No quick drug fix - failure of British drug legalization

National Review, March 24, 1989 by Anthony Lejeune

Advocates of drug legalization often cite the British approach. But the British no longer supply drugs to addicts on request The UK problem is different from ours-and getting worse The experience in America and Britain carries the same message.

AMERICANS WILL BE coming over here to study the advantages of monarchy twenty years after we've become a republic," grumbled a distinguished London doctor who had been asked to explain "the British system" of treating drug addicts. Just as some Americans conventionally believe, without much real knowledge, that British television is better, overall, than American television, so the belief lingers that Britain has a better way of dealing with the drug problem.

There was a difference once. At the turn of the century the opium trade had become a major scandal, and the American Government was afraid that it might spill over into the Philippines. International treaties at the end of the First World War banned the trade. America, where the mood that led to Prohibition was already flowing, wanted all the signatories to forbid the domestic use of narcotics no less strongly-a ban that would include doctors.

It was, indeed, rigorously enforced in the United States. A number of doctors were jailed. But when in Britain doctors began to be prosecuted under the Dangerous Drugs Act, the leaders of the medical profession rose up in arms. They protested against any interference with their traditional right to prescribe whatever they thought best for their patients. A report, commissioned by the government, upheld the doctors' view, and the right to prescribe was restored.

Controlled doses of morphine or cocaine could, therefore, be legally supplied to an addict. But there were very few addicts in Britain between the wars. Noel Coward wrote a famous play on the subject; some jazz drummers took drugs to alter their sense of time; and mystery stories often featured "dope fiends." Drug peddling was a familiar crime but hardly a serious problem.

In America, on the other hand, the problem was already real and increasing, for a variety of historical and cultural reasons. And the fact that doctors were not allowed, in any circumstances, to prescribe drugs for addicts probably did conduce to the growth of a black market. After the Second World War the problem deepened, and some Americans attributed the fact that it was worse in the United States than in Britain largely to this difference in the law; which was a gross oversimplification.

In the 1950s, when I first wrote articles on the subject, I came to the conclusion (which is, by definition, unprovable) that the officially admitted number of addicts in Britain was, by that time, heavily underestimated. And some of the disadvantages of "the British system" were plainly visible. Outside Boot's, the all-night pharmacy in Piccadilly Circus, registered addicts could be seen standing in line just before midnight, waiting for their next prescription to become due. Once, though admittedly only once, I saw a young man injecting himself on the platform of the subway station. And there were some notorious London doctors who dished out narcotic prescriptions freely-or, rather, at a price-to everybody who wanted them.

BECAUSE OF SUCH ABUSES and in the old hope that dangerous drugs could be made to vanish altogether, another attempt was made, in the mid 1950s, to prevent heroin from being prescribed by doctors even as a painkiller in terminal cases; but again the attempt was repelled in the name of medical freedom. This aspect of the matter does still constitute a difference between Britain and America. It provided the do-gooding moral for an episode of Cagney and Lacey, a moral that was probably justified -to the extent that the doctor's freedom to prescribe is important and not much heroin leaks into the British black market from genuine medical sources-but may also be misleading because, according to most doctors, alternative painkillers are now available that should render the use of heroin unnecessary.

Around 1965 the first methadone clinics were established in the United States, and they were soon copied in Britain. Methadone, which, though addictive, is comparatively harmless, offered a generally acceptable way of treating addicts without giving them heroin. In the whole of Britain, at that stage, there were supposed to be about three thousand addicts; in New York City alone there were ten thousand. So the scale of the problem was very different; but, from then on, attitudes and the treatment available on either side of the Atlantic tended to converge.

"The situation," says Dr. Griffith Edwards, Britain's leading specialist in addictions and a former White House advisor, "is messy and unsatisfactory, but there's really nothing now forthe Americans to copy." Under the Misuse of Drugs Act, 1969, British doctors treating a known addict are, at least theoretically, obliged to register his name-just as they would report a communicable disease. This is primarily for statistical purposes; it doesn't affect the treatment they can give. But to prescribe heroin or cocaine regularly, doctors need special licenses, and with methadone available, almost the only ones who obtain such licenses are those working in drug centers. The shady practitioners who used to sell heroin prescriptions have virtually disappeared, represented now only by a few on the unmistakably criminal fringes of the profession.