Anomalies and Mysteries in the 'War on Drugs'
Ann Dally, M.D.
Chapter 11 of Drugs and Narcotics in History, Roy Porter & Mikulás Teich, editors
©Cambridge University Press, 1995. ISBN 0-521-43163-8
THE non-medical use of drugs today is an example of how society,
supported by the medical profession, constructs 'problems' and
invents 'diseases' for which they then find 'treatments'. Some
pharmacological substances, for example alcohol and tobacco, are
major causes of death, yet are permitted to be sold and even advertised,
and are a major source of government revenue. Others are regarded
as 'ethical', and require a doctor's prescription. Some of the
less harmful drugs, for example cannabis and heroin,
are made dangerous by myth, politics, illegality, and other social
factors. Governments and doctors capitalize on collective fantasies.
They publicize the drugs in a way to induce horror and fear. This
policy costs governments and nations dearly, but it provides other
political benefits, including to the medical profession. The dangers
of these substances are both created and emphasized with zeal
rather than evidence. Such evidence as exists is liable to be
concocted and financed in order to exaggerate their dangers.
Illegal drugs are the subject of a 'phoney war', waged by governments
for their own purposes that certainly have nothing to do with
the 'dangers' of these substances. Governments who capitalize
on public shock-horror have a splendid means of diverting public
attention and anger from real issues and for interfering
in the affairs of other nations, even to the extent of sending
spies and troops. This situation is a major cause of crime all
over the world and the criminal drug industry is second only to
the arms trade in wealth, power, and influence. Whole economies
now depend upon the production and sale of illegal drugs and the
people who would least like to see the trade decriminalized or
legalized are the criminal traders themselves. In no other way
could they have so much power or make so much money. This raises
a question. How far are governments who purport to make 'war on
drugs' actually encouraging, profiting from, and involved in the
illegal trade? The same question can be asked of the doctors who
support those government policies.
There is little or no evidence that these drugs are in themselves
seriously harmful until a political situation leads to the creation
of genuinely harmful forms- crack, ecstasy- but there is ample
evidence that the harm they do is actually done by the policies
constructed round them. Yet few politicians, and only one British
politician, have yet admitted this in public. The medical profession
accepts and supports government policies and goes along with the
idea that drugs, rather than fantasies and policies about drugs,
are harming society and must be 'fought'.
For individuals whose fears and fantasies have been stimulated
by governments and doctors, the so-called 'drugs crisis' and the
'War on Drugs' is largely a product of what Freud called primary
process thinking, i.e. the thinking of fantasy and dreams, unfettered
by fact (at least, by fact in context), unimpeded by logic, highly
symbolic, and dominated by anomalies and mysteries. My own part
in the history of the drugs problem has been largely as a participant
and I got into deep trouble as a result, being prosecuted three
times by the General Medical Council. This experience has not
produced any evidence against my views but it has shown how entrenched
are current beliefs about the drugs war and how deeply involved
is the medical profession in supporting those beliefs.
The 'War on Drugs' in its many manifestations is being acted
by doctors, politicians, and public servants who have their
own motives, and often behave in ways that are specious, scary,
or bizarre. There are few things in the world that damage the
quality of life more than present drug policies. These have become
so destructive that I suspect that, in the foreseeable future,
only historians could sort it out. The present situation depends
on people not understanding the situation and on maintaining
their misbeliefs and prejudices. Much energy and public money
is spent on ensuring that this ignorance and misunderstanding
continues, along with the shock-horror fantasies that provide
essential support for western drug policies.
An historian who starts with a reasonably open mind and a moderate
acceptance of the conventional wisdom in the subject is likely
to assume that heroin is dangerous, that addiction means inevitable
deterioration, that doctors are as honourable towards drug addicts
as they are towards other patients, and that America or Britain,
or any other country, is reducing or containing the problem rather
than causing it. Such an historian who looks at the evidence
is in for a shock, but it will be a constructive shock.
My interest in drugs was initially clinical, as a practising doctor.
I stumbled by chance on something that took me into deep waters.
I began to explore further and came across a situation that certain
powerful people did not wish to be explored. They wanted me out
of the field, and in the end they got what they wanted, though
not, I think, in the way they had intended.
The 'something' on which I stumbled was the discovery that our
present situation regarding illegal drugs, including its medical
'treatment', is political and without scientific foundation. Even
after thirty years as a practising doctor, I was so shocked by
what I found that it destroyed in me last remnants of the youthful
idealism that took me into medicine in the first place, when the
National Health Service was about to begin and seemed to be a
dream come true.
I realized that in scarcely any field is so-called 'truth about
drugs' backed by valid evidence. The cooperation of doctors is
vital to the politicians and vice versa. In the medical field
the evidence for what is done and imposed on others is so feeble
as to be virtually non-existent. But important factors are at
stake, including the political careers of important people, ambitious
doctors, high up civil servants, powerful moralists, and those
exploiting less powerful moralists, and, of course, the whole
of the world's illegal drugs industry. It is a conspiracy only
in the sense that many people and institutions have become involved
and now share the need to avoid the truth. It is a dangerous field
for an unsuspecting doctor who is simply trying to help patients.
In this situation addicts, whether or not they are also patients,
are mostly unable to help themselves. Their self-esteem is low,
which is not surprising if one considers how society and the medical
profession treat them. It means that they are unable to form a
pressure group, even for simply providing information. They still
feel they have to play the part of the degraded, dying creatures
that society wants them to be. One might say, they are invented
like that. It is a sad background to the 'War on Drugs' which
must be one of the most phoney (or invented) wars ever
devised or fought. Like many wars, it is based on false information
and misinformation, and is basically not really concerned with
drugs or drug users.
The first anomaly I am going to mention was actually invented
by an historian, Virginia Berridge. With Professor Edwards she
wrote a splendid book on opium use in the nineteenth century,
published in 1981, when the present so-called 'drugs crisis' was
causing concern. There was a visible problem in London and other
big cities at the time, due to a sudden change of policy on the
part of certain powerful doctors. As a result, addicts, unable
to find any help from doctors or anyone else, were congregating
in Piccadilly and roaming the streets. Any doctor who was remotely
sympathetic was inundated with potential addict patients begging
for help, and was under threat from the medical establishment.
The media were full of shock-horror stories about drugs. There
was a strong need for sensible historical background information.
Yet, in the very first sentence of Berridge and Edwards' Introduction,
we read: 'The most acute anxieties of the 1960s "drug epidemic"
have quietened. Drug stories appear less often, and more prosaically,
in the newspapers.' That statement seems to be a provocative denial
of reality. The rest of the book, about the nineteenth century,
seems to be a model of learning and good sense.
Some of the anomalies in the field of illegal drugs are frankly
absurd. A few months ago I was invited to talk at a provincial
medical school and teaching hospital. I chose the title Untruths
about Heroin are Damaging Civilization. Notices of the meeting
were posted all over the hospital and university. Mysteriously
these spelled the title of my talk as one word, and they spelled
it wrong. It stated that I would talk on
This word has forty-two letters. Perhaps only the subject of illegal
drugs could produce so absurd a word. No one offered any explanation
or even mentioned it. In matters of drugs, if it is mysterious
and incomprehensible, anything goes!
That was not the end of it. I had been particularly careful to
make my talk historical and not to advocate any changes except
to call for more honesty and clarity in the definition of terms.
I believe that until we agree what we are talking about and as
long as everyone is talking about different things, it is impossible
to have a reasonable discussion about drug use, drug dependence,
and/or the war on drugs. But as soon as I had finished I saw that
many people had heard a different lecture. Even the chairman,
a retired Professor of Psychiatry, said in his summing up that
I had advocated a free market in heroin. I had not, but he seemed
to find the idea of striving for truth and clarity so threatening
that, so far as he was concerned, I already had heroin on the
supermarket shelves. One person criticized me for, as he put it,
'saying that heroin should be available to expectant mothers'.
I had not mentioned either availability or expectant mothers.
Had we been at the same meeting? I was reassured when several
intelligent and relevant comments and questions made me realize
that I was witnessing just another manifestation of the effect
that this extraordinary subject has on some people.
I told this story while delivering a similar paper at a Wellcome
symposium and again, a member of the audience rose angrily to
his feet and accused me of wishing to put heroin on the supermarket
shelves! I have given versions of that paper on several occasions
since. The only time it did not elicit a hostile and misheard
response was in a small group of sociologists. It seems that the
subject of drugs elicits feelings so powerful that some people
will always hear falsely. To mishear and distort what is said
is the norm in this subject.
The anomalies include the term narcotic. The word traditionally
refers to drugs named because they aid sleep (though it comes
from the Greek narke, meaning stiffness or numbness). Yet
in illegal drugs, 'narcotics' came to include substances such
as amphetamines and cocaine, which are stimulants, have
the opposite effect and actually prevent sleep. Even heroin
and cannabis are not true narcotics. This has led to confusion.
The word 'narcotic' acquired pejorative connotations about substances
that were illegal or of which moralists disapproved. It really
came to be used to mean 'nasty', 'dangerous', or simply 'illegal'.
There are now many different meanings of the word and few attempts
to sort them out.
Some drugs, for example opium and its derivatives such as morphine,
nepenthe, heroin, were at one time regarded as beneficial to mankind
and people kept them and used them rather as they might use aspirin
or Valium now. It is interesting that today the image of Valium
is beginning to change to something dangerous and sinister. I
wonder, will the cycle be repeated?
Somehow the myth arose that so-called 'soft' drugs (whatever those
are) are also dangerous. In the term 'soft', most people think
of cannabis, which is also illegal but about as harmless as a
drug can be for none are totally harmless. It was put about
not only that cannabis is dangerous (and all kinds of phoney research
was done to 'prove' it) but that it leads to 'hard' drugs such
as heroin and cocaine. This must be one of the most politically
astute myths of all because it leads to fear, mostly in parents
who know nothing about the subject. Yet the connection between
'hard' and 'soft' drugs is that they are both illegal and
the Dutch have now demonstrated this by separating them in law
and showing that the connection no longer exists. I personally
asked several hundred heroin addicts what was the connection between
cannabis and heroin and their only answer was that if the police
seize the available cannabis, dealers offer heroin instead. That
was how some of them had become addicted.
Other anomalies: a common Victorian habit, taking a so-called
'narcotic'opium or cocaineto relax, which in many could
be compared to a couple of pints of beer or a gin and tonic, came
to be regarded as a sin and a crime. Addicts, formerly objects
of mild disapproval, rather like drunks or smokers today, were
gradually turned into criminals and outcasts. This was demonstrated
recently in a clever cartoon. The addict Samuel Taylor Coleridge
is sitting at his desk writing poetry and smoking opium. Enter
the man from Porlock, bowler-hatted, flashing a card. He announces,
'Porlock Drug Squad! You're nicked, Coleridge!'
The virtually universal and fairly harmless custom of taking opium
for pain, also came to be regarded as a sin and a crime. Heroin
is banned altogether in the US and I have come across some tragic
cases in Britain in recent years where people who are dying or
have had serious accidents are denied the incomparable benefit
of heroin or morphine on the grounds that they might become addicted.
The Harrison Narcotic Act of 1914 in the United States set the
scene for the prohibition that has been America's policy ever
since. It both reflected and created a climate in which the addict
could be reclassified as criminal and morally evil. Britain, or
rather British doctors, stood out against American and Home Office
efforts to extend the process to Britain. The Rolleston Committee,
which reported in 1926, created a liberal, medical, attitude towards
drug addiction in what was then a small and largely middle-class
problem. This lasted for nearly forty years and enabled many respectable
addicts to live normal lives, as they had always been able to
do. Some, such as the writer Enid Bagnold, were able to lead prosperous
and creative lives while on opiate drugs for as long as sixty
years. This gave the lie to the idea that addiction inevitably
leads to deterioration, but the evidence, as with other evidence,
was ignored or kept secret.
Then, in the 1960s, the system was challenged by an increase in
addiction and its extension to that dangerous body, the working
class. Newspapers began the shock-horror tactics that we know
so well. The medical profession changed its attitude and joined
the word-abusers and concept-manipulators, even to the extent
of allowing, and initiating, shock horror. How did this happen?
That is an interesting question and is, I think, important in
the history of the medical profession in the twentieth century,
though there is no time to explore it here.
In recent years illegal drug use has been given such morally condemnatory
labels as 'drug abuse' and 'drug misuse'. These are now regarded
as medical diagnoses. They appear in official documents
and in the names of official bodiesthe Advisory Council on
the Misuse of Drugs is powerful in forming government policy-
and incidentally drugs are one of the few subjects about which
the two main parties are in complete agreement. There is another
government-funded body, the Standing Conference on Drug Abuse.
Ironically and typically, a new government document emphasizes
the importance of not being moralistic about 'drug abuse'!
This is the only example I can think of where a moral judgement
is used as a medical diagnosis. How did this come about? Why
does no one, or at least no one with influence, protest? Another
way of putting it may be to ask, In whose interest is this
situation maintained? The idea of 'drug abuse' as a medical
diagnosis, and the attitude it reflects, have produced a language
of their own. I call it Drugspeak. In George Orwell's 1984
the language Newspeak, the origin of all the modern so-called
'speaks', was designed in order to make it impossible to think
in any way other than the party line. That's how it is with
Drugspeak. Corruption of language is probably inevitable where
there are strong reasons for suppressing, confusing, or simply
avoiding the truth. It seems that the phrase 'drug abuse', used
to mean 'illegal drug use', was first used in the United States
to express disapproval of the use of cocaine by Southern blacks.
As so often happens, the phrase was, and is, used to condemn the
user and his group rather than the drug itself.
The World Health Organization has also tended to attack the user
rather than the use of drugs. For instance, one committee said
that certain drugs
possess a particular attraction for certain psychologically and
socially maladjusted persons who have difficulty in conforming
to the usual social norms. These include 'arty' people such as
struggling writers, painters, and musicians; frustrated non-conformists;
and curious, thrill-seeking adolescents and young adults.
You can work out the details of Drugspeak by looking and listening
to the use of such words as 'consensus', 'specialty', 'flexibility',
and 'maintenance'. They are all used by drugspeakers in special
ways that maintain the status quo.
Now another anomaly. In June 1983 the British Medical Journal
published an article on the treatment of drug addiction that
must have broken several barriers or records. For instance,
there has long been debate about the scientific value of asking
patients about treatment they have had. But data in this article
were based on asking patients about the treatment that other
patients had had. I do not think that had ever been done before.
Moreover the statistics were absurd or nonexistent and the conclusions
were non sequitur. A lively correspondence followed.
One distinguished psychiatrist wrote asking how it was that sixteen
and a half addicts had done such and such and said that the article
was unworthy of the journal. Another wrote that during his
experience of the clinic system which had come into being in 1968,
the treatment of addicts became not treatment but a competition
between doctors to see who could prescribe the least heroin.
It is a mystery to me that this article was published in the British
Medical Journal. In 1990, when Peter Bartrip's splendid history
of the journal was published, I looked through it for clues.
Of course the article was not mentioned, nor was the interesting
question about what information can usefully be obtained from
patients or from patients talking about other patients. On page
321 the then editor describes how, after 1975, there was 'increased
rigour in vetting original articles for publication... Initially
this means good, unprejudiced and quick peer review, followed
by discussion by an editorial committee and statistical assessment.'
So what happened here?
That is not the end of the story. A few weeks later that article
was used by the General Medical Council, or rather by its prosecuting
counsel, against me to show that my treatment of heroin addicts
had not conformed to the 'consensus' view. My defence counsel
protested (rather too politely, I thought). He pointed out some
of the absurdities in the article and quoted the subsequent correspondence.
I got the impression that this made no difference to the committee,
none of whom, I believe, had any experience of treating addicts.
Then, in 1986 and 1987, they used the article against me again.
It formed an important part of the opening speech for the prosecution.
This time my counsel (a different one) did a brilliant hatchet
job on the article and revealed it in all its absurdities. I thought
that no one would dare to use it again. It was not mentioned by
the GMC for the remainder of my case and their prosecuting counsel
did not return to it in his closing speech. But I was wrong. Since
then that article has been produced by the GMC prosecutors in
every case that I know of against doctors who did not toe the
party line in the treatment of heroin addicts. And it is interesting
and sad that these prosecutors have mostly got away with it. The
reason for this is partly what goes on in the medical defence
organizations that organize and pay for doctors' defence. They
know and have filed away the fact that the BMJ article
has been discredited, but they do not mention the fact or produce
the evidence unless the doctor concerned mentions it himself,
which most of them do not and cannot. It is unlikely that, for
example, a busy general practitioner in the provinces will find
out this kind of thing unless someone points it out to him. I
know personally two doctors who were caught out like this. Both
were GPs in the NHS far from London and I have reason to believe
that they were two exceptionally good doctors. Their offences
were the kind that any well-motivated GP could make any day, and
one of them had been set up by the police in a really dirty trick.
They were naive enough to trust their advisers and not do much
homework. One of them was struck of f the Register and the other
was suspended for three years. I suspect that had they known what
they were up against and had fought yet again the battle about
the absurdity of that article, the GMC would not have felt able
to impose such harsh punishments. But it does show how, where
prejudice and vested interests are involved, such battles have
to be fought over and over again. I think it also reveals the
corruption of entrenched power.
The story I have just told about the BMJ article was largely
repeated in the history of the famous or infamous Guidelines
for Cood Clinical Practice in the Treatment of Drug Abuse of
1984 which became known as the 'Misguidelines'. I have
not time to describe here the amazing (and in my view also corrupt)
way in which they were drawn up. I was a member of the committee
and it was a real eye-opener. The Guidelines were immediately
used (or misused), and have been ever since, against doctors who
disagreed with the official policies. The story of that and many
other anomalies is in my book A Doctor's Story.
In treatment and administration there are so many anomalies and
mysteries that I can give only a few examples. A minor one first,
but it is indicative. We are told that the government is anxious
to get accurate figures about drug users and that this is important
in forming policies. Under the Misuse of Drugs Act, doctors are
required to notify the Home Office of every patient they see
whom they suspect is using illegal drugs, regardless of whether
or not they treat him or prescribe for him. Although I worked
in the field for many years I saw little or no evidence of any
effort made to inform doctors about this. Most doctors do not
even know about it and if they notify addicts at all, it is only
when they prescribe a drug on Schedule 1 or 2 of the Misuse of
Drugs Act, which, for most doctors, is never. Furthermore, while
doctors are paid a small sum for notifying other notifiable
conditions such as measles, tuberculosis, birth or death, they
are not paid for notifying drug addiction. Unless they obtain
special labels from the Home Office, they even have to pay for
the stamp! It does not seem that the government or the Home Office
is very keen to get accurate figures. Why not?
There are many anomalies concerning treatment in Britain's drug
dependency clinics. There has never been a proper assessment of
the success or failure of these clinics, which were set up in
the late sixties in response to political demand and public panic.
It is known that various things happen, such as that some patients
stay off drugs for six months or more after completing a course
of treatment and that some patients go round and round in a seemingly
endless cycle of the same treatment programme consisting of treatment,
then being theoretically 'drug-free' but actually on the black
market, then an 'acknowledged' relapse, then back to the waiting
list and more black market. Then another treatment programme,
more black market, further relapse, and so on Because the choice
of treatment is so limited (it is marginally greater now because
of the AIDS situation) the only option for such a patient is to
stay on the black market with all its risks or to repeat the treatment
as before. There is a case on record who went through the clinic
treatment course twenty-seven times and all he was offered was
yet another round. As a practising doctor, I find it hard
to decide whether we are in the world of Kafka or the world of
Alice in Wonderland. Even harder to understand (or not, depending
on how you look at it) are those clinics that make claims like
'95% success rate'. Success for what? At one time I treated
a number of patients who had been in such clinics. All of them
had left apparently 'drug-free' but in reality were never off
drugs for more than a Sew days and some not even as long as that.
As one addict said, 'If they have a 95% success rate, then I know
all the failures twenty times over.'
Who are the patients who attend the clinics? I do not think anyone
knows. Studies are done on them as though they are typical Of
drug addicts in general, or even as if they are the population
of drug addicts. They are not. The Home Of fice itself has reckoned
that it knows at most about only one addict in five, 20%. Of these
less than one in three is ever seen at a clinic, say 6% of the
total. Of these only a proportion stay on for treatmenthalf
would probably be overstating it. That is 3%. Of those only a
small proportion complete the course, some would say less than
1% of those who attendmaking 0.03% of the total, but
even if we are generous and put it at 50%, that's still only 1.5%
of all addicts. And most of these relapse within a year or two.
So why do they talk in terms of 'success' and what are doctors
doing trying to treat them all by the standard, official, routine,
or the current 'flexible' regime, with its narrow choice of options?
When I was trying to learn about drug addiction and was puzzling
out what on earth was going on, I visited three clinics. In theory
all were fully booked with patients. At that time the clinics
were crying out for new funds to alleviate the rising tide of
addiction and the intolerable burden of patients. In two of these
clinics not a single patient turned up. The doctors and other
staff waited for a couple of hours, then went home. The third
clinic I visited was specially for addicts who were in trouble
with the courts. They were being considered for treatment as an
alternative to going to prison. They all turned up and were really
eager. Each patient was asked whether he was genuine in his desire
for treatment or whether he was just trying to avoid going to
prison? They all said that it was nothing to do with the
court case and that they genuinely wished for treatment.
They were all accepted. Later I heard from a number of patients
who had been through the course that drugs circulated freely in
the hospital ward and that a patient could get anything he wanted.
The staff turned a blind eye and recorded as a 'cure' anyone who
was not actually caught with drugs. This satisfied the hospital
figures. It satisfied the court. And it satisfied the addicts.
When I was treating drug addicts I always used to write to their
former clinics for reports on them as is the custom in clinical
medicine. Normally (i.e. with patients who are not 'drug' cases)
you get a useful report or summary Of the case. But not here.
Clinics usually sent many bulky pages of photocopied material
from the patient's notes, usually giving an enormous amount of
irrelevant information such as recordings of normal blood pressure
over many years (incidentally another anomaly is the concentration
Of many drug dependency 'experts' on normal blood pressure; I
have never been able to find out why they do this). But these
reports nearly always omitted what I thought was important, for
example, the psychiatric assessments of the patient and the doses
of drugs prescribed over the years. I do not believe that psychiatric
assessments had ever been done in many cases, and the information
about their drugs was often withheld, even if I wrote again for
it. I came to the conclusion that it was related to the change
Of prescribing policies in the clinics which occurred in the late
1970s. They suddenly changed from prescribing more or less what
the patient asked for as long as he wanted it to prescribing much
smaller doses for only a few weeks and then recording the patient
as 'drug-free', while at the same time trying to impose the new
regime on all doctors. Yet only a few years before they had been
prescribing huge doses, up to twenty times more than the doses
they were now saying were acceptable.
Another anomaly was that if the clinics sent the information about
doses at all, it usually concerned only what was officially
prescribed Mention was often made of how the patient had 'reduced'
his dose, but hardly ever of the fact that as a result he was
now using black market heroin, though you mostly only had to look
at his arm to see this. Strangely, the clinic notes kept all sorts
of information, like that on blood pressure, which I thought relatively
unimportant, yet usually did not record the patient's black market
habits, which I thought were very important. They were all
on the black market so it seemed to me dishonest to record
them as being 'drug-free' just because they no longer received
This sudden change of prescribing policy is another anomaly. Why
did it happen? It is often said to be based on a study of prescribing
for addicts long term versus short term, published in the Archives
of General Psychiatry in 1980, several years after the
change. That research is often said to show that short-term prescribing
and refusing the addict more than a small minimum is better than
long-term prescribing and that prescribing injectable drugs to
those who are going to use them anyway is counter-productive.
I do not want to go into the details of these arguments about
doses and injection and so on. In theory they are at the heart
of the dispute but I believe that basically they are moral questions
which people try to prop up with figures acquired or arranged
in ways that suit their beliefs. In fact it is difficult to see
the results of that study. It was quite short and if anything
the figures seem to indicate the opposite of what it was
later said to have said. This study is widely used, so widely
that now, more than fifteen years after the change, it is still
used as the basis for the anti-prescribing argument. So is another
study that has an even more chequered history. A research worker
studied addicts in their then customary habitat Piccadilly Circus,
and published an article indicating that those who had long-term
prescriptions from doctors did better than those without. Then
the same author published another article using the same material
but coming to the opposite conclusion. I was told by someone
who knows these things that the first article did not please those
in power. Whatever the explanation, it does suggest that figures,
like Humpty Dumpty, can mean what you want them to mean, no more,
I spent many hours in libraries puzzling over things like that
and I was unable to understand what the so-called 'evidence' indicated.
It was a long time before I realized, and actually a high-up Home
Office official pointed it out to me, that there simply was not
any valid 'evidence' to support the way patients were treated.
It was all personal and political. Only then did the whole thing
begin to make sense.
Much could be said about the effects of all this and about the
world drug situation. The crime. The wrecking of lives. The degeneration
and hounding of potentially useful human beings. But I should
like briefly to mention one result of western drug policies, corruption,
because that is perhaps the biggest anomaly of all. Corruption
is built into the policies, both the law enforcement policies
and the medical policies. When it is uncovered it is often attributed
to the drugs, but really it is due to the drug policies. It
affects everyone in the drugs field, addicts, drug enforcement
officers, civil servants, policemen, doctors. I could give you
many examples of all these but I shall confine myself to few.
In just one American state, Georgia, over a period of five years,
thirty-two sheriffs were jailed for drugs offences. What can
you expect when, for instance, a police chief is offered half
a million dollars to be in church on a particular Sunday morning
and another the same sum not to be anywhere near the local
airfield, where he probably would not be going anyway? The inevitable
corruption is not only of those caught by the law but of those
who administer the law and those who work under it. I believe
it is the worst aspect of the 'War on Drugs'.
An example of corruption in Britain (and I could give you many
examples) is the number of policemen, especially in London, who
have been found guilty during the past few years of drug offences,
mostly selling drugs or planting them on people whom they then
charge with 'possession with intent to supply', a weasel charge.
I have personally come across many cases of police corruption,
but none of those led to charges. I believe that this corruption
of police has been influential in lowering public regard for the
police and it may have contributed to the generally low standards
which have led to recent police scandals involving other forms
The corruption of doctors makes me, as a doctor, particularly
sad. When the present drug problems began to surface, in the early
1960s, I believe we could have contained it by encouraging general
practitioners to help addicts, perhaps for extra payment, and
psychiatrists could have been available to deal with difficult
cases. But we did not do that. The government of the day wanted
to make a more dramatic show, the public wanted to see more action,
and some doctors in what were regarded as rather inferior backwaters
(such as the old asylums) wanted more power. So we got expensive
clinics that were shut away from the GPs and even from the hospitals
where they were placed. Other departments in the hospital were
not and are not interested. They do not want to see addicts and
do not care what happens to them. The clinics are isolated and
the normal system of checks and balances between departments does
not operate in them. Other doctors got the idea that all drug
cases need specialist treatment, though this is no more true in
drug addiction than in anything else. Drug addiction was pushed
into corners where new so-called 'specialists' carved out careers.
GPs ceased to regard it as anything to do with them and developed
an antipathy to it. I once did a survey of eighteen GPs in an
outer suburb of London to find out whether they would consider
treating addicts, which, in theory, they are officially encouraged
to do. The official line on this has long been verbally to encourage
GPs to look after addicts while at the same time discouraging
them by covert threats. Some GPs now even believe, or choose to
believe, that they are not allowed to treat addicts, which
is quite untrue. Anyway, of my eighteen GPs, not one was willing
to look after addicts and sixteen were positively hostile to the
idea. Some GPs even put up notices saying that they will not treat
drug addicts even for conditions unrelated to drugs. Although
this is against the terms of their contracts, none has ever been
disciplined for refusing to treat a drug addict. It seems that
addicts attract a kind of 'licensed nastiness' wherever they go
and no one cares about them. A few addicts have complained to
the GMC, but they always get the same answer- that the GMC 'has
no power' in such matters! Even worse, some GPs refuse to treat
the families of drug addicts. I have often had to act as unofficial
GP to wives and children, even for tiny babies. It was really
upsetting. It is as though people are now programmed to think
that everyone with any connection with drug addicts is untouchable
and to be rejected. That is a dangerous belief in a doctor.
Yet the former Chief Inspector of Drugs at the Home Office, Bing
Spear, who probably knows more about the problem than anyone else
in the country, has often been quoted as saying that at the time
the panic about drugs began and the law was changed, 'We didn't
need clinics. We needed a thousand doctors to take on one addict
each.' I have heard him say it many times. Had that happened,
I believe that the problem of drugs and treatment by GPs would
have developed together and much more healthily. Britain was in
a situation from which she might have led the world but she threw
away the chance. Now that is all water under the bridge. Fortunately
things have begun to improve and a small but increasing number
of GPs now do look after the addicts on their lists.
Another anomaly is that it seems that at the time no one except
the politicians both medical and general even wanted the
clinics. Some hospitals had to be bribed, for example, with research
money, to create them, and even then some of them took the money
and then did not build the clinics. The papers are now being
released under the thirty-year rule. I heard that some of them
have mysteriously disappeared but I am sure there is plenty of
material left there for a perceptive historian.
Then there is the corruption of the law itself, the erosion of
human rights, at first applied only in situations of drug 'abuse'
or drug trafficking but then extended to wider situations (for
example, in the Criminal Justice Acts, and for fraud). It seems
to be generally accepted now that a person found guilty of selling
drugs is assumed to have obtained all his assets illegally and
these can be confiscated by law unless he can prove his innocence.
The principle that a person is deemed to be guilty until proved
innocent is new in British law, though some might say it already
existed in immigration. Since people are taught to hate and despise
drug addicts and people do not care much what happens to those
they hate and despise, no one protests. If a politician wishes
to limit liberty and human rights, it is a good way to do it.
I think that needs to be looked into too.
The existence of drugs lowers environmental standards (or 'the
quality of life'). In international affairs, particularly American
foreign policy, strongly supported by Britain, drugs provide a
splendid excuse to interfere in the affairs of foreign countries
(Colombia, Central America, Pakistan) or to resist international
cooperation (Thatcher's attitude to abolishing European frontier
control). Are such power games the nub of the whole extraordinary
business? Is the situation an exercise in using people's fears
and prejudices in order to increase political power? What other
possible explanations are there?
Bias, misinformation, and vested interests are now so entrenched
that it is impossible to have open discussions about illegal drugs
until those taking part agree on the meaning of the terms. Even
then, there is so much prejudice and fear that it is likely to
be impossible. Thus discourse about whether or not 'narcotics'
should be legalized or 'decriminalized' has little meaning at
It is sometimes forgotten that drug addicts are mostly basically
normal people, with normal problems and families, jobs, and aspirations.
I have collected three albums of photographs of families and children
and holidays and hobbies.[l4] Each concerns a drug addict or the
children of a drug addict. It shows them getting married, playing
with their children, boating, birdwatching and so on.
An important prop for maintaining the 'War on Drugs' has been
the government campaign against drug use. It began with posters
as well as TV. The posters were of the actor who became a 'pin-up'
boy because of his effect on teenagers. It continued on TV mostly
after midnight when most addicts are in bed like anyone else.
Advertisements are trying to sell us something. We know that it
is to warn against heroin, to counteract heroin, to urge us not
to take it. Yet it is a campaign based on lies and targeting a
specific group. A white male, good-looking in the modern stylehe
became a pin-up. Is the campaign directed at the white, trendy
community? If he did not take drugs he could be YOU or your son.
The implication is that if he had not been so foolish as to 'choose'
drugsor if he had not failed to 'just say no', he would
have been a presentable chap. It is only the drugs that
prevent him from being 'one of us'.
This reinforces fears and prejudices of the well-defended. The
only black in the group of posters I managed to get was the porter
pushing the trolley, emphasizing his low status occupation. Seemingly
the campaign was trying not to offend the black community by associating
drugs with ethnicity and also making a point of not associating
it with housing, unemployment, poverty, etc. The whole campaign
seemed to aim to induce smugness in a targeted group who would
probably never touch drugs. There is a cosy feeling about being
told what you 'know' is true.
The campaign also aimed to maintain widespread untruths about
heroin. The advertisement assumed that we know that you get 'low'
if you take heroin. It compounds this with 'How low can you get?'
There is no room for asking 'Do you get low?' or even 'Why do
you get low?' It offers no evidence. Of what it actually says,
only the constipation is true. The aching limbs go with withdrawal
from the drug, but if you are going to confuse the effects
of heroin with the effects of withdrawal, why mention only this?
Much worse are the diarrhoea, anxiety, severe pain, and so on.
The lies mean that the advertisements lose credibility with anyone
who knows anything about drugs. The campaign assumes that the
'just say no' approach is easy. Every addict knows it is easy
only for people who are not tempted. There is no mention of nutrition
or the fact that heroin addicts get ill not because they take
drugs (unless they take too much, as with alcohol or any other
drug) but because they spend all their money on drugs and do not
eat properly. There is no mention of poisonsthe dangers
of shooting into your veins the impurities with which black market
drugs are cut: brick dust, Vim, flour, and so on. These and not
the drug itself are what damages. Every addict knows this so obviously
the campaign is not directed at them. Those who have any contact
with drug users know it too. These include the young people likely
to be recruited to drugs, just the people, you would think, that
the government want to influence. But by telling them lies, the
authorities lose any credibility they might have had. The only
people likely to be impressed are those who know nothing about
drugs and are unlikely to come into contact with them. It is their
prejudices that this campaign aims to reinforce. They are probably
the majority (or thought to be the majority) and they have many
votes. Presumably these are the audience that is being targeted.
It seems to me that the classification made in the government
anti-drug campaign is between drug takers who are white, foolish,
and simply fail to say 'no' and non-drug users who are white and
have had the sense to 'just say no'. It is a way Of targeting
a group who already believe what you are saying, to make them
feel more secure and perhaps smug, and to give the appearance
that you are tackling a serious problem.
One of the difficulties in the history of medicine is to see modern
situations and constructions in as detached and critical a way
as we see past situations. The present situation in drugs, if
you bother to examine the evidence, is a wonderful opportunity
to do just that.
1. H. Dale Beckett, 'Heroin: The Gentle Drug', New Society,
26 July 1979. (back)
2. Virginia Berridge and G. Edwards, Opium and the People:
Opiate Use in Nineteenth Century England (London, 1981). (back)
3. Reported in Independent newspaper, 17 December 1991. (back)
4. T. Bewley and A. H. Chodse, 'Unacceptable Face of Private Practice:
Prescription of Controlled Drugs to Addicts', British Medical
Journal, 286 (1983), pp 1876-7 (back)
5. R. Hartnoll and R. Lewis, Letter, British Medical
Journal, 287 (1983), p. 500. (back)
6. Peter Dally, Letter, British Medical Journal, 287 (1983),
p. 500. (back)
7. James H. Willis, Letter, British Medical Journal, 287
(1983), p. 500. (back)
8. Peter Bartrip, Mirror of Medicine: A History of the BMJ
(Oxford, 1990). (back)
9. Ann Dally, A Doctor's Story (London, 1990), chapter
10. Information given by H. B. Spear when he was Chief Inspector
of Drugs to the Home Office, c. 1986. (back)
11. Prof. J. Killorin, Personal Communication based on local statistics.
12. H. B. Spear, formerly Chief Inspector of Drugs, Home Office,
Personal Communication. (back)
13. A. Baker, former Senior Medical Officer, Ministry of Health,
Personal Communication. (back)
14. Now lodged in the Contemporary Medical Archive Collection
at the Wellcome Institute for the History of Medicine, London. (back)