Fall 1983 – Issue 30 - Stanford Lawyer - Stanford University

growth of heroin addiction washalted, and the success of the clinicsat reducing diversion of prescribedheroin is shown by a doubling of theprice of the drug on the illegalmarket in 1968, when the clinicsystem took hold.In recent years, however, therehas been yet another major alterationin the British system. Unlike the1967 change, which was the result ofa new statute amidst considerablepublicity, this one has been the productof a gradual and almost unnoticedevolution. The pressurestoward greater social control over anew and more refractory kind of addict,together with a feeling that, byand large, oral methadone was asafer and more therapeutic maintenancedrug than injectable heroin,have caused the clinics to maintainfewer and fewer addicts on heroinand to substitute methadone instead.The extent to which this has occurredwould surprise those who stillbelieve in the unique "Britishsystem." One study of two Londonclinics showed that only five of 2258addicts under treatment were receivingheroin. Another clinic entirelydiscontinued prescribingheroin when the staff decided thatthe major reason they were stillmaintaining a few patients on thatdrug vvas to impress visitingAmericans.Even the few clinics that still maintainany number of addicts on heroinor morphine do so under a kind ofgrandfather clause. Those patientswho were started on such drugswhen they originally were treatedfor addiction, and have made whattheir physicians regard as a good adjustment,may continue to receivethose drugs.New addicts, those who have returnedto the clinic after temporarilydropping out of treatment, and thosewho have not adjusted in the sensethat they have remained unemployedor been in trouble with thelaw, have been placed on oral methadone,often over their strenuousobjections. In short, as a practicalmatter, the "British system" ofprescribing heroin to maintain addictsis no more.The Relevanceof the British ExperienceOf course, the fact that Britain hasabandoned heroin maintenance doesnot in itself mean other nationsshould not try it. After all, the Britishmay simply have made a mistake.On the other hand, one might arguethat even if the British were correctin abandoning maintenance in theircountry, conditions in our quite differentcountry may be more favorable.However, most observers (includingthe author) believe the opposite-that conditions in this country areless, not more, favorable to a heroinmaintenance approach. For one,heroin addicts in Britain andAmerica are very different kinds ofpeople, and were even more so whenthe British system was most conspicuouslysuccessful. A far higherpercentage of British addicts weremedically created, while many moreAmerican addicts initially usedheroin for pleasure. Similarly, mostAmerican addicts h~"'1 criminalrecords before their .-, rst use ofheroin, while this is true of a much8Stanford Lawyer Fall 1983