quick peer review, followed by discussion by an editorial committee and statistical assessment.' So what happened here?
That is not the end of the story. A few weeks later that article was used by the General Medical Council, or rather by its prosecuting counsel, against me to show that my treatment of heroin addicts had not conformed to the 'consensus' view. My defence counsel protested (rather too politely, I thought). He pointed out some of the absurdities in the article and quoted the subsequent correspondence. I got the impression that this made no difference to the committee, none of whom, I believe, had any experience of treating addicts. Then, in 1986 and 1987, they used the article against me again. It formed an important part of the opening speech for the prosecution. This time my counsel (a different one) did a brilliant hatchet job on the article and revealed it in all its absurdities. I thought that no one would dare to use it again. It was not mentioned by the GMC for the remainder of my case and their prosecuting counsel did not return to it in his closing speech. But I was wrong. Since then that article has been produced by the GMC prosecutors in every case that I know of against doctors who did not toe the party line in the treatment of heroin addicts. And it is interesting and sad that these prosecutors have mostly got away with it. The reason for this is partly what goes on in the medical defence organizations that organize and pay for doctors' defence. They know and have filed away the fact that the BMJ article has been discredited, but they do not mention the fact or produce the evidence unless the doctor concerned mentions it himself, which most of them do not and cannot. It is unlikely that, for example, a busy general practitioner in the provinces will find out this kind of thing unless someone points it out to him. I know personally two doctors who were caught out like this. Both were GPs in the NHS far from London and I have reason to believe that they were two exceptionally good doctors. Their offences were the kind that any well-motivated GP could make any day, and one of them had been set up by the police in a really dirty trick. They were naive enough to trust their advisers and not do much homework. One of them was struck of f the Register and the other was suspended for three years. I suspect that had they known what they were up against and had fought yet again the battle about the absurdity of that article, the GMC would not have felt able to impose such harsh punishments. But it does show how, where prejudice and vested interests are involved, such battles have to be fought over and over again. I think it also reveals the corruption of entrenched power.
The story I have just told about the BMJ article was largely repeated in the history of the famous or infamous Guidelines for Cood Clinical Practice in the Treatment of Drug Abuse of 1984 which became known as the 'Misguidelines'. I have not time to describe here the amazing (and in my view also corrupt) way in which they were drawn up.[9] I was a member of the committee and it was a real eye-opener. The Guidelines were immediately used (or misused), and have been ever since, against doctors who disagreed with the official policies. The story of that and many other anomalies is in my book A Doctor's Story.
In treatment and administration there are so many anomalies and mysteries that I can give only a few examples. A minor one first, but it is indicative. We are told that the government is anxious to get accurate figures about drug users and that this is important in forming policies. Under the Misuse of Drugs Act, doctors are required to notify the Home Office of every patient they see whom they suspect is using illegal drugs, regardless of whether or not they treat him or prescribe for him. Although I worked in the field for many years I saw little or no evidence of any effort made to inform doctors about this. Most doctors do not even know about it and if they notify addicts at all, it is only when they prescribe a drug on Schedule 1 or 2 of the Misuse of Drugs Act, which, for most doctors, is never. Furthermore, while doctors are paid a small sum for notifying other notifiable conditions such as measles, tuberculosis, birth or death, they are not paid for notifying drug addiction. Unless they obtain special labels from the Home Office, they even have to pay for the stamp! It does not seem that the government or the Home Office is very keen to get accurate figures. Why not?
There are many anomalies concerning treatment in Britain's drug dependency clinics. There has never been a proper assessment of the success or failure of these clinics, which were set up in the late sixties in response to political demand and public panic. It is known that various things happen, such as that some patients stay off drugs for six months or more after completing a course of treatment and that some patients go round and round in a seemingly endless cycle of the same treatment programme consisting of treatment, then being theoretically 'drug-free' but actually on the black market, then an 'acknowledged' relapse, then back to the waiting list and more black market. Then another treatment programme, more black market, further relapse, and so on Because the choice of treatment is so limited (it is marginally greater now because of the AIDS situation) the only option for such a patient is to stay on the black market with all its risks or to repeat the treatment as before. There is a case on record who went through the clinic treatment course twenty-seven times and all he was offered was yet another round.[10] As a practising doctor, I find it hard to decide whether we are in the world of Kafka or the world of Alice in Wonderland. Even harder to understand (or not, depending on how you look at it) are those clinics that make claims like '95% success rate'. Success for what? At one time I treated a number of patients who had been in such clinics. All of them had left apparently 'drug-free' but in reality were never off drugs for more than a Sew days and some not even as long as that. As one addict said, 'If they have a 95% success rate, then I know all the failures twenty times over.'
Who are the patients who attend the clinics? I do not think anyone knows. Studies are done on them as though they are typical Of drug addicts in general, or even as if they are the population of drug addicts. They are not. The Home Of fice itself has reckoned that it knows at most about only one addict in five, 20%. Of these less than one in three is ever seen at a clinic, say 6% of the total. Of these only a proportion stay on for treatment—half would probably be overstating it. That is 3%. Of those only a small proportion complete the course, some would say less than 1% of those who attend—making 0.03% of the total, but even if we are generous and put it at 50%, that's still only 1.5% of all addicts. And most of these relapse within a year or two. So why do they talk in terms of 'success' and what are doctors doing trying to treat them all by the standard, official, routine, or the current 'flexible' regime, with its narrow choice of options?
When I was trying to learn about drug addiction and was puzzling out what on earth was going on, I visited three clinics. In theory all were fully booked with patients. At that time the clinics were crying out for new funds to alleviate the rising tide of addiction and the intolerable burden of patients. In two of these clinics not a single patient turned up. The doctors and other staff waited for a couple of hours, then went home. The third clinic I visited was specially for addicts who were in trouble with the courts. They were being considered for treatment as an alternative to going to prison. They all turned up and were really eager. Each patient was asked whether he was genuine in his desire for treatment or whether he was just trying to avoid going to prison? They all said that it was nothing to do with the court case and that they genuinely wished for treatment. They were all accepted. Later I heard from a number of patients who had been through the course that drugs circulated freely in the hospital ward and that a patient could get anything he wanted. The staff turned a blind eye and recorded as a 'cure' anyone who was not actually caught with drugs. This satisfied the hospital figures. It satisfied the court. And it satisfied the addicts.
When I was treating drug addicts I always used to write to their former clinics for reports on them as is the custom in clinical medicine. Normally (i.e. with patients who are not 'drug' cases) you get a useful report or summary Of the case. But not here. Clinics usually sent many bulky pages of photocopied material from the patient's notes, usually giving an enormous amount of irrelevant information such as recordings of normal blood pressure over many years (incidentally another anomaly is the concentration Of many drug dependency 'experts' on normal blood pressure; I have never been able to find out why they do this). But these reports nearly always omitted what I thought was important, for example, the psychiatric assessments of the patient and the doses of drugs prescribed over the years. I do not believe that psychiatric assessments had ever been done in many cases, and the information about their drugs was often withheld, even if I wrote again for it. I came to the conclusion that it was related to the change Of prescribing policies in the clinics which occurred in the late 1970s. They suddenly changed from prescribing more or less what the patient asked for as long as he wanted it to prescribing much smaller doses for only a few weeks and then recording the patient as 'drug-free', while at the same time trying to impose the new regime on all doctors. Yet only a few years before they had been prescribing huge doses, up to twenty times more than the doses they were now saying were acceptable.
Another anomaly was that if the clinics sent the information about doses at all, it usually concerned only what was officially prescribed Mention was often made of how the patient had 'reduced' his dose, but hardly ever of the fact that as a result he was now using black market heroin, though you mostly only had to look at his arm to see this. Strangely, the clinic notes kept all sorts of information, like that on blood pressure, which I thought relatively unimportant, yet usually did not record the patient's black market habits, which I thought were very important. They were all on the black market so it seemed to me dishonest to record them as being 'drug-free' just because they no longer received prescribed drugs.
This sudden change of prescribing policy is another anomaly. Why did it happen? It is often said to be based on a study of prescribing for addicts long term versus short term, published in the Archives of General Psychiatry in 1980, several years after the change. That research is often said to show that short-term prescribing and refusing the addict more than a small minimum is better than long-term prescribing and that prescribing injectable drugs to those who are going to use them anyway is counter-productive. I do not want to go into the details of these arguments about doses and injection and so on. In theory they are at the heart of the dispute but I believe that basically they are moral questions which people try to prop up with figures acquired or arranged in ways that suit their beliefs. In fact it is difficult to see the results of that study. It was quite short and if anything the figures seem to indicate the opposite of what it was later said to have said. This study is widely used, so widely that now, more than fifteen years after the change, it is still used as the basis for the anti-prescribing argument. So is another study that has an even more chequered history. A research worker studied addicts in their then customary habitat Piccadilly Circus, and published an article indicating that those who had long-term prescriptions from doctors did better than those without. Then the same author published another article using the same material but coming to the opposite conclusion. I was told by someone who knows these things that the first article did not please those in power. Whatever the explanation, it does suggest that figures, like Humpty Dumpty, can mean what you want them to mean, no more, no less.
I spent many hours in libraries puzzling over things like that and I was unable to understand what the so-called 'evidence' indicated. It was a long time before I realized, and actually a high-up Home Office official pointed it out to me, that there simply was not any valid 'evidence' to support the way patients were treated. It was all personal and political. Only then did the whole thing begin to make sense.
Much could be said about the effects of all this and about the world drug situation. The crime. The wrecking of lives. The degeneration and hounding of potentially useful human beings. But I should like briefly to mention one result of western drug policies, corruption, because that is perhaps the biggest anomaly of all. Corruption is built into the policies, both the law enforcement policies and the medical policies. When it is uncovered it is often attributed to the drugs, but really it is due to the drug policies. It affects everyone in the drugs field, addicts, drug enforcement officers, civil servants, policemen, doctors. I could give you many examples of all these but I shall confine myself to few. In just one American state, Georgia, over a period of five years, thirty-two sheriffs were jailed for drugs offences.[11] What can you expect when, for instance, a police chief is offered half a million dollars to be in church on a particular Sunday morning and another the same sum not to be anywhere near the local airfield, where he probably would not be going anyway? The inevitable corruption is not only of those caught by the law but of those who administer the law and those who work under it. I believe it is the worst aspect of the 'War on Drugs'.
An example of corruption in Britain (and I could give you many examples) is the number of policemen, especially in London, who have been found guilty during the past few years of drug offences, mostly selling drugs or planting them on people whom they then charge with 'possession with intent to supply', a weasel charge. I have personally come across many cases of police corruption, but none of those led to charges. I believe that this corruption of police has been influential in lowering public regard for the police and it may have contributed to the generally low standards which have led to recent police scandals involving other forms of crime.
The corruption of doctors makes me, as a doctor, particularly sad. When the present drug problems began to surface, in the early 1960s, I believe we could have contained it by encouraging general practitioners to help addicts, perhaps for extra payment, and psychiatrists could have been available to deal with difficult cases. But we did not do that. The government of the day wanted to make a more dramatic show, the public wanted to see more action, and some doctors in what were regarded as rather inferior backwaters (such as the old asylums) wanted more power. So we got expensive clinics that were shut away from the GPs and even from the hospitals where they were placed. Other departments in the hospital were not and are not interested. They do not want to see addicts and do not care what happens to them. The clinics are isolated and the normal system of checks and balances between departments does not operate in them. Other doctors got the idea that all drug cases need specialist treatment, though this is no more true in drug addiction than in anything else. Drug addiction was pushed into corners where new so-called 'specialists' carved out careers. GPs ceased to regard it as anything to do with them and developed an antipathy to it. I once did a survey of eighteen GPs in an outer suburb of London to find out whether they would consider treating addicts, which, in theory, they are officially encouraged to do. The official line on this has long been verbally to encourage GPs to look after addicts while at the same time discouraging them by covert threats. Some GPs now even believe, or choose to believe, that they are not allowed to treat addicts, which is quite untrue. Anyway, of my eighteen GPs, not one was willing to look after addicts and sixteen were positively hostile to the idea. Some GPs even put up notices saying that they will not treat drug addicts even for conditions unrelated to drugs. Although this is against the terms of their contracts, none has ever been disciplined for refusing to treat a drug addict. It seems that addicts attract a kind of 'licensed nastiness' wherever they go and no one cares about them. A few addicts have complained to the GMC, but they always get the same answer- that the GMC 'has no power' in such matters! Even worse, some GPs refuse to treat the families of drug addicts. I have often had to act as unofficial GP to wives and children, even for tiny babies. It was really upsetting. It is as though people are now programmed to think that everyone with any connection with drug addicts is untouchable and to be rejected. That is a dangerous belief in a doctor.
Yet the former Chief Inspector of Drugs at the Home Office, Bing Spear, who probably knows more about the problem than anyone else in the country, has often been quoted as saying that at the time the panic about drugs began and the law was changed, 'We didn't need clinics. We needed a thousand doctors to take on one addict each.'[12] I have heard him say it many times. Had that happened, I believe that the problem of drugs and treatment by GPs would have developed together and much more healthily. Britain was in a situation from which she might have led the world but she threw away the chance. Now that is all water under the bridge. Fortunately things have begun to improve and a small but increasing number of GPs now do look after the addicts on their lists.
Another anomaly is that it seems that at the time no one except the politicians both medical and general even wanted the clinics. Some hospitals had to be bribed, for example, with research money, to create them, and even then some of them took the money and then did not build the clinics.[13] The papers are now being released under the thirty-year rule. I heard that some of them have mysteriously disappeared but I am sure there is plenty of material left there for a perceptive historian.
Then there is the corruption of the law itself, the erosion of human rights, at first applied only in situations of drug 'abuse' or drug trafficking but then extended to wider situations (for example, in the Criminal Justice Acts, and for fraud). It seems to be generally accepted now that a person found guilty of selling drugs is assumed to have obtained all his assets illegally and these can be confiscated by law unless he can prove his innocence. The principle that a person is deemed to be guilty until proved innocent is new in British law, though some might say it already existed in immigration. Since people are taught to hate and despise drug addicts and people do not care much what happens to those they hate and despise, no one protests. If a politician wishes to limit liberty and human rights, it is a good way to do it. I think that needs to be looked into too.
The existence of drugs lowers environmental standards (or 'the quality of life'). In international affairs, particularly American foreign policy, strongly supported by Britain, drugs provide a splendid excuse to interfere in the affairs of foreign countries (Colombia, Central America, Pakistan) or to resist international cooperation (Thatcher's attitude to abolishing European frontier control). Are such power games the nub of the whole extraordinary business? Is the situation an exercise in using people's fears and prejudices in order to increase political power? What other possible explanations are there?
Bias, misinformation, and vested interests are now so entrenched that it is impossible to have open discussions about illegal drugs until those taking part agree on the meaning of the terms. Even then, there is so much prejudice and fear that it is likely to be impossible. Thus discourse about whether or not 'narcotics' should be legalized or 'decriminalized' has little meaning at present.
It is sometimes forgotten that drug addicts are mostly basically normal people, with normal problems and families, jobs, and aspirations. I have collected three albums of photographs of families and children and holidays and hobbies.[l4] Each concerns a drug addict or the children of a drug addict. It shows them getting married, playing with their children, boating, birdwatching and so on.
An important prop for maintaining the 'War on Drugs' has been the government campaign against drug use. It began with posters as well as TV. The posters were of the actor who became a 'pin-up' boy because of his effect on teenagers. It continued on TV mostly after midnight when most addicts are in bed like anyone else. Advertisements are trying to sell us something. We know that it is to warn against heroin, to counteract heroin, to urge us not to take it. Yet it is a campaign based on lies and targeting a specific group. A white male, good-looking in the modern style—he became a pin-up. Is the campaign directed at the white, trendy community? If he did not take drugs he could be YOU or your son. The implication is that if he had not been so foolish as to 'choose' drugs—or if he had not failed to 'just say no', he would have been a presentable chap. It is only the drugs that prevent him from being 'one of us'.
This reinforces fears and prejudices of the well-defended. The only black in the group of posters I managed to get was the porter pushing the trolley, emphasizing his low status occupation. Seemingly the campaign was trying not to offend the black community by associating drugs with ethnicity and also making a point of not associating it with housing, unemployment, poverty, etc. The whole campaign seemed to aim to induce smugness in a targeted group who would probably never touch drugs. There is a cosy feeling about being told what you 'know' is true.
The campaign also aimed to maintain widespread untruths about heroin. The advertisement assumed that we know that you get 'low' if you take heroin. It compounds this with 'How low can you get?' There is no room for asking 'Do you get low?' or even 'Why do you get low?' It offers no evidence. Of what it actually says, only the constipation is true. The aching limbs go with withdrawal from the drug, but if you are going to confuse the effects of heroin with the effects of withdrawal, why mention only this? Much worse are the diarrhoea, anxiety, severe pain, and so on.
The lies mean that the advertisements lose credibility with anyone who knows anything about drugs. The campaign assumes that the 'just say no' approach is easy. Every addict knows it is easy only for people who are not tempted. There is no mention of nutrition or the fact that heroin addicts get ill not because they take drugs (unless they take too much, as with alcohol or any other drug) but because they spend all their money on drugs and do not eat properly. There is no mention of poisons—the dangers of shooting into your veins the impurities with which black market drugs are cut: brick dust, Vim, flour, and so on. These and not the drug itself are what damages. Every addict knows this so obviously the campaign is not directed at them. Those who have any contact with drug users know it too. These include the young people likely to be recruited to drugs, just the people, you would think, that the government want to influence. But by telling them lies, the authorities lose any credibility they might have had. The only people likely to be impressed are those who know nothing about drugs and are unlikely to come into contact with them. It is their prejudices that this campaign aims to reinforce. They are probably the majority (or thought to be the majority) and they have many votes. Presumably these are the audience that is being targeted.
It seems to me that the classification made in the government anti-drug campaign is between drug takers who are white, foolish, and simply fail to say 'no' and non-drug users who are white and have had the sense to 'just say no'. It is a way Of targeting a group who already believe what you are saying, to make them feel more secure and perhaps smug, and to give the appearance that you are tackling a serious problem.
One of the difficulties in the history of medicine is to see modern situations and constructions in as detached and critical a way as we see past situations. The present situation in drugs, if you bother to examine the evidence, is a wonderful opportunity to do just that.
NOTES
1. H. Dale Beckett, 'Heroin: The Gentle Drug', New Society, 26 July 1979. (back)
2. Virginia Berridge and G. Edwards, Opium and the People: Opiate Use in Nineteenth Century England (London, 1981). (back)
3. Reported in Independent newspaper, 17 December 1991. (back)
4. T. Bewley and A. H. Chodse, 'Unacceptable Face of Private Practice: Prescription of Controlled Drugs to Addicts', British Medical Journal, 286 (1983), pp 1876-7 (back)
5. R. Hartnoll and R. Lewis, Letter, British Medical Journal, 287 (1983), p. 500. (back)
6. Peter Dally, Letter, British Medical Journal, 287 (1983), p. 500. (back)
7. James H. Willis, Letter, British Medical Journal, 287 (1983), p. 500. (back)
8. Peter Bartrip, Mirror of Medicine: A History of the BMJ (Oxford, 1990). (back)
9. Ann Dally, A Doctor's Story (London, 1990), chapter 9. (back)
10. Information given by H. B. Spear when he was Chief Inspector of Drugs to the Home Office, c. 1986. (back)
11. Prof. J. Killorin, Personal Communication based on local statistics. (back)
12. H. B. Spear, formerly Chief Inspector of Drugs, Home Office, Personal Communication. (back)
13. A. Baker, former Senior Medical Officer, Ministry of Health, Personal Communication. (back)
14. Now lodged in the Contemporary Medical Archive Collection at the Wellcome Institute for the History of Medicine, London. (back)