3 HUNG UP ON THE NEEDLE

When I first began to spend time around the Soho clubs in 1965 the worlds of the heroin addict or 'junkie' and of the amphetamine user or `pillhead' were very clearly separate. The society of those who were involved with the needle was very restricted. Schur in his study of 1965 rejected the idea that there was any 'addict subculture' in Britain, and American observers were anxious to point out that British addicts were geographically dispersed, rarely in contact with each other, and predominantly middle-class. Towards the end of the 1950s, a group of Canadian heroin addicts had settled in London and many of them became the patients of a particular doctor. Some of these were responsible for infecting young English youths by selling from the surplus of their prescriptions which in most cases were large and in some cases were enormous. Probably the role of these Canadian addicts in spreading addiction has been exaggerated. But it is certainly possible to trace the early spread of a heroin subculture among the young in London, by a study of case to case infection, to the early addict society in the early 1960s. Until the end of the 1960s, however, the needle culture did not affect many working-class youths, and even as late as 1967 the teenagers who used the all-night coffee clubs in Soho were mainly involved in amphetamines taken by mouth.

The early heroin addicts used to use two pubs to the north of Oxford Street as meeting places. Boots' at Piccadilly Circus was popular for the cashing of prescriptions, and the junction of Coventry Street and Haymarket became widely known as 'junkies' corner', a reputation which it retained long after most of the addicts had left. These addicts were fairly isolated, lonely individuals. They tended to be middle-class and to be of above average intelligence. I got to know a number of these pre-1965 addicts. Brian was a middle aged Canadian who had been addicted for about twenty years. Paul was a young East Londoner who used to frequent some of the bigger West End clubs, and had been on heroin since about 1964. Keith was one of the original East End addicts. He was working-class, very out of touch with the junkie literature or with the West End bohemian/jazz/folk idiom, and he used the West End merely as a source of supply. Jean, a young South London girl, had been addicted to heroin since 1962. Many of these early addicts are now dead, many are still addicted and have a legendary status around the West End, while others are 'cured'. They were never involved as a group with the all-night club world of the adolescent pill-takers, although some of them passed through the cafe 'pot and pills' stage in their early days, and some of the younger ones became involved in the clubs in Soho after 1967.

I found these early junkies much easier to relate to than the younger 'teeny bopper' pillhead kids. This was partly due to my own personality: the addicts tended for the most part to be fairly introverted, meditative, dreamy people—a bit like me! But it was also because they were emotionally very dependent, rather in the way that small children or very immature teenagers are. So long as they got their heroin, they would praise you to the skies as the greatest gift to the drug scene, and they would help to inflate your ego with their plausible addict blarney. Heroin addicts are good manipulators and can put on the agony as well as the charm. The early addicts too were a fairly articulate group. Once one became known as a sympathetic counsellor, there was no great problem about being accepted within the addict subculture: the problem was rather that of how to wean addicts from oneself, in order to enable them to grow and mature.

All-night cafes, clubs and bars were sometimes harder to get into, particularly where they consisted of a tightly-knit subculture of a delinquent type. I found the Soho coffee clubs for the most part fairly easy—the management were sympathetic, and the clientele quickly accepted me as part of the scene. But there were other places where I found it hard going. One of these was a pub chiefly frequented by servicemen and other mainly middle-aged men looking for homosexual satisfaction, and by 'rent boys' and others waiting to help meet the demand and exploit them. I never really found pastoral work practicable here, although a priest who was more turned on to the gay scene might have found it easier. I always felt awkward and uncomfortable here in a way that I never did among the younger gay set. Only if I were seen as part of a well-established drinking group would I be accepted in this pub as a non-hostile presence, and even then the relationship was that of a superficial pub chat. Another difficult one was a club which was used by skinheads from all over London. Part of the problem here was that they themselves felt threatened by, and insecure in, the atmosphere of the West End, and so they built up barriers of aggression against any interlopers. Perhaps also they were less conscious of any obvious 'need', and did not take kindly to 'do-gooders'. Usually my 'method', insofar as I had one, in places which were difficult to penetrate was to go around with somebody who was accepted. This had its dangers, however, chiefly that of being identified with one clique or group. At different times I was identified closely with the male homosexual community with junkies, and with left-wing beatnik groups. One can become too worried about this danger: no priest can expect to be good with all sections of the community, and it is very important to accept one's limitations.

Sometimes it is possible to work with the individual members of a group, but never to touch the group itself as such. An example of this was Hell's Angels. I have never at any point been involved with any chapter of Hell's Angels or with Angels as a group. But individual Hell's Angels have often come through St Anne's, and I found myself involved with them frequently in discussions about magic, the occult and psycho-spiritual problems. The fact that I knew San Francisco and Oakland, even though superficially, was of great prestige value, and I was able to help individual Angels over particular problems.

Towards the end of 1967 and particularly during 1968 we were caught up in the most significant drug epidemic in the recent history of London's drug culture. Methyl-amphetamine hydrochloride began to circulate on a large scale, usually in the form of Methedrine ampoules. Methedrine is a very powerful cerebral stimulant and had been introduced originally in the late 1930s, its use being restricted to post-operative conditions, spinal anaesthesia, and, to some extent, abreaction in psychiatry and the treatment of obesity. The use of oral Methedrine became obsolete with that of the other amphetamines (though they continued to be prescribed) and by the time of the epidemic of illicit use, the clinical use of the injectible preparation had become very limited. Why did Methedrine use increase during 1968? I think it is clear that the activities of three doctors in particular were responsible for the spread. One doctor substituted Methedrine for cocaine as a stimulant to be used alongside heroin. So injectible Methedrine began to spread among two sections of the drug-taking population. The first was that of heroin addicts who now began to use Methedrine instead of cocaine. The second was the amphetamine users who had progressed from oral to intravenous use of the drug. It was the spread of Methedrine ampoules which, above all else, brought together the heroin addicts and the wider community of adolescents who were involved with amphetamine use. It was Methedrine use which provided the bridge between the needle culture and the kids in the clubs. It was Methedrine which played the 'escalation' role which is often, wrongly, attributed to cannabis. It was Methedrine which made the process of 'fixing' an integral part of the West End drug culture. The West End was not the same after Methedrine: it was more destructive, more hopeless, more needle-centred.

There had been major epidemics of methylamphetamine abuse in Japan in the 1940s and in the United States in the 1950s and 1960s, and today. it is methylamphetamine which constitutes the major illicit substance in such high drug use areas as San Francisco. The term 'speed' was the popular term for methyl-amphetamine, and the slogan 'Speed Kills' was widely publicized throughout the United States in 1967 and 1968. The slogan was picked up and used by the Underground Press in Britain in 1968. So International Times on 9 August 1968, printed a notice:

SPEED KILLS

It is not widely known that the side effects of taking certain drugs can do as much damage as the drugs themselves. Amphetamines are not as safe as has been supposed and there is growing concern on the scene about the widespread use of methedrine.

The amphetamine methedrine is a powerful drug which distorts the mental state. Although it is used clinically to cure such disorders as Parkinsonism, Epilepsy, Enuresis and Obesity, abuse of the drug can have lasting and devastating effects.

Methedrine is one of the most dangerous drugs around at the moment and although it is less physically addictive than heroin, its prolonged use can cause very unpleasant conditions.

The most striking feature of someone who is habituated to methedrine is a paranoid psychosis with delusions and hallucinations which may be indistinguishable from paranoid schizophrenia. A methedrine user feels persecuted—friends become enemies—voices of a persecutory nature may be heard and the persecutors (real to the sufferer but totally imaginary) may be seen and attacked.

Methedrine taken for a prolonged length of time will stop a girl's periods and diminish sexual potency. There is a possibility of brain damage even after the use of the drug is discontinued and the conditions mentioned earlier can happen sooner or later to anyone who shoots methedrine.

In fact fixing any drug with unsterile needles can cause

Septicaemia (blood poisoning)
Tetanus (lockjaw)
Jaundice
Gangrene
Abscesses
Syphilis
Gonorrhoea
For further information ring Release
SPEED KILLS

The slogan was fairly successful, and Methedrine never really caught on within the British Underground which has always remained loyal to cannabis and the psychedelics. But in 1968 Soho was a speed scene, and the damage remained long after the voluntary restriction of November 1968 by which the drug was withdrawn from retail pharmacies.

Methedrine keeps people awake for abnormally long periods of time, and so deprives the body of food and rest. We found that it was a particularly attractive drug among the young vagrants in the West End because it removed these two basic necessities of life. The immediate sensation after an injection is the 'flash' which has been described as a 'total body orgasm'. In the United States, methylamphetamine circulates in crystal form, and is illicitly manufactured in black market speed labs. Kids in such areas as Haight-Ashbury will inject 1,000-5,000 mihigrammes per day, although the pharmacology textbooks say that 250 mihigrammes is a lethal dose. The 'speed freak' has usually been through the stage of oral use of the drug, and his first experience of injection will be one of ecstasy. After several months he will inject the drug many times each day, and may remain awake for three to six days continuously. During this period he becomes more and more tense and paranoid, and finally 'crashes', that is, falls into a period of very deep sleep which will last for a day or more. The 'flash' and the 'crash' are the two peaks of the intravenous speed scene. There seems little doubt that short-term use of amphetamine can precipitate a paranoid psychosis in non-psychotic individuals, and large-dose amphetamine abuse appears to replicate the schizophrenic psychosis more closely than other drugs such as LSD. Out of 310 intravenous amphetamine users who sought help at the Haight-Ashbury Clinic in the summer of 1967, nearly 90 per cent showed acute anxiety reactions, nearly 60 per cent showed amphetamine psychosis, while smaller numbers were suffering from exhaustion or withdrawal.*

In 1968 the Institute of Psychiatry's Addiction Research Unit made a study of Methedrine abuse in London, and interviewed seventy-four users. Their conclusions were published in the British Medical Journal on 21 June 1969, and were similar to those of the American research.
In 1968 I got to know a group of lesbian Methedrine users who clustered around a set of clubs and coffee bars in the north of Soho. They constituted a tightly-knit group which was held together by the needle, by sexual relationships and by the subcultural life both of Soho and of prison. As a group, they moved between the clubs and prison with ritual rapidity. As with the young male homosexual group in the club which I described earlier, relationships in this group were pretty unstable, but they tended to last longer, and their break-ups, if they occurred, to be more tragic, than among the boys. I found these girls tremendously kind and warm, but intensely jealous and possessive.

At the same period in which I was concerned with these girls in Soho, Dr Paul D'Orban, Medical Officer of Holloway Prison, was of great help to them in the prison setting. His study of heroin dependence and delinquency in women, published in 1970 in the British Journal of Addiction, was based on a study of sixty-six girls, many of whom overlapped with my Soho group. His conclusions were that the girls were, on the whole, above average in intelligence but showed poor educational attainment; that most of them had a highly unstable work history prior to their addiction, and that their sources of income were precarious and often obscure. At their time of arrest, thirty-five of the sixty-six had no fixed abode or were sleeping rough. There was no history of mental illness, alcoholism, drug addiction or crime in most of the families, and only a small percentage had been in psychiatric hospitals before they were addicted. But there was a high incidence of broken homes-63 per cent had suffered such deprivation under the age of fifteen, and 39 per cent under the age of five. Of the group, 48 per cent were exclusively or predominantly homosexual, and D'Orban found that 'homosexual orientation generally predated drug abuse, and did not appear to be causally related to involvement in the drug subculture'. They were a very highly disturbed group, and, viewed in the context of their general disturbance, their drug addiction seemed a minor symptom.

Both among this group of girls, and among the general community of Methedrine users, the cult of the needle was more important than the drug itself. This was true of intravenous users in general. They tended to be com pulsive drug users, and Methedrine (and other amphetamines) was a drug which lent itself to such compulsive use, more than, for example, LSD did. This was because tolerance did not develop so quickly, and also because the amphetamines tended to relieve anxiety whereas LSD would often provoke it. The role of the needle within a group of users is central, and turning on the Methedrine almost always occurred within a group setting. Within such a group of 'speed freaks', there is compulsive talking, frenzied activity and an apparent euphoria. Hyperactivity is common. The steps of St Anne's House, regularly used for vomiting and urinating by the local alcoholics, were never scrubbed so well as in the days of Methedrine! But more important is the excessive talk. Many speed users feel that after the initial flash they can talk more easily to others about their problems, and there is often a flow of self-expression, even if nobody else is listening. Equally common is an onrush of enthusiasm, when the user may profess undying love for some other person, or may express his conversion to religion, and so on.

Getting a user off the needle is more important than getting him off the drug. It is possible for a cannabis or LSD user to make a good adjustment to life in spite of, and in a few cases because of, his drug use. But once a person is involved with the needle, he is involved in a very destructive way of life. Destructive, not simply physically in terms of overdose, infection or death, but in terms of the effect on his personality, his sexual behaviour, and his social relationships. Often the 'fix' takes the place of sexual intercourse, and one finds a lot of very disturbed sexuality within the needle culture. It has been suggested that the needle user is a chronically depressed individual who seeks to prolong an act of self-destruction, which is also a frustrated search for release. Bert Jansch's song Needle of Death expresses it thus:

'Through ages man's desire
To free his mind, to release his very soul, Has proved to all who live
That death itself is freedom for evermore, And your troubled young life will make you turn
To a needle of death.'

If this is so, our task is to try to help the addict to change his life-style from one which leads to death and destruction to one which leads to life and hope.
All through the period of involvement with addicts in the East End, and even more so during our early time in Soho, we were continuously conscious of the inadequate, indeed virtually non-existent, facilities for treatment. It was during 1967 and 1968 that the campaign for treatment centres became really militant. In order to relate the history of this campaign as we saw it, I need to return to my letter to The Times of 9 November 1966. In this letter I had referred to the Minister of Health's statement of 2 August 1966, in the Commons. In this he claimed, 'There are already centres for the treatment of addicts, and more beds could be made available if the demand increases'. (The Times, 3 August.) I was puzzled by this claim, which seemed to bear little relationship to the actual situation which I was encountering almost daily, and I wrote to the Ministry for clarification. In a letter dated 19 August 1966, a Ministry of Health official informed me that the Minister, in his statement, 'was not referring to any action that had been taken following the second report of the Brain Committee', but rather to 'some specialized units' which already existed. It went on: 'It may be of interest to add that there are thirty or so hospitals in the London area which accept drug addicts for treatment as in-patients including the specialized units.' But of the out-patient clinics there was no sign.

Meanwhile, doctors who had been seeing, and prescribing for, addict patients, were withdrawing from the scene. On 11 November the Sun devoted a good deal of its front page to an announcement that Dr Geoffrey Dymond would no longer be seeing heroin addicts. He had about eighty addicts as patients. On the same day, the Daily Mirror reported that addicts were calling at the Home Office for help, and claimed that one hundred and thirty addicts were affected by Dr Dymond's withdrawal. These reports were followed by longer accounts in the Guardian on 19 November (`Two ministries refuse to help drug addicts') and the Sunday Times on 20 November ('Addiction: the official double-talk, and the daily realities of treatment'). Dr Hawes was reported as having sent his applicants to the Ministry of Health. The Dymond affair sparked off a certain amount of publicity, and probably alerted the Ministry of Health to the fact that something was happening. But it was not until 1967 that the battle began in earnest.

Early in 1967 two Chelsea doctors, Peter Chapple and Geoffrey Gray, opened the Chelsea Addiction and Re search Institute (later the National Addiction and Research Institute) at premises in Beaufort Street. The Sun, in an article on 12 January, described them as 'defiant doctors . . . tired of waiting for Government action'. However, on 28 January, the Guardian reported informal discussions about the establishment of treatment centres. This followed the issue of a memorandum from the Ministry of Health to all the regional hospital boards, urging hospitals to collaborate in the treatment of addicts. By this time the Press was assuming that the implementation of the Brain proposals would take place—sometime. On 8 March, the Minister issued a memorandum suggesting that the London hospital boards should introduce out-patient services for heroin addicts immediately, and that in-patient services should be expanded, and on 25 April, during the Commons Standing Committee on the Dangerous Drugs Bill, he rejected accusations that hospital facilities would be inadequate.

On 20 June, the Dangerous Drugs Bill was debated in the Lords. Lord Stonham claimed that the Bill would 'help considerably in containing the general problem and bringing compassionate but real help to those who need it' (Hansard, House of Lords, Volume 283, No. 163, column 1271.) He pointed out that 'addicts are free at any time to seek treatment' (column 1272), though he wisely did not say where! 'I will leave it to my noble friend Lady Phillips', he explained, 'to describe in more detail when she comes to wind up the debate our plans for a system of special treatment centres for addicts to heroin and cocaine' (column 1275). But when at last Lady Phillips rose, her contribution was, 'I was asked to tell the House something about the treatment centres. I am not certain at this stage that it would be something your Lordships would particularly wish to know.' (column 1316.)

In the meantime impatience was growing, and on 31 May, Dr Hawes had written to the Minister, pointing out that the position had changed for the worse. Lady Frankau, a very well-known physician with large numbers of addicts as patients, had died—a factor which apparently the Ministry in its planning had not anticipated!—and there were now very few doctors who were willing to accept addicts as patients. He urged the Minister to 'put into operation as an urgent measure several temporary clinics.' On 22 June, the Ministry replied, and listed a number of hospitals in London, which, they claimed, 'had already established out-patient treatment facilities for heroin addicts.' These were St Thomas's (Lambeth); Westminster; King's (St Giles); Oldchurch (Rom ford); Harold Wood; Whipps Cross; St Clement's, Bow; Hackney; and North Middlesex. They added that University College Hospital 'expects to start a limited service shortly', and that Charing Cross and the Maudsley might have services later. The letter pointed out that 'until hospital facilities are available generally in London it would be premature and unhelpful to addicts as a whole, to give any publicity to the units concerned'. Precisely how, without publicity, the addicts were expected to know of the existence of such centres, the letter did not explain.

Dr Hawes, anxious to discover what 'out-patient treatment facilities' actually meant, contacted all the hospitals which had been listed, and asked them to describe their facilities. The replies were extraordinary.

Westminster and Lambeth Hospitals alone accepted that they had 'treatment centres', and gave details of their opening times. Harold Wood Hospital, however, explained that 'there has been an error in the information given to you'. 'To my knowledge', wrote the hospital secretary, 'an out-patient treatment centre in respect of Drug Addiction has not been established at this hospital'. Similarly, Whipps Cross Hospital insisted that 'we have no out-patient treatment centre for treatment of drug addicts', but that they would 'deal with' addicts in casualty (as, presumably, would any casualty hospital.) Hackney Hospital said that their treatment centre was still in process of being established. St Clement's similarly said that their centre was still 'at the paper stage', and had neither staff nor other provisions. North Middlesex Hospital said that they could only deal with patients who lived in the Tottenham, Edmonton and Enfield areas, areas which were not, at this time, if at any time, known centres of heroin addicts. Oldchurch Hospital wrote that 'there is no established out-patient treatment centre for the treatment of Drug Addiction', but that the hospital could give emergency treatment only in the casualty department. King's College Hospital said that Dr 011endorf—a well-known critic both of the Brain Report and of the Ministry of Health!—ran an out-patient clinic once a week, but that he was in the United States at the time. University College Hospital, according to a circular from the Inner London Executive Council dated 7 July, could only accept twelve patients, and only from the N.W.1. and W.C.1. postal districts. So much for the Ministry's 'facilities'!

The Ministry, however, not only believed in the existence of their 'facilities' but also began to use the term 'clinics' about them. On 5 July, in the Lords, Lady Phillips said proudly, 'Noble Lords will be delighted to know that there are now in operation eleven out-patient clinics in London, and plans for four other centres are under urgent discussion.' (Hansard, House of Lords, Volume 284, No. 172, columns 731-732.) Nobody has ever been able to discover where these clinics were. I do not believe that they existed at all. So far as one is able to tell, Lady Phillips's 'eleven out-patient clinics' must have been somehow related to the 'out-patient treatment facilities' mentioned in the Ministry's letter, which numbered nine, and most of which were non-existent. However, two days after Lady Phillips's speech, on 7 July, the Daily Mail and the Sun simultaneously discovered an actual, functioning clinic—but it was not one sponsored by the Ministry! 'Drugs clinic in station buffet', 'Doctor holds drugs clinic in a cafe' were the headlines. Dr John Petro was shown in his 'consulting room'—the tea buffet of Baker Street Underground Station. Dr Petro had previously been seeing addicts in a West End hotel. The Daily Mail followed its discovery by reports of delays in the Ministry's treatment plans.

It was on 8 July also that, with Dr Hawes's collaboration, I released details of his correspondence to the Press. The Times of that day carried a front page article quoting the letters. On 16 July the Sunday Times carried a lengthy article, 'The strange case of the missing treatment centres' in which the correspondence was again quoted at length. They followed this in a later issue by a disturbing piece by Alex Mitchell describing the rejection of addicts by the alleged centres. Meanwhile, Dr Petro continued to prescribe, and on 30 May the Daily Telegraph had drawn attention to Dr M.W. Browdy, aged eighty-two who was practising in Shaftesbury Av., across the road from St Anne's House, and was gathering large numbers of addicts.

At the end of 1967 Dr Petro was operating from a hotel in Bayswater, and was involved in a controversial case in Hertfordshire Quarter Sessions in which a nineteen-year-old girl was charged with possession. As a result of the publicity, on 11 January 1968, he appeared on the David Frost Programme on television, where he was attacked and questioned by a number of well-known figures on the London drug scene. After the broadcast, he was arrested by an officer of the Drug Squad, and charged with failing to keep his Dangerous Drugs register. At Marylebone Court on 12 January, he was allowed bail. On 14 February he was fined 11,700 with £21 costs for seventeen offences. By this time, he had moved to a surgery in Stratford, East London, where he continued to see addicts and to prescribe.

It was after the arrest of Dr Petro that a group of us at St Anne's House began to wonder what further pressure could be brought to bear upon the Ministry. At this time, the Association for the Prevention of Addiction had an office in the house which was regularly visited by West End addicts, and it was decided to open an emergency clinic. The Daily Mail on 13 January under a heading 'Emergency drugs for Dr Petro's patients', announced that a clinic at St Anne's would remain open throughout the following weekend. Dr Petro had flown to a village in Argyll. Addicts were phoning the Home Office who could do nothing but refer them to St Anne's, an ironic comment on the Ministry of Health's claims about treatment centres. On 15 January The Times ran a long article in which I was quoted as saying that the clinics were 'a figment of the Ministry's imagination' and were `semi-fictitious'. 'In London today there are only four or five such clinics, and they operate on only a fragmentary and skeleton basis. When the crisis comes—as it did this weekend—it is in other directions that the stranded addicts will turn.' Our emergency clinic was run by Ian Dunbar and dealt with about a hundred addicts. The following weekend, on 22 January, the APA held a Press conference at St Anne's at which Dr Francis Camps, Professor of Forensic Medicine at the London Hospital Medical College, called for voluntary help to establish independent drug centres, the need for which had been shown by the success of the St Anne's clinic.

The Ministry of Health continued to insist, against all the evidence, that their clinics existed, and in a statement they claimed that there were ten hospitals in the London area for the treatment of heroin and cocaine addicts as in-patients, and fourteen hospitals for the treatment of out-patients! However, a letter from the Ministry to hospital secretaries on 26 January listed only eleven hospitals, in which, it was claimed, 'out-patient treatment facilities' were available, and four where 'emergency treatment only' was available. This was an interesting letter, and began by expressing concern that 'some drug addicts have been turned away from certain hospitals in the London area'. It proceeded to give guidelines for the use of clinics and other facilities, and it included the statement: `If an addict arrives at a time when the clinic is functioning, he should be directed to that clinic whether or not he has an appointment, and whether or not he carried a letter of reference from his local practitioner.' Four days after this letter, on 30 January, the Minister, in a Commons Written Answer, gave the same list of 'out-patient facilities' and also listed eleven hospitals at which 'in-patient treatment facilities' were provided. By this time, the Ministry had lost virtually all its credibility, and most of the people on the drug scene had ceased to take its claims seriously. In an interview on Granada TV on 12 February, the Minister attacked those who 'suggested that the treatment facilities which I announced in the House of Commons a week ago do not exist. This is quite untrue. They do exist.'

Alex Mitchell of the Sunday Times was not so sure. He wrote an article, 'Minister's addict clinics are just a myth' on 18 February, in which he described the results of a survey of fifteen hospitals. Mitchell showed that the chances of an addict being taken on as a patient at any of the clinics was very small. There were long waiting lists, catchment areas, inadequate staffing and facilities, and general chaos. By 16 April, when the Dangerous Drugs (Supplies to Addicts) Regulations 1968 came into effect, the situation was becoming less confused. The treatment centres at last began to assume some reality. General practitioners were forbidden to prescribe heroin and cocaine for addicts. So, over two years after the Brain Report, there was a hope that some order might come to the confused drug scene. The Methedrine crisis, however, reached its peak as the treatment centres were becoming established, and so it was not until the middle of 1969 that one began to see some pattern emerging.

Would the clinics have appeared when they did if there had not been so much publicity? It is hard to answer. I certainly got the impression in 1967 that the attitude of the Ministry of Health was twofold. First, they condemned those wicked, over-prescribing doctors. But, secondly, they hoped that these same doctors would continue to prop up the old system until the Ministry was ready with its new treatment centres, and would then gracefully withdraw. Lady Frankau's death took them by surprise, and it led to Dr Hawes's unexpected revelations in the Press, and so brought the whole terrible business out into the open. Even then, it took a lot of publicity and publicly fought battles to force the Ministry into action. Mr Kenneth Robinson, then Minister of Health, in his television appearance on 12 February 1968, commented about the voluntary bodies, 'I only wish they found it possible to call attention to their own efforts without constantly denigrating the efforts of others, particularly the efforts of the Government, and I would have thought that at least the reverend gentlemen that are associated with these bodies would have heard of the injunction to do good by stealth'—an injunction which he presumably thought was in the Bible! This, of course, was simply a contemporary version of the advice given by Amaziah to the prophet Amos to go and work in the land of Judah, and not to prophesy at Bethel which was the seat of government (Amos 7.13). The provision of treatment facilities, like so many other forms of social care, only came as a result of an intensive campaign by voluntary agencies, much of it in the face of strong resistance.

On the day that the Dangerous Drugs Regulations made it an offence for general practitioners to prescribe heroin and cocaine for addicts, Dr Christopher Swan set up the 'East London Addiction Centre' in Queensbridge Road, Shoreditch. Its notepaper described Dr Swan as the Medical Director, while the 'Medical Secretary' was one 'Stephen Hartford (General Secretary, National Association on Drug Addiction)'. During the summer of 1968, large numbers of young pill-takers found their way to Dr Swan's clinic. On 10 January 1969, he was sentenced to fifteen years' imprisonment. John Petro, who had been struck off the Medical Register in May 1968 continued to prescribe until the end of that year, when his appeal was rejected. Later, he went on ministering informally around Piccadilly, dealing with abscesses and overdoses, and giving medical attention and advice. He was, and still is, widely respected and liked by many junkies, and many more have a kind of love-hate relationship with him. The publicity which attended these two doctors led many people to two false beliefs. The first was that these were the only, or the worst, examples of irresponsible prescribing. This is, I think, open to considerable doubt: there were others who managed to escape publicity. The second false belief was that it was the 'junkies' doctors' who were responsible for the spread of addiction. That they contributed to the drug scene is beyond dispute, but they were symptoms of a disease, not the causes of it. They were products of the so-called 'British system', a 'system' which, by 1968, for a variety of reasons, had got out of control.

During 1969 and 1970, after the Act came into operation, and the treatment centres started to function, our most serious problems of drug abuse in Soho were connected with the intravenous use of methadone (also referred to by its British trade name Physeptone) and crushed barbiturate capsules. The restrictions on Methedrine in October 1968 and the gradual reduction in supplies of heroin from this period onwards led to a search for injectible substitutes. The barbiturates, in the form of such capsules as Tuinal and Nembutal, were readily available and, when used intravenously, highly dangerous. The effect of the barbiturate drugs is to depress the central nervous system, to reduce inhibitions, and to allow the expression of conflict. Thus the barbiturate addicts, unlike heroin addicts, are often irritable, aggressive and violent. The majority of barbiturate users in the British Isles are, of course, middle-aged and elderly people, who use them, under medical direction, as sleeping agents. During 1969-70 we increasingly saw numbers of young barbiturate addicts. On 24 June 1970, the main Christian groups working in the field met at St Anne's. There were representatives of the Coke Hole Trust, the New Life Foundation, Life for the World, Hill Farm, and Spelthorne St Mary. From this meeting we sent a letter to the Home Secretary, in which we expressed concern 'that a good deal of our work is being undermined by what appears to be thoughtless, and at times irresponsible, prescribing of sedative and hypnotic drugs, particularly barbiturates, by some general practitioners. It is extremely easy in many cases for addicts to persuade doctors to prescribe barbiturates'. We suggested the introduction of a coloured prescription pad on which all scheduled drugs should be prescribed, and which should be kept always under lock and key or on the doctor's person.

Earlier, on 26 March 1969, Norman Fowler had reported in The Times another significant development, the appearance of illegally imported heroin from the Far East on the London black market. The report did not mention the Gerrard Street area of Soho, but it was well-known that this was where the illicit material was available. It was usually a mixture of heroin and caffeine, originated in Hong Kong, and sold in London at about thirty shillings (£1.50) a grain, although the actual heroin content was dubious. Within a few weeks, other reports began to appear. Alan Bestic, writing in the Daily Mirror, claimed that 'a highly organized trade in Chinese heroin is sabotaging the Government's year-old plan to curb Britain's epidemic of addiction'. He su!4:ested that about five pounds of heroin was being smuggled in each month. Bestic named Gerrard Street as the centre of the 'big business' which had developed. Similar accounts, based apparently on identical sources, appeared in both The Times and the Guardian on 8 July. Analysis of 'Chinese heroin' at this time revealed that it consisted of 40 per cent heroin, 35 per cent quinine, 20 per cent caffeine, and 5 per cent of unidentified substances. This was similar to the 'Red Chicken' which was sold in Hong Kong. The traffic was in fact organized by Hong Kong expatriates, although English addicts were used to distribute to the customer. The distribution centres included Gerrard Street and Macclesfield Street, and also the district around Goodge Street Station and Tottenham Court Road.

The physical and mental deterioration of the West End street addict was a source of concern to all the agencies working in the area. The Association for the Prevention of Addiction opened a day centre in the area, first at St Anne's House, and later at premises in Covent Garden. Later other day centres were set up, one by New Horizon, also originally at St Anne's, and then in the Drury Lane area, and another by the Helping Hand organization at Charing Cross. The APA's King Street Day Centre, which closed in 1970, had catered for the vagrant and semi-vagrant 'Piccadilly junkie'. It was a referral base, linking the addict with his clinic and with accommodation. First aid was provided for abscesses and overdoses. During 1969 the centre was seeing between forty and fifty addicts each day. Many of these were injecting barbiturates. The centre was able to provide food and nutrition, clothes, accommodation, medical and psychiatric help, and legal assistance where necessary, and to give assistance with methods of hygiene and injection. Physical assistance was the first priority, and the hard-core addict was their primary concern.

I believe that a properly run day centre is a necessary part of any care of addicts within a community such as the West End. But it needs to be seen as part of the therapeutic process, and related to an ongoing treatment programme, and to other facilities within the area. If this is not so, the day centre may become a centre for the reinforcement and spread of the needle culture and its destructive characteristics. We have found in the past at St Anne's House that by allowing addicts to gather, we were providing a base for the addict society and therefore indirectly for the spread of addiction. It is difficult sometimes to decide whether one is caring for the addict as a person or merely propping up his way of life.

We were finding that we needed to pay far more attention to after-care, and we began to act as a liaison point between the Soho street addict and therapeutic communities in other parts of the country. After-care facilities are still very poor, and in 1968 they were even worse. The Government's Advisory Committee Report The Rehabilitation of Drug Addicts, published in 1968, has led to very few results. It is incredibly difficult to find people and places to which former drug users can go and receive care and guidance after they have left hospital. It is partly because of this that relapse to drugs occurs so frequently. But even where attempts at after-care are made, relapse is still common, and one has to be prepared for continual failures and be ready to start afresh. Thus Violet, a girl who had been on heroin in the early 1960s, nearly died during the vicious winter of 1967-68. She was admitted to a succession of hospitals, and finally we got her away from London to a family in the West of England. After several moves around the country, during which she moved in and out of hospitals, she returned to Soho after an absence of three years. What will become of her now one does not know, but she has brought at least eight people to the point of nervous exhaustion through her immaturity and dependence. Again, Mary was a young girl who originally started to use amphetamines in a cafe in a northern city, and after a period in approved schools and borstals, she hit Soho in 1967, when she began to use heroin. She developed a lesbian relationship with a girl whom she had met in Holloway, and together they returned to the north. But after six months the attraction of Piccadilly was too great, and she returned and became a dealer in illicit heroin. In spite of various attempts at after-care, she always returns to Soho where her physical condition quickly deteriorates. There are many other examples. It is important to continue to hold them in prayer and not to lose hope even where the future seems very bleak indeed.

On the other hand, it is not correct to say, as many do, that no drug addicts are ever 'cured'. Jack lived a vagrant life around Piccadilly, sleeping in St Martin's Crypt in the daytime and hanging around an all-night coffee-bar in St Anne's Court at night. He was using heroin and crushed barbiturate capsules. In 1969 we were able to find him a place in an agricultural community in the West of England, and, after considerable guidance and care, he married, and has now been off all drugs for over two years. Roy and Karen were both addicted to heroin, and, through the care of an evangelical group in the South of England, are now off, have a small baby, and are growing spiritually in a marvellous way. Jackie was part of the lesbian community in Soho and used Methedrine, but was never heavily involved with the needle. We placed her with a family outside London, from whom, after some months, she ran away, and was arrested and charged with theft of a vehicle. After a return to prison, we lost contact with her until she turned up on a farm in the West country where for two years now she has been in charge of the poultry. In all these cases, however, a tremendous amount of time, patience and love has been required.

A very large part of our work in Soho has been with young people for whom, at present at any rate, the West End of London is an integral part of their life-style. Hence our ministry has not been one of after-care or 'rehabilitation' but simply of containment. We have tried to provide crisis caring within this area of high infection. There are a large number of young drifters who move between Soho and the problem districts of other cities and towns, and are known to most social workers, probation officers and clergy in all these places. The most extreme example of this pattern is a young man, Geordie, who must be known to every social agency between Land's End and John 0' Groats. On one occasion a London probation officer compiled a list of twenty-nine social workers and others in London who were currently involved with his problems! In a short period, I have had telephone calls or letters about him from a social worker in Liverpool, Samaritans and a Methodist church in Manchester, prison chaplains in Wakefield, Liverpool, Durham and London, and a Franciscan friar on his way to Inverness! He moves about the country at an incredible speed, collects social workers and clergymen as others collect stamps, but always returns to Soho and to the bars around Piccadilly. The West End can contain him while other areas of the country find him quite impossibly deviant in his behaviour and manner, and he invariably gets into trouble when he leaves Soho for long. There are many young people who would be labelled 'psychopaths' or 'psychotic' for whom the West End is a magnet: within its subcultural life, they can lose themselves for a time. It is important therefore to see that all the forces which operate within the West End scene are not destructive and negative in their impact upon such individuals. Part of our ministry at St Anne's has been to provide what the Americans would call crisis intervention facilities.

NOTE. The names of drug users and former drug users mentioned here have all been altered, and in some cases other aspects of their identity had been disguised.

* The most thorough study of the San Francisco speed scene is in David E. Smith (ed), Journal of Psychedelic Drugs, Volume Two, Issue Two: Speed Kills—A Review of Amphetamine Abuse.