Fall 1983 – Issue 30 - Stanford Lawyer - Stanford University

Obviously, if we could make such asystem work, it would have manyadvantages. A policy that allowedaddicts easy and cheap access to thedrug would free us from the coststhat we all suffer from making thequest for heroin so difficult. However,such a policy could also entailunknown but perhaps huge publichealth and welfare costs.What could we hope to gain byadopting a heroin maintenance program?And would the hoped-for benefitsoutweigh the probable costs?The British SystemBefore we look more closely at theadvantages and disadvantages ofheroin maintenance, it will be helpfulto describe what is often called theBritish system. Almost everyoneknows that the British treat heroinas a medical, not a legal, problem;hence, they make heroin available toaddicts under a prescription system.Unfortunately, like so much of whatalmost everyone knows, this is nottrue.Before 1914 (when the UnitedStates Congress passed the restric~tive Harrison Act), British andAmerican laws as to opiates weresimilar. Though Britain had, in 1868,restricted the right to sell opiates topharmacists, opiates were still freelyavailable and were widely consumedin tonics and as home remedies. Thedrugs were used not only to cure illsand to make people feel better, butalso to quiet children. In some areas,such as "the fens" around Cambridge,opiate addiction was quitecommon, but, though this was seenas a public health problem, it was notregarded as very important. As inthe United States, it was the pressureresulting from the internationalopiate traffic that required thatsomething be done about Britain'sown legal treatment of opiates.In 1920, Parliament passed theDangerous Drugs Act, a law which,on paper, seems strikingly similar toour Harrison Act of six years earlier.Most opiates were prohibited fromover-the-counter tonics, and it wasmade a serious criminal offense tobuy or sell such drugs outside ofmedical channels.As in the Harrison Act, the issue ofmedical maintenance of addicts wasunresolved, and even the languageof the two statutes was parallel. TheHarrison Act provided that opiatescould be supplied by a physician only"if in the practice of his profession,"while the British law allowed a physicianto supply opiates "so far onlyas is necessary for the practice of hisprofession."The crucial difference, however,came with the interpretation of thesewords. Unlike the American authorities,who successfully moved to preventany maintenance on opiates, theBritish appointed a distinguishedcommittee of physicians to look intothe question. The commission recommendedthat addiction should betreated simply as a medical complaintand that physicians be allowed,under very general guidelines,to prescribe opiates for themaintenance of their addicted patients.The authorities enforcing the lawnot only acquiesced in this view but,in practice, left the occasions of6Stanford Lawyer Fall 1983