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Illegal Drugs, Communities and Public Policy - Drugs - Facing Facts

Illegal Drugs, Communities and Public Policy - Drugs - Facing Facts

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Published by The RSA
The RSA Commission proposes that some of the solutions to delivering a coherent drugs policy are to be found where the problems are most directly experienced - in local communities. It also examined the 'drugs problem' beyond the bounds of a political context which makes true open-mindedness very difficult. Its report offers some fresh answers to these most intractable questions.
The RSA Commission proposes that some of the solutions to delivering a coherent drugs policy are to be found where the problems are most directly experienced - in local communities. It also examined the 'drugs problem' beyond the bounds of a political context which makes true open-mindedness very difficult. Its report offers some fresh answers to these most intractable questions.

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Drugs policy in Britain has historically had two facets: a health-
centred approach to the health harms resulting from drug misuse
and a drive against drug-related offending through the criminal
justice system. Each approach has always been seen as important
but has at different times been given different priorities. At present,
for all the money that has recently gone into providing treatment,
the criminal-justice approach is firmly in the ascendant.

When drug misuse first started to be conceived of as a problem
for British society in the mid-19th century, it was defined as
a threat to health and therefore as a medical issue. By the turn
of the 20th century the newly emerged medical profession was
asserting its authority to define and treat addiction as a disease,
and the Pharmaceutical Society was claiming the right to be
the sole legal supplier of drugs.

However, drug use in the meantime had also begun to be framed
as a criminal justice problem. At the outbreak of war in 1914,
British policy on drugs became the responsibility of the Privy
Council Office as, in the absence of a Ministry of Health
(not created until 1919), no other department was willing to
take on the responsibility. Two years later, in the middle of the
First World War, an interdepartmental meeting in June 1916
agreed that the problems of drugs misuse were most appropriately
viewed as ‘police matters’. They reached this conclusion in the
wake of public concerns over the rumoured use of cocaine
by troops and munitions workers. The regulations promulgated
under the Defence of the Realm Act of 1914 that we referred
to in Chapter 2 introduced a definition of ‘harmful’ substances
(primarily cocaine and opium) and criminalized their unauthorized
supply and possession. The new definition brought drugs within
the sphere of the Home Office because it was the department
responsible for the Defence of the Realm Act, and made it, in
effect, the lead ministry in terms of policy, though doctors still
retained practical control in terms of treatment.

In the early 1920s the penal approach to drugs control
gained ground in the UK. A clause in the Treaty of Versailles
of 1919 had required signatories to legislate for their internal
drugs problems. The Dangerous Drugs Act 1920 authorized
the ‘Secretary of State’ – in practice the Home Secretary –
to regulate the manufacture, sale, distribution and possession

107

RSA_Drug_Report_Part_II_prf4:Layout 1 1/3/07 16:32 Page 107

227G Stimson and E Oppenheimer, Heroin
addiction: treatment and control in Britain,

Tavistock, 1982.

228Contemporary document cited in an
historical overview of drug policy carried
out in the course of the Shipman Inquiry.

Shipman Inquiry, Fourth Report –The Regulation
of Controlled Drugs in the Community,

2004, p.46.

of dangerous drugs. The drugs to which the Act applied could
be extended in future by an Order in Council when such drugs
were considered ‘likely to be productive, if improperly used,
of ill effects… analogous to those produced by morphine or
cocaine’. The Dangerous Drugs Regulations of 1921 provided
for a licensing and regulatory framework to implement the
provisions of the Dangerous Drugs Act, limiting the supply,
prescription and possession of dangerous drugs to doctors,
dentists or vets. This was the first statutory expression of special
privileges given to doctors in relation to dangerous drugs.

Two years later the Dangerous Drugs Amendment Act 1923
imposed heavier penalties for drug offences and gave the police
increased powers of search. The heavier penalties and new
powers were partly in response to a changed public – or at least
press – mood. The ‘vice’ conception of drug use dominated the
newspaper reports of the period, with stories of “peddlers” and
“dope fiends”.227

There was concern about high-profile celebrity
deaths and drugs were increasingly associated with foreigners.

The stringency of the Dangerous Drugs Amendment Act was also
partly driven by the Home Office’s desire to follow the model
of America’s 1914 Harrison Act, which treated drugs as a criminal
issue and restricted the powers of doctors to prescribe them.
However, the new British Act left the medical profession more
freedom of action than did the Harrison Act, allowing any doctor
to dispense opiates ‘so far as may be necessary for the exercise
of his profession’. A regulation proposed by the Home Office
in 1922 that doctors should not be permitted to prescribe
a controlled drug for their own use was withdrawn following
objections from the British Medical Association. The Home
Office nevertheless remained broadly opposed to the prescribing
of ‘maintenance’ doses of dangerous addictive drugs on the
grounds that ‘abrupt withdrawal from drug dependence was
possible and that any other form of treatment was improper’.228

To set out what constituted legitimate prescribing practice,
the new Ministry of Health set up a committee under
Sir Humphrey Rolleston, President of the Royal College
of Physicians. The committee’s report in 1926 not surprisingly
found in favour of retaining significant medical input into the
problem of substance misuse. The Dangerous Drugs Regulations
of the same year reasserted the ‘disease’ model of addiction and
confirmed that prescribing heroin and morphine to addicts was
a legitimate medical treatment. These regulations established what
was subsequently labelled the ‘British system’ under which addicts
could receive a regular supply of heroin or morphine in order

Drugs –facing facts

108

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229Adrian Barton, Illicit Drugs: use and control,
Routledge, 2003.

230V Berridge, Opium and the People: opiate
use and drug control policy in nineteenth
and early twentieth century England,

Free Association Books, 1999, p.269.

231Set up initially in 1958 by the Department
of Health and Social Security at the instigation
of the Home Office, to re-examine the
Rolleston Committee’s decision to allow
doctors to prescribe heroin and morphine
to drug addicts.

to maintain or gradually to reduce their use without their
doctors being liable to prosecution. ‘The legacy of Rolleston
was to create a dual approach to substance use and misuse,’
one observer has written:
On the one hand the police retained the power to prosecute
unauthorized use, supply and possession, thus criminalizing
drug users not authorized by the medical profession.
On the other hand, the medical professions retained the
right to diagnose, define and treat addiction. In this way
a dual approach developed, with substance misusers being
defined as either criminal or sick depending on the arm
of the British system with which they came into contact.229

The Rolleston Report had declared that drug use was a problem
to be solved and not a sin to be punished, and between the 1920s
and the early 1950s the dominant approach to the problem was
indeed a medical approach, with doctors prescribing to a small
number of individual addicts, many of them doctors themselves.230
But such prescribing always took place within the existing
criminal framework; and in the late 1950s and early 1960s the
situation changed. Instead of the largely middle-class, middle-
aged and professional therapeutic opium users of the interwar
years, there emerged, as we saw in Chapter 2, a far larger group
of much younger users taking drugs – primarily cannabis and
amphetamines – for pleasure.

These developments prompted a wave of legislation to deal with
the rising numbers of users and the wider range of drugs used
in new cultural settings. In 1964 the Dangerous Drugs Act made
the cultivation of cannabis illegal, and the Drugs (Prevention
of Misuse) Act 1964 brought amphetamines within controls.
As for opiates and cocaine, there had for some years been
concern that a small number of doctors had been prescribing
irresponsibly, with the result that excess quantities of heroin and
morphine had been leaking onto the illegal market. In 1965 the
second report of the Brain Committee recommended that this
leakage should , if possible, be brought under control.231

The report
led to the passage of the Dangerous Drugs Act 1967. Regulations
under the new Act stipulated that doctors now had to be specially
licensed by the Home Secretary in order to prescribe heroin
or cocaine and that the names of addicts had to be notified
to the Chief Medical Officer at the Home Office (not, notice,
to any official of the Ministry of Health).

Under the 1967 Act specialist drug dependency units or clinics
were established to handle prescribing. Originally offering
injectable heroin on a maintenance basis, they increasingly came

The evolution of drugs policy

109

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232G Stimson and R Lart, ‘The relationship
between the state and local practice in the
development of national policy on drugs
between 1920 and 1990’, in ed. J Strang and
M Gossop, Heroin addiction and the British
System,
Vol.1, 2005.

233The composition and role of the Advisory
Council on the Misuse of Drugs is discussed
in some detail in Chapter 19 below.

to offer oral methadone on a reducing basis. In general,
according to Professor Gerry Stimson, drugs treatment was
taken out of the hands of the GP at this point and given, for the
most part, to psychiatrists. ‘This “psychiatrization” of the problem
fitted well with the growth of psychiatry as a specialism in the
1960s.232

Doctors were still the experts on medical problems
caused by the use of drugs, but from now on there would be
more and more use of the criminal law to achieve, among other
things, public health gains.

The Misuse of Drugs Act 1971 and the National Drug Strategy

In 1971 the Misuse of Drugs Act established the approach
to drugs and the misuse of drugs that still prevails. The Act
introduced a classification system for illegal drugs (only),
in a hierarchy that was intended, at least, to be drawn up
by reference to the harms, largely medical, that each substance
causes. The Act also enshrined in law a clear distinction between
the supply and the possession of drugs, and it set up the Advisory
Council on the Misuse of Drugs as a source of independent
advice on the risk of harmful effects ‘sufficient to constitute
a social problem’ that might be caused by the misuse of drugs.233
The term ‘controlled drugs’ now replaced ‘dangerous drugs’
in all relevant domestic legislation.

Although much of the 1971 Act was couched in medical
language, the 1980s were largely dominated by an enforcement
approach in response to a sharp rise in drug-related crime
(partly as a result of the restrictions on GPs’ ability to prescribe)
and also in response to a very rapid spread in the use of drugs.
At one end of the spectrum, there was a marked growth in
injecting heroin use. At the other, there emerged a new culture
of recreational drug use, with the rise of ‘dance’ drugs – mostly
ecstasy and amphetamines – involving a much wider range
of people than in the past. The amounts of imported drugs rose
steeply, and policy increasingly focused on supply reduction.

At the same time public health concerns over HIV/AIDS
and a serious AIDS epidemic among injecting drug users
in Scotland obliged policy makers to take seriously the need
to reduce the medical harms caused by drugs. That an important
role in drugs policy was still claimed for doctors was evidenced
by a series of directives from the Department of Health, most
notably Treatment and Rehabilitationin 1982 and the 1984
Guidelines of Good Clinical Practice in the Treatment of Drug Misuse
(to be followed in 1991 with Drug Misuse and Dependence
Guidelines on Clinical Management,updated in 1999). Through
these directives the Department of Health exerted pressure

Drugs –facing facts

110

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234Barton, op.cit.

on doctors to involve themselves in treating and controlling
problematic drug use.

By this time the drugs policy community could be seen as
composed of two sometimes competing elements.234

Supply

and dealing were the undisputed territory of the criminal
justice system, but where drug use was concerned both law
and medicine were laying claim to the same constituency
of drug users. The Home Office retained overall control
of policy, which was developed within a criminal justice
framework; but the medical profession continued to stake
its claims to have some input. In the 1980s, in the absence
of a comprehensive government drugs strategy, there was little
cooperation: the police and customs worked to enforce the
law, and doctors treated those users who happened to come
to their attention. But the need for collaboration was becoming
increasingly obvious. In 1994 a Department of Health
report entitled Across the Dividecalled for joint working.
The following year the Major government set up the Central
Drugs Coordination Unit and a ministerial sub-committee
of the Cabinet on the misuse of drugs. They were headed
by the Lord President of the Council, thus locating the
Central Drugs Coordination Unit in the Privy Council Office.

The Unit was the first body to attempt to coordinate drugs
policy under national leadership. Its 1995 strategy document,
Tackling Drugs Together,defined drug misuse as a major social
problem, giving it a prominence that it has never since lost.
Tackling Drugs Togetherlooked at the drugs problem through
the prism of law and order but also acknowledged the importance
of reducing demand through treatment, as well as through
education and prevention; and it gave explicit recognition to
the concept of harm reduction. By creating a broader definition
of ‘harm’, to include harms to the community as well as harms
to the individual, it created a policy umbrella under which the
law-and-order and medical approaches could combine, even
if the resources were still going primarily into the criminal
justice system and into efforts at supply reduction.

This combined approach was largely continued by the
Blair government in the ten-year drugs strategy that it launched
in the 1998 document Tackling Drugs to Build a Better Britain.
The latter was issued from the Cabinet Office, which now
incorporated the Central Drugs Coordination Unit, headed
by Britain’s first drugs ‘czar’, former Chief Constable Keith
Hellawell. The strategy’s most prominent feature was its central
focus on drug-related crime and its insistence that health services

The evolution of drugs policy

111

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235J Strang and M Gossop, ‘The “British
System” of drug policy: extraordinary
individual freedom, but to what end?’
in ed. J Strang and M Gossop, Heroin
addiction and the British System,
Vol. 2,
Routledge, 2005, p.215.

236DTTOs are still available in Scotland
and there are currently no plans to legislate
for their removal. The closest equivalent
in Scotland to Drug Rehabilitation
Requirements is the attaching of Specific
Conditions to probation orders, requiring
offenders to attend drug treatment
or education programmes.

237Keith Hellawell resigned a year later in
protest at the downgrading of cannabis to
Class C and the relaunching of the drugs
strategy, which he described as ‘a re-spinning
of the issue to appear as if something has
been done’. Guardian,10 July 2002.

and the criminal justice system should combine to combat it.
One source has characterized the document as calling for
‘a strange strategic alliance …between law enforcement and
the call for greater access to treatment… Treatment was thus
re-conceptualized as an intervention which might lead to
reduction of criminal behaviour.’235

The ground had been prepared for an alliance of this sort
by the 1991 Criminal Justice Act which gave courts the power
to impose drugs treatment – ‘coerced treatment’ – as part
of a sentence. In the absence of clear guidelines to sentencers
or information on the availability of treatment, the courts had
so far rarely used this power, but the post-1997 government liked
it and in the 1998 Crime and Disorder Act introduced Drugs
Treatment and Testing Orders (DTTOs) as a further step towards
coerced treatment. DTTOs (since replaced by Drug Rehabilitation
Requirements that work in a similar way)236

require a high degree
of collaboration between law-enforcement and health agencies.
They require police to catch offenders, drug workers to assess
their need for treatment and then to provide it, probation officers
to ensure compliance with the Order and courts to monitor
progress. Nevertheless, they are essentially criminal-justice led.
(In a further development of this linkage between treatment and
the criminal justice system, the Criminal Justice Interventions
Programme, later renamed the Drug Interventions Programme,
would be introduced in 2003.)

The government’s criminal justice approach to drugs, as part
of its general emphasis on law and order, was made even
clearer in June 2001 when, as part of a major reorganization
of departmental responsibilities, the Central Drugs Coordination
Unit (now known as the Anti-Drugs Coordination Unit) was
relocated to the Home Office. The announcement from the
Prime Minister’s Office read:
The Prime Minister has made a number of major changes
to the machinery of government. Taken together, they will
ensure a much sharper focus on the Government's priorities
…The Home Office will be streamlined, losing a number
of functions which are not central to its work, to allow
it to focus on tackling crime, reform of the criminal justice
system and asylum. As part of this, the UK Anti-Drugs
Co-ordination Unit will transfer into the Home Office
from the Cabinet Office.
A little later, the drugs czar was sidelined, being given only
a part-time advisory role, and the Home Office openly assumed
the lead in the drugs strategy.237

A similar move was made in
Scotland in 2005 when lead responsibility for drugs policy was

Drugs –facing facts

112

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238The Directorate was renamed the Crime
and Drug Strategy Directorate in 2006.

transferred from the Health Department to the Justice
Department. In Wales, however, responsibility rests with the
Minister for Social Justice and Regeneration and in Northern
Ireland with the Department of Health, Social Services and
Public Safety.

The evolution of British drugs policy in the twentieth century
is a story of constant efforts by successive governments to use
the law, the criminal justice system and the medical profession
to prevent the use of controlled drugs and limit the harm that
they do. Drugs policy has rarely been a subject of party-political
contestation. Both Conservative and Labour parties have adopted
an approach that treats drug use as first and foremost a matter
for the criminal justice system, with prevention and treatment
as subsidiary concerns.

Despite this consistent emphasis on crime, however, the
international drugs trade has advanced and developed faster
than all the efforts at enforcement and it has proved necessary
to introduce new legislation at regular intervals, with the
governments of both major parties showing themselves ready
to add to the growing body of drugs laws. On the face of it, the
large volume of new legislation and the frequent reorganizations
of the government agencies dealing with drugs suggest that
governments themselves have not believed that existing
approaches were proving particularly successful.

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