Drug Abuse

11 Control of Drugs

The control of illicitly used drugs poses a multitude of intractable problems. We do not know precisely their effect or their mode of action in the body; we cannot do more than guess about the strength, nature, purpose of the motives that cause some people to become dependent on drugs; we have even less idea of the probable effect of widespread drug use on our society. Here, as menacingly as anywhere in the field of public policy, the penalties for wrong decisions loom. Should one be liberal or penal? If neither, where in between? One can make out a case for the possibility of total social degeneracy and breakdown consequent on movement in either direction.

In particular, we fear to make the experiment of liberality; but whether we like it or not, the experiment is being made for us. Drugs are becoming part of the lives of people in every part of society: housewives in the Welsh valleys, school-children in Sheffield, artists in Cornwall, West Indians at High Wycombe, racing cyclists at Brentford, psychiatrists and their patients at Hendon; to all of these, drugs that were unknown to ordinary people in Britain a generation ago are becoming accepted accessories of life. Technological advance reaches inwards, and it is impossible to keep it in the hands of the Establishment. Regulations and attitudes towards drugs, formed when their illicit use was confined to a small, tractable minority, are now being strained The purpose of this chapter, and indeed of this book, is not to advocate immediate, drastic changes to these social adaptations, but more to suggest new facts and attitudes for discussion: to help to make it possible to reorientate ourselves to considerable and increasing drug use.

The first problem is: Why do we want to control drugs? This is a hard question. Now that freer sexual behaviour is becoming assimilated into our moral system, it seems that drug-taking is moving into its place as one of those matters that are defended or attacked with more than rational heat, a question to which considerations of logic are only marginally relevant. It is probably more useful, therefore, first to examine unconscious reasons for restricting drug use. These are various. An obvious motive is that someone under the influence of drugs can be frightening or angering; he is hard to recognize, and consequently his behaviour is unpredictable. It is not until one thinks of alcohol as a drug that one realizes how subtly we have adapted to its use. The drunk is immediately recognizable by the way he stands, by the expression of his face, by his gait, by the situation in which we find him, by the way he talks, even by his smell. We know very well how he is likely to behave, and we make great allowances for actions that would otherwise be unacceptable. There are other adaptations to alcohol: it is distinctively flavoured, so one could hardly take it in ignorance. It is diluted so that the process of getting it into the bloodstream takes time and some physical effort. It is expensive enough not to be used absolutely casually.

Drugs on the other hand are subject to few of these controls. Their users show no signs that are intelligible to the ordinary person. Because we do not understand the cues, we can only recognize users by their overtly anti-social acts. As a result the drug gets the blame that we would, in the case of alcohol, attach to the user. Here for example is a trivial news story:

DRUG TAKERS OVERTURN GRAVESTONES
Two young men who had taken drugs ran riot in Brookwood Cemetery, Surrey, late one night.... They pushed over forty-eight memorials with considerable force between 11 p.m. and 11.30 p.m.... causing damage estimated at £2,500.... On each of two charges of possessing a quantity of a drug (Cannabis Resin) without authority, they were given a conditional discharge.'

The ordinary reader must feel that something shocking has happened; he may be less sure where to put the blame. If the boys had been drunk, the situation is clear: they were wrong to get drunk, more wrong than to behave badly. But drugs — one is not certain. This doubt and ambivalence towards drugs — or more accurately, towards acts done under the influence of drugs, the only evidence people have of their existence - encourages drug users to assert their moral exemption, to claim that it was the drug that did the deed, not they. This in turn intensifies the alienation towards drugs, and makes it more difficult to develop the social adaptations to them that we have towards alcohol.

Such rejection of the possibility of human control over drugs in turn enables society to see the drug user as incurably different, and therefore as a scapegoat. This is stronger in America than here; but it is necessary to point it out as one of the consequences - of penal control of drugs. Trocchi puts it well:

It's a nice tangible cause for juvenile delinquency. And it lets most people out because they're alcoholics. There's an available pool of wasted-looking bastards to stand trial as corrupters of their children. It provides the police with something to do, and as junkies.and pot-heads are relatively easy to apprehend because they have to take so many chances to get hold of their drugs, a heroic police can make spectacular arrests, lawyers can do a brisk business, judges can make speeches, the big peddlars can make fortunes, the tabloids can sell millions of copies. John Citizen can sit back and watch evil get its just deserts.2

Then, as we have seen, drug use is not simply a pharmacological affair between the user's body chemistry and an alien substance; it is the cause and effect of a sub-group of society, and in many cases the drug itself- or its visible accessories - are a part of social display. Young people in particular use drugs to demonstrate their rebellion and emancipation from their elders. However unconscious the message, society receives it loud and insulting. A passage in the Utopiates, describing American beatnik marihuana users who react against middle-class backgrounds by their dramatically squalid way of life, analyses one facet of society's reaction.

We suggest that the police officer — or citizen — is, in fact, threatened by his quite accurate but partially unconscious understanding of what some users do mean or intend by their drug use. That threat mobilizes the individual's feelings about past trauma of his own, trauma experienced at the hands of parental authorities during the difficult stages  of learning order and suppressing impute. These individuals respond, with disgust, anger, revulsion and fear and 'cleanse' themselves by the standard human ploy of making the enemy external, that is of scapegoating.... The emotionally aroused police officer who calls these users dirty' and hates them for their 'self-indulgence' is quite an accurate diagnostician, even though the diagnosis is in the service of his own defence system.3

The problem of the rebellious, dependent young has always been to find something they can do without hurting themselves, that will still look dangerous enough to force their elders to stand and fight. For the moment drugs, particularly the soft drugs - marihuana, amphetamines - do the trick nicely.

So, another motive for society's interest in drug control is that here one finds something intimately connected with juvenile revolt that can be weighed, counted, analysed, held in the hand and sworn to in court. Something rather more satisfactory as evidence of young ingratitude than long hair and contemptuous expressions.

And finally, drugs that are thought to provide ecstasy, visions or even happiness and contentment without reference to one's material or social position, pose an obvious social threat. The cohesion of society and its control over its members depend on the inability of anyone to obtain satisfactions unless he pays for them: to pay for them he must earn, and in earning he conforms to the major rules of society. The trouble with the drug user is that he has found a way to escape from society's controls: he has no family to earn and care for, he has no self-respect, he has no home, he needs no job. Quite obviously, if more than a small minority of people lived as he does, our social system, held together by the iron chains of mutual production and consumption, would fall apart. The results would be unpleasant for those who were not drug users, and so it is not surprising that those whose job it is to enforce the written and unwritten laws take a very dim view of illicit drug use. Heroin, the banisher of anxiety, is particularly dangerous, since worry - over one's Status, security, old age - is the mainspring of free enterprise capitalism. One works oneself, because one is dedicated and finds fulfilment in the service of society: one is not so sure about all the others. It is probably not a bad thing that they are spurred on by their anxiety over rent and retirement, the need to buy food and status-giving consumer durables. If anyone, after an injection or a pill costing a few pennies, were able to sit back and let the world go hang, where would we all be? On the other hand, equally dangerous drugs that support the social system by stupefying those who, like many housewives, would otherwise find it intolerable, are not seen to present any problem.

Paradoxically, the conscious grounds for drug control are far less easy to set out. We just do not know enough to separate the effects of drug use from the social conditions in which it is attractive. Thus, we can hardly use Hong Kong with its 300,000 addicts in a population of 4 millions as a model for British society if, for some reason, heroin became generally available, becinise the economic and social conditions are so different. Probably there normal people prefer to be stupefied rather than endure ordinary life. Similarly the reported evils of hashish in underdeveloped North African countries are probably only symptoms of poverty.

The moral question is perhaps slightly easier to attack. Here, of course, I am putting my personal views. My own feeling is that adults who know what they are doing — and no one can become a heroin addict without this knowledge — should be allowed to get on with it. I am not convinced that heroin use, in a sensible climate of opinion, is necessarily worse for the sort of person who Inds it attractive than the vain attempt to live an ordinary life.

We should be humble enough to consider drug use one of the freedoms we enjoy in our society. And perhaps we forget that man is—, almost above all his other qualities, a self-optimizing machine; that he is built to adapt to his training and surroundings in some way that tends to increase his chances for survival. Often his behaviour seems inconvenient, intolerable, self-destructive; this is because we can see only the half of the situation that lies outside the organism — the equally important internal arrangements of the drug user are hidden from us. We ought to consider the idea that in the situation he finds himself, his behaviour is - more for his good than not. We should hesitate to interfere unless  we can make radical changes either in his internal or external environments, or both, and so make drug use an option that he will prefer not to exercise.

These Considerations apply particularly strongly to adolescent drug users, Addiction or habituation rather than occasional use is asymptorn of something badly wrong. The fact that their personalities have not finally formed means there is some hope of altering them internally and externally enough to make drug use unnecessary; and we have an obvious duty to make this attempt But it has to be well considered; superficial efforts may, well exacerbate their problems.

Practical Considerations Relevant to Drug Control

One solution to a drug problem is to forget it. In the West, where the objective damage due directly to the use of drugs is small, much of the ultimate harm they do is caused by the reaction of hostile social attitudes. Thus in France, although the country was the international centre of the heroin traffic in the thirties and I after, although heroin factories still exist round Marseilles, there are, officially, only sixty addicts and no drug problem. One suspects that this is simply due to the French tolerance for individual aberration. In the same way we have no barbiturate 'problem', although this drug is actually and potentially much more dangepus than heroin.

However, we are hardly likely to achieve such karmic acceptance. The opposite of acceptance is penal restriction of drug use, a policy pursue4, apparently without great success, in the U.S.A., Canada, Hong Kong and other countries. In fact, as will appear below, this policy does actually reduce addiction — though unfortunately it produces more virulent side-effects. It is extremely important that we, in Britain, do not make this mistake. Not only can it cause misery, degradation, illness, squalor and early death in addicts, it is brutalizing for society, and because of its lack of overall success generates an extremist public attitude.that makes more libetal approaches politically impossible. We have this problem in a mild way with marihuana now; the Americans, many of whom feel that the penal approach was a disastrous mistake, find it difficult now to experiment with more lenient methods.

The hard line towards addiction also tends to create and extrude intractable sub-cultures of users. This process of separation Is examined by Willcins4 in terms of feedback loops. Briefly, his argument is that as a minority appears it begins to establish its own recognition symbols, values, ways of behaving which distinguish it from the main culture. If its activities are antisocial, pressure from the main will tend to isolate it and to deny its members access to the ordinary rewards of society. This is met by a negative reaction in the minority culture which re-intensifies its rebellion; so the loop rolls on. This analysis alone wSuld suggest that sub-cultures must expand explosively: experience shows this is not the case. Wilkins, having provided a force of expansion in the sub-culture, does not appear to consider the countervailing pressures which society brings to bear on it. There seem to be two restraining forces: society's physical power to restrict, or make difficult, the sub-culture's activities, and in the ultimate resort, to kill all its members; secondly, the more immediate point that as the distance between the minor and major groups increases, so the number of new recruits abnormal , enough to be willing to make the jump decreases. One sees the operation of this second control in the British Nazi Party whose members are few, but very extreme. The danger in applying pressure to the several sub-species of drug user is that we reduce the willingness of the compulsive drug user to accept our society' and to accept help from it, and we make communication with him almost impossible. Extreme pressure, short of annihilation simply produces a small number of absolutely intractable deviates: drug addiction in America shows this sort of position. By relaxin social pressure one runs the risk of increasing the numbers o people affected, but one also increases their accessibility. In the end we have probably gained. A second beneficial result is that as social pressure is reduced, so more diverse agencies can hel with the problem. Extreme pressure calls for the Army, somethi less the police, less again and one can use doctors, social workers, psychiatrists. So many doctors in America have gone to prison for giving drugs to addicts in an attempt to establish a relationship with them that useful medical and psychiatric help is now almost unavailable to the drug user, except in the few rather isolated hospitals that deal with these cases.

Another consequence of using force to suppress drug use is an inconsistency that should be unacceptable in a civilized society. Drug users are recognized as being ill;* their illness is the cause of their drug use; therefore potential drug users are ill. The police are being used to repress symptoms of conditions that need medical attention.

International Control of Drugs

One of the first international organizations to reach within the frontiers of member states of the League of Nations, and now the United Nations, is the machinery that controls the manufacture and international trade in addictive drugs. As a piece of bureaucracy, it is impressive and serves as a valuable model for other international endeavours, such as the control of nuclear energy; as a method of preventing addiction and illicit drug use throughout the world, it is singularly ineffective.
A thorough account of its operation would be tedious. It is enough to say that in theory the member countries submit yearly estimates of their manufacture and consumption of some eighty dependence-producing drugs. An elaborate sum then shows what has gone astray; the nation responsible is invited to explain itself. The major defect of this system is that illicit manufacturers submit no estimates, and until 1961 no country was obliged to report its growth of poppy. Even now many countries where mush poppy is grown have not the internal organization to make this report. In its broad effects the system of treaties, conferences and conventions has slowly driven the manufacture of heroin — the most compact opiate — back into the East, nearer to the poppy fields. But any successes in controlling addiction, such as Japan's or Formosa's before the war, are due to individual rather than collective effort.

This mechanism has only secondary effects in Britain. When the machinery was being constructed during the thirties, our domestic drug problem was negligible. We were able to accede to the most demanding treaties, and were glad to, both as an example to more indulgent nations, and so that we could apply the most rigorous standards in our own colonies. In particular we were anxious to repress a subversive Egyptian sub-culture that centred on hashish. It seems that but for the needs of empire, we would not have proscribed hashish, and we would now have no cannabis problem. Since our heroin problem is home-gown, and state-financed (directly attributable, with much of the rest of the world's addiction problems, to our refusal to let China ban opium in the 1830s, and to our Opium War victory of 1842), international control of drugs is irrelevant to our troubles. If, by some disaster of public policy, we allow a real black market to rise here, there is no reason to suppose that the United Nations Narcotics Commission will cause traffickers much difficulty in getting supplies from abroad.

Black Market

A practical and moral reason for preferring some sort of liberal drug control system, is to avoid the growth of a black market. It is no longer believed that a vigorous black market in itself makes addicts (see p. 34), but there are a number of more serious peripheral disadvantages. For one thing it occupies a number of people in work that serves no useful social purpose, and it occupies an equal numberof more useful people in attempts to stop it. In fact, it is probably fair to say that in a vigorous situation of repression, the black marketeers and the police work in mutually unhelpful partnership. The black market provides the police with addicts and peddlers to arrest, seizures of drugs, and prestige; the police provide the traffickers with a captive market that cannot haggle or object, whose only price ceiling is set by their own abilities to steal, rob and whore. The black market too inadvertently helps the police combat addiction, for the drugs are sadly diluted at every stage of their journey. `Cutting' a parcel of heroin in half only five times between grower and addict will reduce its purity to 3 per cent; its price will increase several hundred times over the journey. Thus an ounce of heroin that can be bought in Italy for $60 will fetch $28,000 on the streets of New Yorks — a happy commercial advantage the Mafia owes entirely to the energy of the American Department of the Treasury. The result of this dilution is that very few addicts, perhaps one in five, actually have had enough heroin to become addicted.6

Although an active black market reduces addiction and drug use, it does nothing to relieve the social damage due to the addict's way of life, and it also causes him to commit a great deal of expensive crime to support his habit. Winick estimates that each addict in New York has to steal up to $90,000 worth of goods a year.s

In the summer of 1969 there were rumours that a proper black market operation was being set up in London. Powdered heroin, either imported from China or made in France, was being found in police searches, and it was estimatedu that some 40,000 fixes (enough to supply 300 addicts) were being smuggled into Britain every month. But by May 1970 Chinese heroin had almost disappeared. Perhaps the traffic had been suppressed by the Chinese community in Britain, who take very good care of their public relations. In any case, a black market can only develop against a system of repression: as long as addicts can get nearly enough her6in without much difficulty, there can be no solid opening for a black market in opiates.

It is a heartening sign of the success of the heroin containment strategy that the black market price of methadone, the slow-acting, unexciting opiate substituted in some treatments for heroin (see p. 149), has now risen to between 75p and Ll a grain. Two years ago it could hardly be given away.

Some of the vast mass of new research into drugs has been on the side of the user. An interesting project was analysis of drugs purchased on the street for fidelity to description and purity. A gross of drugs bought in Munich in 1972 showed only 80 that were as advertised; the other 64 samples were,either adulterated or something completely different. One sample of 1, SD turned out to be 60 per cent sulphuric acid.' 7 An agency exists in America for routine analysis of drug samples; useful as a guide to what is actually happening as well as providing material for the legal defence of drug users.

Police

One result of the explosive spread of drug use since 1965 has been the increased interest of the police. Many policemen now have experience of drug users, and find they pose an unfamiliar and unpleasant problem. The police are trained and organized to deal with professional criminals; both the police and criminal sub-culture have grown up together over the last century and a half. Both sides know the rules and have a certain respect foryach other. With drug users the police are at a loss. These are people who offend all their instincts for order and discipline; while criminals provide an opponent one can decently dislike, young addicts can only be objects of pity. Yet society requires the police to track them down and arrest them as if they were criminals, The links between drug culture and the anti-authoritarianism of student politics, with the fact that many well-known and wealthy young people in the pop business, acting, films, are drug users, exacerbates the difficulties of the police, who dimly feel that their job of protecting society shouldn't include making available the freedom for this sort of self-indulgence. Terence Jones, a Detective Superintendent with the Hertfordshire Constabulary, neatly sums up the situation in his Drugs and the Police.11

The world of drug addiction is a strange one and one in which the police officer sometimes feels it difficult to mingle. Used as he is to the jargon of the criminal and his more predictable ways, the police officer finds the rather juvenile slang of the addict and his complete lack of direction rather nauseating. They are pitiful people so much in need of the help they spurn. They are dangerous people not only to themselves but to every impressionable young person with whom they come in contact. If they won't be cured they must be controlled. This is the role of the police.

The difficulty in police relationships with drug users is that, fundamentally, police forces are trained and organized to prevent , one person doing something illegal to another person. There is always a victim/informant and a criminal. The police stand in the middle as an almost neutral agency, which must receive the complaint and information of the one before it can proceed agiinst the other. Once that is done, it lapses into passivity again.*
When policemen have to deal with drug users, the situation is quite different. Here there is no complainant. The drug user is doing whatever is illegal to himself In an attempt to manufacture the 'complainant police organization and training demands, they have to cast the user himself in this role — hence Jones writes: 'They are pitiful people so much in need of the help they spurn.' Not unnaturally, since they must conceive they are acting for the users' ultimate good, as 'complainant' the police tend to be rather arbitrary in their treatment of him in the criminal role. So when the Advisory Committee on Drug Dependence held its hearings on police powers,13 'Release' complained that the police had assumed arbitrarily wide powers of search, made it unnecessarily difficult for young prisoners to secure bail, made charges before the substance was analysed, and made it difficult or impossible for young prisoners to telephone parents or solicitors, The courts, too, are less than helpful: the two biggest magistrates' courts in central London do not, as a matter of principle, give legal aid in drugs cases. A thorough review of the practice of British policy and courts is to be found in Guilty until Proved Innocent?, an assessment of the Criminal Law Revision Committee's eleventh report: Evidence (General).

Another interesting result of the lack of an injured party' in drug offences, is the lack of control over policemen who handle drugs, particularly in large quantities. In the ordinary crime—say of theft — there is an injured party who has lost goods or money. Even though the police — for their own profit — and the criminal, to minimize his punishment, might like to conceal some or all of the proceeds of the crime, the injured party will prevent this, because he wants his property back or insurance compensation for his full loss. But when a drugs trafficker arrested with, let us say, a hundred-weight of hashish in his car, he is unlikely to complain if the police keep 109 lb for themselves, and charge him in court with possession of 1 lb. Thus it is easy and profitable for the police to become dealers in drugs themselves,
through, of course, traffickers they have arrested, whom they can turn into accomplices through withholding their power to prosecute.

Having referred to some general points, we can now consider the control of different classes of drugs.

The Law

A new Act came into effect in 1973: the 'Misuse of Drugs Act 1971'. This consolidated the existing law, extended it and made it possible for new drugs to be added or dropped from the ,prohibited schedules by an Order in Council — that is, withOut reference to Parliament. Optimistic persons have seen in this an opening through which the Home Secretary could legalize cannabis without political scandal.

The new Act repeals the Dangerous Drugs Acts of 1965 and 1967, and the Drugs (Prevention of Misuse) Act 1964. It divides drugs into three classes: A includes opium, heroin, morphine, pethidine, cannabinol (not as a part of hashish or marihuana), LSD and other hallucinogens, injectable amphetamines, notably methedzine; B consists of codeine, pholcodeine, cannabis, cannabis resin, and five stimulant drugs of the amphetamine type, of which the three most important are: benzedrine, dexamphetamine, drinamyl ; C contains lesser amphetamine-like drugs.

Penalties are related to the type of drug and the type of offence — possession or trafficking. The maximum penalty of fourteen' years' imprisonment and/or an unlimited fine applies to the following acts to do with drugs in Classes A and B: producing; supplying or offering to supply; possessing with intent to supply to another; unlawfully importing or exporting; being the occupier of premises and knowingly permitting drugs transactions to take place there; and contravening a direction prohibiting a doctor from possessing, supplying or prescribing a controlled drug.

Simple possession of a Class A drug is punishable by seven years' imprisonment, Class B by five years, Class C by two years — and/ or an Onlimited fine in all cases.

To stop over‘prescribing, which seems to have been a cause of the rapid growth of heroin addiction in the last few years, the Act gives the Home Secretary power to ban any doctor from prescribing, supplying or possessing drugs in the three classes.

The Act creates two statutory defences to drugs charges. A defence to possession is to show an intention to dispose of the drug in a lawful manner. Although it's meant to cover people like schoolmasters who may confiscate drugs from their charges, and are therefore protected as long as they destroy them or give them to the police as soon as may be, it must also apply to anyone who, on being stopped by a policeman in the street, produces a joint and gives it to him, saying, 'I'm so glad to have met you; I was on my way to the police station to hand this in.' The second defence protects people charged with production, supply or possession who can prove that they didn't know, nor had reason to suspect the existence of a fact that the prosecution has to prove. So, if someone gave you some white powder saying it was bicarbonate of soda although it was heroin, you could escape conviction if you could convince a court of your mistake.

The new law also introduces the word 'knowingly' into the section which makes it illegal to permit drug transactions in your house. This is' to avoid the problem of Sweet v. Parsley, where a Miss Sweet, who lent her cottage to some friends, was convicted under the old law when they were convicted of possession of cannabis although she wasn't there and knew nothing about it.

Apart from saying that the new law is as wrong as the old in Creating drug use or abuse as a criminal act rather than a social preference or, in extreme cases, as a symptom of some major psychological problem, there is not a great deal to criticize. Rather more worrying is the development of case law after the successful prosecution of Oz in 1972 under the Obscene Publications Act. One of the passages complained of was a medical advice column called Dr Hip Pocrates — written in fact by the student health physician at Berkeley, California. An L S D user had written to say that his left hand and arm had gone totally dead during an LSD trip. Dr. Hip replied that:

All L S D available on the black market today is illegally produced by chemists who, of necessity, run make-shift laboratories. Compounds Produced in these laboratories contain impurities which may be more dangerous than the pure drugs.

LSD is related to ergot, a substance which causes constriction of blood vessels including those in the brain. Ergot is a fungus which grows on aye and other grains. During the Middle Ages epidemics of ergot poisoning occurred in which the characteristic symptoms were gangrene the feet, legs, hands and arms.

If I were you I would have a thorough physical examination. You live near a Free Clinic where you can speak frankly to a physician about these experiences.'8

The prosecution successfully contended that since there was no explicit advice not to use L SD except under medical super. vision, the passage was obscene.

Control

We must assume for the moment that we should do all we can to prevent people, particularly adolescents, developing the heroin habit.

The present theory of control is elegant, and if it could be made to work, foolproof. The essence is that each addict is given free exactly as much as his body needs for the next day. He has no option but to inject it; there is none over, to make new addicts, eventually he and all the other existing addicts will give up drugs or die. Since' supply is exactly fitted to demand, there is no cause for a black market, and therefore no generation of new addicts in that quarter. End of problem. In practice it is not quite like that. The quantity of heroin supplied is critical: too little creates a black market by demand, too much creates one by supply. That every two addicts recruit a third every year (see above p. 20) shows the extent of this over-supply in the past. This second state of affairs contributed to the addict explosion that faces us nôw, a situation caused as much by a breakdown in' medical services as by the new habit of proselytizing. There are only a  few doctors who are prepared to put up with addicts — perhaps only a dozen in London, and hardly any in the provinces. As the number of addicts increased, these practitioners became flooded with customers, were quite unable to form the close, authoritative parental bonds with each of their patients that successful control or treatment demands, and simply to make their lives bearable were forced to prescribe lavishly. With no workable system of identification, addicts were able to go to two or three doctors and get treble rations; with no means of withdrawing patients these doctors were unable to establish proper dose levels.- Cone sultations became horse-trading sessions at which the addict and the doctor tried to outwit each other: since the addict has one mania, but the doctor several hundred things to think about, the issue was hardly in doubt. At least one doctor seems to have been won over, for he was described to me by some of his patients as forcing heroin on them. The Brain Committee were told of one case of a boy who had jabbed his arm with a pin, and then succeeded in getting a prescription. Under these conditions our system could hardly be expected to work.

In a series of interviews with doctors who treat addicts, one told the Sunday Times

. . . every interview with an addict is a battle of wills. They are driven by a need one can't understand oneself, and they will lie, beg and scheme to get more, and more again.

Another doctor:

Sometimes you get tired of arguing and think, `Oh well, what's the harm?' And you let whoever it is have the extra grain, or half grain. But, you see, if it isn't making you tired, you're not doing your job.1

In the absence of facilities for withdrawal, or a simple chemical test to establish the addict's dosage, the only way society can keep the amount of heroin prescribed to the amount that is physiologically needed is by using doctors who have the energy to force addicts back to the sticking point in debate.

One immediate remedy would be to increase the amount of will-power opposing addicts' demands by recruiting more doctors to deal with them. Say there are a thousand addicts, and that the most one doctor can handle adequately is 30— that gives a requirement of 33 doctors, 21 more than the dozen already practising. If we are to take addiction seriously, these doctors had better work full-time at the priblem, perhaps under contract to a central body that would also be responsible for hospitalization, psychiatric and social after-care services, registration of addicts and research into addiction. In terms of employment, comparing tivase doctors with general practitioners, we are saying that each addict needs as much attention as a hundred people on an ordinary panel. Considering the demands addicts make, this is reasonable.

The Brain Committee's Second Report proposed that the prescription of heroin should be confined to Treatment Centres, and suggested that there should be a power to detain addicts who have volunteered for withdrawal while they pass the crisis. Some of this Report's proposals were put into action in April 194. It then became illegal for any doctor, not specially licensed by the Ministry of Health, to prescribe heroin and cocaine to addicts. Some 600 licences were granted to doctors working in those hospitals who had, or were likely to set up Treatment Centres. So far there are twenty-six in London, a couple in Birmingham, Manchester and so on. The aim at the time of writing seems not to be so much directed towards treatment as controlling the prescription of heroin. An addict, once he is `registered' at a Treatment Centre — the details are relayed to a file at the Home Office — then has to attend once a week. A prescription for the drugs he needs is posted to his chosen chemist every week, and he goes there every day to pick up the next day's supply. The essence of the scheme is uniformity of treatment: once a dose is settled the addict has to stick to it, and if he goes to another Treatment Centre the doctor there will discover his dose and prescribe the same. The result is that (a) whatever the addict's original dose was his tolerance soon builds up to what he is getting and therefore (b) he has none to spare for the black market but (c) he is not 'hungry' enough to buy extra drugs. In recent years the British treatment system has followed the American pattern in converting heroin addicts to methadone (see p. 148), a much less dynamic drug, and one that is much less susceptible to black-Market operations.

So far the doctors involved in the programme are feeling their way. At least the total addict population is being revealed and there is some regular contact between them and the State. It is interesting that some doctors complain that because the 'Treatment Centre system' says how much drugs each addict should be given, it destroys the 'doctor-patient relationship'. This is true, but perhaps it is because the doctor-patient relationship is irrelevant in the drug addiction problem. The classical relationship between the two is based on the idea of a single disease; the two collaborate to defeat it, and no one else has any authority in the matter. lithe disease is easily communicated it may establish an epidemic, and society as a whole has to be represented - thé patient's contacts have to be traced, he has to be put in a special hospital, etc. With heroin addiction, the problem is, as it were, all epidemic and no disease. It now appears to have been something of a fallacy to treat it as if it were a disease because the 'germs' - the doses of heroin - are social currency, they are given, sold, traded, passed about in response to social rather than biological laws. In order to control heroin addiction, society, and that means that doctors who deal with addicts, has to present a united face. It is no use one having a 'hard' attitude and another 'soft'. Both may be equally successful with diseases and patients that cannot move about, but in the drug situation all the 'hard' doctors' patients leave and go to the soft' ones.

In perspective, the 1968 moves to control heroin by the limitation of, the right to prescribe heroin and cocaine to addicts was as mach aimed at doctors as at addicts themselves, because it had become apparent that the medical profession itself was unable to control those of its members who, for one reason or another, prescribed irresponsibly.

An example of this was the unfortunate affair of Dr Petro. This elderly practitioner had, for what reasons it does not matter, a very soft attitude towards drug addicts. He ran an extraordinarily rickety practice round Paddington from 1966 to 1968, seeing his patients in station waiting-rooms, hotels, wherever he happened to be. He was widely criticized for 'selling' prescriptions for heroin, but since he didn't work for the Health Service he could only live by charging fees. He was investigated by the General Medical Council and struck off the register for infamous professional practice, though the fault was probably not so much his, as society's inability to deal with the addicts who flocked to him. One can also criticize the enforcement of medical ethics, for although his practice was disapproved of little could be done to control him short of the final, blasting step of disqualification. The Misuse of Drugs Act, 1971 (see p.178) gives the Home Secretary the power to remove a doctor's right to prescribe certain classes of drugs.

Well-intentioned though the Treatment Centres may have been, their operation has come under some criticism. Cutbacks in funding caused by the economic difficulties of the late seventies have reduced the scope of their action. According to a Release report19 published in 1977, it was becoming harder to register at a clinicat best the paperwork might take two to three weeks, or, at worst, so long that the addict gave up and went elsewhere. Admission to hospital for a physical cure took even longer, while the necessary follow-up services needed to reform the ex-addict's lifestyle, which, as we have seen, are much more important than 'cure', have been almost completely abandoned.

Barbiturate

Although this drug is objectively as addictive as and/rather more destructive than heroin, it is at the moment controlled only under the Pharmacy and Poisons Act. As a Fourth Schedule dru& it can only be sold retail on a prescription given by a doctor,: dentist or vet. It would seem logical to make it a D.D.A. drug, but although the public in general is very willing to follow the lead of authority in its attitude to drugs, there must be so many, people more or less dependent on barbiturates that sudden restrictive measures would simply make vast numbers of outlaws. Besides, in the sense that there is very little worry about the drug, we have no barbiturate problem; there is little point in creatihg one by legislation. A Campaign on Use and Restriction of Barbiturates (OUR B) was started in the autumn of 197520 to persuade doctors — mainly by direct-mail propaganda — to reduce their prescribing of this most damaging drug, which is responsible for most U.K. admissions to mental hospitals for drug dependence. It is hoped that bk 1978 there will have been a substantial reduction in the use of barbiturates.

Amphetamines

Assuming that it is impossible to stop people taking some Sort of mood and personality alterers, amphetamines in moderate doses are probably as good as alcohol, and in some respects better, especially for the young. There would be little objection to
teenagers taking half a dozen or so over a week-end; but the habit of swallowing the pills in handfuls is alarming. These excesses, if persistent, are symptoms of personality disorder, but they can also occur in those who have not yet learned, and are not taught by the existing sub-culture, how to use the drug properly. There are perhaps two things to be done about this.

The first is to alter the attitudes of adults towards this drug. While parents and teachers regard it as the purple kiss of Satan, teenage attitudes to it are hardly likely to be more, rational. If a boy takes the pills to be rebellious and because he wants to shock, he has no reason to limit his dose. They are not, to him, an ordinary substance like tea or food or beer; they have a symbolic value and the more he takes the more emancipated he becomes. We can short-circuit this problem by bringing to bear the same attitudes as we do towards teenage drinking; to say that it is silly and unpleasant to take too much.

Then, it is unrealistic to expect to stamp out the supply of amphetamines. People all over the world like them too much; the prospects for repression are shown by their ready availability in H.M. prisons,8 and the failure of a recent campaign to stamp them out in Sweden.

The ideal would be to dilute amphetamine preparations as we do alcohol; this however is likely to be impossible because of the cost of storing and transporting the vast quantities that are used in medicine. It might be more practical to include a substance thât would cause nausea if twice the maximum clinical dose were taken. It would be necessary to make these 4safe' pills available to the black market in some subtle way, so their abundance would drive out unsafe foreign imports.

It will still be necessary to nurture a sensible and acceptable cultural attitude towards the use of amphetamines. For this reason legal sanctions will still be necessary, but the efforts of the police and the courts should be directed less towards the futile task of eliminating them than to the repression of unacceptable social behaviour under their influence. People who use amphetamines must be taught that they have to behave as responsibly as alcohol drinkers. That is, after all, dot a very high standard.

The Drugs (Prevention of Misuse) Act, 1964, prohibits the importation or manufacture of amphetamines without a licence from the Home Secretary and provides penalties for the illegal possession of the drug: a fine of £200 and/or six months iminisonment on summary conviction, or an unspecified fine and/or imprisonment for two years on conviction or indictment. It has been repealed and replaced by the releyant sections of The Misuse of Drugs Act 1971, which imposes heavier penalties. It cannot be said that either Act represents very imaginative or effective legislation.

A more practical step was taken in October 1968 when the Ministry of Health persuaded the manufacturers of methedrine, the potent, liquid form of amphetamine, to supply it only to bospitals for a trial period of a year. This was done because the institution of Treatment Centres, and the consequent beginnings , of control over heroin, had multiplied addicts' use of methedrine some five times in a few months. By 1977 prescribing of ampheta. mines had almost stopped, largely as a result of initiatives taken by doctors themselves.

Cannabis

Black market hashish in Britain is supplied either by well-organized smuggling, often in large parcels, of hemp grown in the Lebanon, Pakistan-or Cyprus, or by `do it yourself' smuggling by students and young people who have been abroad on holiday. This last, as the Advisory Committee on Drug Dependence reported,15 has stabilized the black market and made it unattractive to really large-scale criminal operators. Them is evidence that the use of cannabis is steadily spreading over the country. Seizures of imports by the Customs have smoothly increased since the war, and the numbers of cannabis prosecutions have also increased, with white people being convicted more often than colourect since 1964. A little hemp is grown in Britain, but the climate does not really suit the plant.

Possibly because of the widespread association of marihuana use with holding radical political opinions, governments seem prepared to spend considerable sums of money on scientific aid for attacking it. Thus the Americans have developed an airborne 'sniffer' that can detect fields of hemp from a height of 200-300 feet — these devices were used in Mexico during the 1970 campaign to eliminate the traffic into the U.S.A. In England the Atomic Weapons Research Establishment at Aldermaston has produced a technique for detecting cannabinol condensates on the fingers of Smokers for up to three hours after smoking, with a guaranteed minimum time of detection of one hour. It is said that washing with soap and water affords no protection, but it is possible that washing in ether would, since this is the agent used to transfer the residues to the chromatographic apparatus.15

There are no apparent reasons for cannabis's status as a Dangerous Drug. It is not addictive, its use does not in Western society cause crime or unacceptable sexuality, and it does not lead to addiction to the hard drugs. The major problem with this drug is that it is illegal. This has three undesirable effects: first, an underground, cannabis-using subculture is created and maintained that puts the potential heroin addict one step nearer access to the hard drugs; second, it lessens respect for D.D.A. drugs in the thousands of young people who have tried marihuana or hashish and know from personal experience how harmless the drug is; third, it causes considerable waste of man-power, either through creative and educated people being sent to prison for possession of the drug —a Glasgow doctor Was sentenced to six months recently — or through the use a policemen, who would be better otherwise employed, to track down the drug and its users.

The non-addictiveness of cannabis, and the dependence of the smoker's experiences on what he learns from the sub-group that uses the drug, mean that it is possible for society to control the behaviour of users. After nearly forty years of repression most of the rowdiness has been eliminated from cannabis-using groups in this country, and it seems that the behaviour of the useirs of this drug could now quite adequately be controlled by the ordinary machinery of the law. Legalization of cannabis — as the Laneet9 pointed out — would offer considerable revenue in taxation. My own impression is that the Home Office would be happy to be quit of this problem — except that legalization of cannabis would be the political suicide of the incumbent Home Secretary; but Britain is restrained by the international agreements that proscribe this drug along with the opiates and cocaine.

Since 1966 things have moved fast in the cannabis field. Large numbers of people use the drug — the Advisory Committee on Drug Dependence, quoted on p. 83, accepted that. there are 30,000-300,000 users, and a survey done for the B.B.C. TV programme Midweek in 1973 showed that four million people in Britain had smoked cannabis. Public opinion, from its relatively uninformed state in the mid sixties, is becoming sharply polarized. In the meantime the salient events were: the trial of the Rolling Stones in 1967 for possession of cannabis, the publication of the well-known full-page advertisement in The Times, paid for by the Beatles, which' began with the statement, 'The law against marijuana is immoral in principle and unworkable in practice' and went on to set out the current medical view of the drug — much 1 as it is put in these pages. It drew attention to the disproportionately heavy sentences available for those convicted of possessing the drug — ten years imprisonment or a fine of £1,000 — and was signed by some sixty respectable names from science, medicine and the more up-to-date arts. An organization, ' Release ', was formed to organize legal advice for young people arrested on drugs charges; run by young people itself, it serves as a useful  link between the world of drugs and the world of the establishment. The Wootton cninminee reported, late 1968, in the sense that marihuana was not a dangerous drug, and that while the penalties for possessing small quantities of it should be nominal or abolished, the penalties for trafficking in it should be made heavier. In effect this would begin to bring the lawion marihuana into line with that on alcohol. The next step would be for the State to make marihuana preparations available through selected, controlled outlets. But this is not likelY\ to happen for some years, if only because licit marihuana would pose an enormous threat to the equally enormous established cigarette and alcohol industries. A threat to them is a threat to the State, because a third of the British government's income is derived from taxes levied on the sale of these addictive drugs. Non-addictive marihuana might prove an unreliable sulltitute. But nevertheless one hears that the major cigarette companies have already completed marketing studies; they have designed packs and rêgistered trade names for a marihuana marketing operation. Al the same time the alcohol manufacturers in America, and probably in Britain, are spending large sums - of the order of $100 million a year - to 'de-advertise' marihuana, by financing critical scientific studies, and by subsidizing anti-drug politicians.

On the other hand the police, as so often when they are asked to enforce unpopular laws with which they themselves agree, have found themselves in sharper and sharper opposition to public opinion over this question. This is one example of the police-public dichotomy:. the police see and deal with only the squalor of drug addiction; to them all drug use is pernicious and crippling. Because the police tidy these people so neatly away the public - particularly the intellectual pro-marihuana public - doesn't see them. While both sides think they are arguing the same topic, they work from contradictory premises to reach opposite conclusions. Anyway, at the time of writing the police have the last laugh. Marihuana prosecutions are very frequent, and as often happens when the police are put in a situation they dislike, they lake the letter of the law to extreme lengths. An example was the recent prosecution of no less than seventeen people at the Old Bailey for possession of one small lump of hashish found in a guitar case in the same room. (In another charge, which one has to admire as a stroke of jurisprudential genius, three heroin addicts playing around with their works in the bathroom of the same flat, were charged with an obscene exhibition. But the judge directed the jury to return a verdict of not guilty on this last charge.)

A survey by Release21 of sentencing policy in courts in England and Wales reviewed 1974 figures. In that year there were nearly 10,000 successful prosecutions for cannabis offences. One fifth resulted in prison sentences, either immediate or suspended. Simple possession was usually punished with fines ranging from £40 to £70, though in some out-of-the-way places where magistrates were not used to the offence, they could be as high as £75 to £100. Couriers of drugs in bulk got roughly one to three years, while dealers in large quantities for profit got up to six years.

Hallucinogens

These drugs present the same problems as amphetamines, only in a more acute fain'. Their ease of manufacture and concealment means that extirpation is impossible,* while the immaturity of the L SD-using community offers no guarantees that the drug will Ioe used responsibly. It is necessary that something be done becai., although the psychosis rate among normals is ,low, illicit L SD use is likely to produce psychosis more frequently. The drug is apt to be taken in hostile or worrying situations, and illicit - use tends to attract people who are already unstable. Since this psychosis can cause a long illness, it is desirable to be more stringent over the control of hallucinogens than the raw accident rates would suggest.

In terms of law enforcement, there is almost nothing that can be done. Since L S D is such a concentrated drug, large amounts can easily be smuggled into the country, or concealed when it is here. The Customs can only hope to seize imports if they are tipped off, and the police can only hope to discover illicit laboratories on the basis of information received'. In fact, in 1969 and 1970, several such laboratories were found as a result of nprmal underworld treachery, but this activity can have had little effect on the market supply of L SD. There were also reports that large quantities were originating from the chemistry department of the Humboldt University in East Berlin, and that the raw materials for manufacturing L SD here were supplied, with Government connivance, from East Germany, as part of yet another sinister Communist plot to corrupt the youth of the West. An interesting study of the purity of black market drugs in Canada 16 found that only 68 per cent of samples alleged to contain L SD actually did so, and that only half consisted of the pure drug. It is significant for the British drug user that in general British LSD is considered inferior to that of Nprth American manufacture, so one might suppose a similar study here would show even more startling results.

So the only practicable control on the use of L SD is in the attitude of drug users themselves. Perhaps happily, the first proselytizing enthusiasms of the mid sixties seem to be waning. Certainly L SD psychiatric casualties are becoming rarer.

Cocaine
As this edition was going to press in the early summer of 1974, a wave of cocaine use (see p. 86) was spreading, over the underground communities of London.. Unknown as an illicit drug in England since the naughty twenties, its use may be forced on those who normally smoke marihuana by the success of the concerted catrOpaign against cannabis by the customs and law enforcement agencies of the West. By 1977 cocaine had become quite fashionable, but its expense restricted its use to small and rather self-admiring circles.

Finally

We should try to see drug use as an inevitable result of technical advance. There are few people so satisfied with their lives that they will refuse any alteration. It is unrealistic to expect them to, morpunrealistic to see this always as some sort of sickness. It is perfectly within man's power to develop sensible attitudes to all drugs; to use them rather than be used by them. At the Same time we must not expect perfectibility. As the major social ills are cleared away so minor ones emerge; drug abuse is one of them that ( may, by the time the situation is stabilized, affect 50,000-70,000 people in this country. Drug problems are the price we must pay for having effective medicines.

As a corollary to this, we must remember that the availability or attractiveness of drugs seems to play a small part in the formation of drug dependent personalities. Almost without exception, the studies quoted here of people who become unable to live without drugs of one sort or another - some addictive, some not - show that the decisive causes of this situation lie in their personalities and not in the drug. Drug dependence is a symptom and not a disease.

*Or rather, they were. The first Brain Report regarded addiction as 'an expression of mental disorder rather than a form of criminal behaviour'. The second says that the addict is 'a sick person, provided he does nat resort to criminal acts' when, presumably, he is no longer sick. (Reports of the Interdepartmental Committee on Drug Addiction, H.M.S.O., 1961, 1965.)

*See my Scotland Yard, London, 1970, for a fuller analysis of this.

*In spite of the illegality of LSD in America it is estimated that 10,000 students in the University of California have tried it 10

< Prev		Next >