Britain, Drug Use in

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BRITAIN, DRUG USE IN

The legal use of what we now term illicit drugs was widespread in nineteenth-century Britain. Opiates in various forms were used by all levels of society, both for self-medication and for what we now call recreational use. The differentiation between medical and nonmedical usage was not clearly drawn then. Concepts such as addiction were not then widely accepted. The story of drug use in Britain since the late nineteenth century is the story of how and why drugs became defined as a social problem and which factors brought the establishment of certain forms of drug-control policy. These were, in fact, issues that often bore little relationship to the objective dangers of the drugs concerned.

In the early twentieth century, there was limited involvement either by doctors or by the state in the control of drug use and addiction. The supply of opiates and other drugs was controlled by the pharmaceutical chemist. As dispensers and sellers of drugs over the counter, they were the de facto agents of control. A rudimentary medical system of treatment operated via the Inebriates Acts (codified in 1890), whereby some inebriates could be committed to a form of compulsory institutional treatment. Legislation covered only liquids that were drunk (e.g., Laudanum) not injectables. Users of hypodermic morphine or cocaine were therefore not included under this system.

Drug addiction was not perceived as a pressing social problem in early twentieth-century Britain, nor, indeed, was it one. Numbers of addicts decreased as overall consumption declined. No specific figures are available for that period, but various indicators, such as poisoning mortality statistics, indicate this conclusion. The twentieth century nevertheless brought increased controls and the classification of opiates and other drugs as dangerous. Dangerous drugs were regulated through a penal system of control rather than through the mechanisms of health policy.

Two factors brought regulation. The first was Britain's involvement in an international system of drug control; the second was the impact of World War I (1914-1918) and its aftermath. U.S. pressure on the international scene pushed an initially unwilling Britain into a system of control that rapidly extended from the 1909 Asian regulation discussed at Shanghai to the worldwide system envisaged in the 1912 Hague Convention.

Prior to World War I, however, only the United States, by way of the Harrison Narcotics Act of 1914, had put this system of drug control into operation. Britain favored a simple extension of the existing Pharmacy Acts. The influence of emergency wartime conditions, however, brought a differently located and more stringent form of control. The fear of a cocaine epidemic among British soldiers patronizing prostitutes in the West End of Londona fear which on later investigation proved to have been largely illusoryallowed the passage of drug regulation in 1916 under the Defence of the Realm Act. International drug control in its turn became part of the postwar peace settlement at Versailles. The 1920 Dangerous Drugs Act therefore enshrined a primarily penal approach; control was located in the Home Office rather than in the newly established (1919) Ministry of Health.

British drug policy was henceforward marked by a tension between rival conceptualizations of the drug-addiction issue; drugs as a penal issue versus drugs as a health matter. The 1920s saw this conflict at its height. Britain seemed likely to follow a penal course similar to that of the United States, on whose 1914 act the British legislation was consciously modeled, but British doctors soon re-asserted their professional control. By 1926, Britain's Rolleston Report legitimated a medical approach that could entail medical "maintenance prescribing" of opiates to a patient who would otherwise be unable to function. The Rolleston Report established what became known as the Brit-Ish System of drug controla liberal, medically based systemalbeit one that operated within Home Office control.

This system remained in operation for nearly 40 years, until the rapid changes of the 1960s. The 1920s, 1930s, and 1940s were decades when the numbers of addicts were small and there were few nonmedical users (less than 500). It is generally recognized that the British System of medical control operated because of this situation rather than as the cause of it. This equilibrium began to break down after World War II (1939-1945), when more extensive recreational, or nonmedical, use of drugs (such as Heroin and Cocaine) began to spread for a variety of reasons. These included the spread of cannabis (Marijuana)from the new immigrant to the white population, overprescribing of heroin by a number of London doctors, thefts from pharmacies, and the arrival of Canadian heroin addicts. Other drugsin particular, Amphetaminesalso became recreationally popular.

The official numbers of heroin addicts rose rapidly, from 94 persons in 1960 to 175 in 1962; and cocaine users increased from 30 in 1959 to 211 in 1964. Nearly all of these were nonmedical consumers. The average age of new addicts also dropped sharply. Initial government reaction, in the report of the first Brain Committee (1961), was muted; however, the second report (1965), produced when the committee was hastily reconvened, had an air of urgency. Controls were introduced on amphetamines in 1964. The report's proposals (implemented in the Dangerous Drugs Act of 1967) took the prescribing of heroin and cocaine out of the hands of general practitioners and placed it in those of specialist hospital doctors working in drug-dependence units. A formal system was established that notified the Home Office about addicts.

The clinic system established in 1968 did not operate as originally intended. In the 1970s, as the rise in numbers of addicts appeared to stabilize, clinic doctors moved toward a more active concept of treatment, substituting orally administered Methadone for injected heroin and often insisting on short-term treatment contracts rather than on maintenance prescribing. These clinic policies aided the emergence of a drug black market in Britain in the late 1970s. An influx of Iranian refugees from the Islamic revolution of 1979, bringing financial assets in the form of heroin, also stimulated the market.

The British elections of 1979 returned a Conservative government with a renewed emphasis on a penal response to illicit drugs. Britain participated enthusiastically in the U.S.-led international "war on drugs," but there were also strong forces inside Britain arguing for a more health-focused approach. In 1985, the discovery of acquired immunodeficiency syndrome (AIDS) among injecting drug users in Edinburgh, Scotland, was the trigger for policies that emphasized the reduction of harm from drug use rather than a prohibitionist stance. Nevertheless, in the early 1990s, the tension between penal and health concepts and the interdependence of the two approaches to policy still remained unresolved.

The use of drugs within British society continued to expand in the 1990s. Amphetamines are still second only to cannabis as the most widely used drugs in the United Kingdom, but few users are in contact with drug treatment services or seek any medical help. Services are oriented towards opiate users and black market amphetamine is not expensive, so there is a lower likelihood that financial problems will force users into treatment. Heroin use has also continued to grow. During the 1980s this emerged in a large number of communities round the country and in a pattern different from that of the 1960s. This new pattern of use mainly involved adolescents and young adults, and the heroin was taken by a new method called "chasing the dragon"heating heroin on tin foil, with vapors inhaled through a tube. But there was great regional variation, with injecting still popular in some areas. Heroin use has continued to grow; the number of known addicts has grown from about 5000 in 1980 to approximately 50,000 by the late 1990s, with figures still growing at about 20 percent a year. Cocaine use has also risen, but the speed and penetration of crack cocaine into the country has been nowhere near as rapid or as substantial as U.S. commentators had predicted. Surveys suggest that snorting cocaine is more popular than crack or heroin and is on the increase in clubs. Ecstasy (MDMA) use has also received wide media publicity, but surveys suggest it is used less frequently than other "dance drugs," LSD and amphetamine.

British governments, conservative for most of the 90s and governed by the Labour party since 1997, have continued to publish national strategies on drugs, the first of which appeared in the 80s. In 1995, Tackling Drugs Together: a strategy for England, 1995-1998, was published and strategies for Scotland and Wales followed. The strategy committed the government to take effective action through law enforcement, accessible treatment and a new emphasis on education and prevention to increase community safety from drug related crime; reduce young people's drug use and reduce health risks and damage associated with drug use. In 1998, the new Labour government published Tackling Drugs Together to Build a Better Britain: the Government's Ten Year Strategy for Tackling Drug Misuse, which reiterated these main themes. Former Chief Constable, Keith Hellawell, was appointed "Drug Czar," or national coordinator; his deputy had a background in rehabilitation services.

The relationship between penal and health responses in drug policy has remained central. Arrest referral schemes are common and the government is now to expand pilot treatment and testing orders, which will give an alternative to custody to drug using offenders who agree to undergo treatment. Treatment services in prisons have expanded since the incorporation of the prison health service into the National Health Service: new treatment programs and a through-care service for drug using prisoners will be set up. Mandatory urine testing in prisons has proved controversial. Some policy analysts have argued that U.K. policy is moving to a harsher stance, in effect to compulsory treatment and to a greater emphasis on criminal justice initiatives, and to coercion. The government's unwillingness to accept the conclusions of an independent inquiry into drug policy, which recommended liberalization of the law on cannabis, has been cited as evidence of this. However, there is also official interest, following a House of Lords report, in the medical uses of cannabis and a National Treatment Agency is to be set up, emphasizing the health aspects of drug use. The duality of policy continues.

(See also: Anslinger, Harry J., and U.S. Drug Policy ; British System of Drug-Addiction Treatment ; Opioids and Opioid Control: History )

BIBLIOGRAPHY

Berridge, V. (1993). AIDS and British drug policy: Continuity or change? In V. Berridge & P. Strong (Eds.), AIDS and contemporary history. Cambridge: Cambridge University Press.

Berridge, V. (1999). Opium and the people. Opiate use and drug control policy in nineteenth and early twentieth century England. London: Free Association Books.

Royal College of Psychiatrists and Royal College Of Physicians. (2000). Drugs: Dilemmas and choices. London: Gaskell.

Virginia Berridge

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