Fall 1983 – Issue 30 - Stanford Lawyer - Stanford University

maintenance almost entirely up tothe physicians. As a result, under theBritish approach, addiction becamea matter between the addict and hisphysician. The doctor would prescribemorphine or heroin and theaddict'would obtain his supply froma pharmacy just as he would anyother medicine.The situation endured essentiallywithout change until the 1960s. Bythat time, many American authoritieswere convinced that Britain had"the answer." And even those whodisputed whether heroin maintenancewould work in the UnitedStates tended to agree that Britain'ssystem was working quite well inthat country.There were only a few hundred addictsin the whole nation. Thesewere overwhelmingly medical addicts,who had become addicted duringa course of treatment with opiates-often for chronic pain. Theydid not use drugs for euphoria anddid not seem particularly inclinedtoward crime. Probably most significant,they did not belong to any addictsubculture; indeed, most addictsdid not even know another addict.Not only did the addicts themselvesseem to adjust well to heroinmaintenance, but there were societalbenefits as well. Because of the lowprice of the drug, no addict had tosteal or sell drugs to maintain hishabit.In addition, the heroin maintenancesystem was credited with havingprevented the development of anillegal market. Since addicts couldobtain heroin quite inexpensivelyfrom their private physicians, andthen, after World War II, virtuallywithout cost from the NationalHealth Service, it was believed thatno profit could be made from traffickingin the drug.Of course the system was not foolproof.The addict could conceivablysell a part of his supply, if he wishedto and could find a buyer. And the individualphysician had to be trusted,for the benefit both of his patient andof society, to hold down the levelof his opiate prescriptions to theamount needed to sustain the addict'shabit. Nonetheless, by all accountsthe system worked well untilthe early sixties. Then it began tobreak down.The Breakdown of the SystemIt has been said that the problem wascaused by a few American-style addictswho came to Britain fleeing anew Canadian law which sharply increasedthe penalties for drug violations.Others have argued that thesocial use of heroin was a culturalinnovation imported from theUnited States.Perhaps the most important factorwas the development of a youthculture which was, for the first time,large and affluent enough to developcertain folkways of its own in oppositionto the dominant older culture.This style not only included clothing(Carnaby Street) and music (the BeatIes),but the recreational taking ofmarijuana, "pills," and, to a limitedextent, opiates.In any event, it is now clear that arelatively small number of youngmen who centered their lives on opiatetaking and dealing, aided by aconsiderable degree of naivete orsimply profiteering on the part of afew British physicians, quicklydestroyed the British system as itthen existed. The new-style addicts,it turned out, could often inducephysicians into prescribing considerablymore than needed to sustaintheir habits, and they were able tofind ready purchasers for the surplusamong their friends. Between 1961and 1969 the number of British addictsincreased more than fivefold,and, perhaps even more significant,the kind of addict changed dramatically.The new addicts were youngerand less stable and had values verydifferent from those of the medicaladdicts who had previously been thegrist for the system. While the totalnumber of addicts in Britain stillamounted to only about threethousand- a figure which could bematched in a five-block area ofHarlem - the public becamealarmed; a commission was convokedto look into the problem; and,in 1967, Parliament made majorchanges in the system.The most important change wasthe withdrawal of the ordinaryprivate physician's power to prescribeopiates for the maintenance ofaddicts. Only physicians speciallylicensed for the purpose could nowdo this. Moreover, though somegeneral practitioners were in factlicensed to do so, the prescription ofheroin or morphine to maintain addictssoon became restricted, as apractical matter, to a number ofhospitals and clinics - of which thethirteen in London handled the greatbulk of British addicts.These clinics were staffed by physicianswho quickly became specialistsin heroin addiction and whotended to be considerably more suspiciousof addicts' stated requirementsthan individual practitionershad been. The clinic physiciansrecognized that their responsibilitywas not only to their patients but tosociety as well. They tried very hardto make sure that their patients usedand did not sell the heroin they hadprescribed, refrained from the use ofother illegal drugs, and held steady,noncriminal, employment. The preferencewas still that the addict beweaned away from his drug, but itwas understood that he would continueto receive his heroin if he madea tolerable adjustment.So far as we can tell, the switch tothe clinic system was, for the mostpart, successful. The explosiveFall 1983 Stanford Lawyer7