Profiting from the American mistake, the Rolleston committee recommended that "with few exceptions addiction to morphine and heroin should be regarded as a manifestation of a morbid state" 22-that is, an illness that any physician could legally treat by supplying the necessary morphine or heroin.
This recommendation was accepted, and British physicians remained free to prescribe morphine and heroin for addicted patients through the succeeding decades.
One obvious advantage of this system was that it enabled the United Kingdom Home Office to keep tabs on the number of addicts currently receiving morphine or heroin. Some physicians voluntarily notified the Home Office when they added an addict to their roll of patients; other cases were picked up quite easily by periodically checking the special prescription records that physicians and pharmacies were required to keep when they dispensed an opiate.
The results can best be described as magnificent. By 1935, the United Kingdom reported to the League of Nations that there were only 700 addicts left in the entire country.23 The number of addicts continued gradually to drop after 1935, as old addicts died off and few new ones were recruited, until the official figure of addicts known to the United Kingdom Home Office reached a low of 301 for the entire country in1951.24
These figures require some minor qualification. Since physicians were not required to notify the Home Office directly, the identification of some new addicts was delayed until their names were picked up during the periodic prescription audits. On the other hand, there was a similar delay in striking dead addicts off the list. Thus the figures fairly well represented the number of addicts receiving opiates legally.
Another qualification to the official figures concerns people who might be securing morphine or heroin in other ways than on prescription. There were certainly such uncounted cases. They had several sources of supply. Some British physicians, for example, freely prescribed very large doses of morphine and heroin to their addicted patients. Addicts naturally tended to gravitate to these generous physicians, and a patient receiving more than he really needed might be tempted to share his excess with a friend, or even to sell a part of it.
There was a very firm ceiling on the amount of opiates thus diverted, however. For if the friend or customer became addicted-that is, if he found that he needed a daily supply of the drug in order to keep well and socially functioning-he had only to go to a physician to secure the drug cheaply and legally, with an assurance of medicinal purity and quality. Thereupon he was added to the official count. The addict statistics cited above include addicts who secured their initial supplies from a friend or who bought them, and who thereafter turned to a physician when addiction set in.
A major feature of this system, in addition to the way in which it reduced the number of addicts to a negligible level, was its effect on law enforcement. There were, of course, violations of the law. Occasionally, for example, a physician or pharmacy failed to keep the required records in sufficient detail. Occasionally someone smuggled in a little heroin-though he could not get American prices for it because very cheap legal heroin was available. Occasionally someone stole morphine or heroin from a chemist's shop or warehouse. Yet law-enforcement officials had a very easy time of it, for their only real concern was to keep narcotics out of the hands of nonaddicts. Unlike their opposite numbers in the United States, they were not saddled with the hopeless responsibility of trying to keep narcotics out of the hands of addicts. Nor were the British courts and prisons jammed with narcotics offenders.
During the period from 1924 through the 1950s, Americans visiting Britain were naturally impressed with the British system, and on their return urged that a similar system be tried here. Many of the proposals of committees of the American Medical Association and the American Bar Association, and other similar proposals described above for legal narcotics dispensing in the United States, grew directly out of such visits to Britain.
These proposals were met by condemnation of the British system by United States Commissioner of Narcotics Harry J. Anslinger and the Federal Bureau of Narcotics. Repeated official American statements and speeches alleged, for example, that London, like New York, had a black market in heroin. This was unquestionably true. The market centered around Soho and Piccadilly. What the critics of the British system failed to add was that the market supplied a few dozen "weekend users," perhaps even a hundred or more. To jeopardize the entire system, and the contribution it was making to the nation's health and security, in order to try to stamp out a few peripheral shortcomings was simply not the British way. There was probably also a realization that the publicity accompanying raids on Soho and Piccadilly would attract additional customers and further popularize heroin.
Commissioner Anslinger and others also charged that the British addict count was phony, that Britain had addicts not included in the official reports. This, too, was unquestionably true. What the critics failed to add was that there were dozens of such unreported addicts, perhaps even a few hundred. The American heroin black market, in contrast, supplied tens of thousands of addicts-and made even an approximate count impossible.
Finally, Commissioner Anslinger and others insisted that if the British system worked in Britain, it was because Britain was an island, or because the British were law-abiding citizens, or because of other national differences.* This is a point to which we shall return.
* It has also often been alleged-most recently by Drs. Frederick B. Glaser and John C. Ball in the Journal of the American Medical Association 21 in 1971-that the British system worked because it started out half a century ago with only a "negligible" addiction problem. This allegations as we have shown, does not square with British drug-use history.
Beginning about 1960, a modest change occurred in the British heroin problem. A group of fifteen Canadians plus a smaller group of Americans migrated to London to take advantage of high-quality, low-cost, legal heroin there-and proceeded to set up a "heroin subculture" on the American and Canadian model. They made a number of friends, and these friends also became addicted.
Only a moderate commercial black market developed, however. For at the very point when a potential black-market customer became addicted, be simply went to a physician and secured high-quality legal heroin without paying the black-market price. The availability of lowcost legal heroin also made it unnecessary for this new crop of British addicts to become thieves or prostitutes.
Nevertheless, the British during the 1960s became understandably distressed as more and more young people became addicted to heroin. The numbers remained exceedingly small by American standards, but the trend seemed ominous (see Table 3).
The 162 new heroin addicts reported to the United Kingdom Home Office in 1964 may be contrasted with the 10,012 new addicts reported in that year to the United States Federal Bureau of Narcotics-with the warning that the British count was far more complete than the American count, since the British gave free heroin to those willing to be counted, while Americans who let their addiction become known risked imprisonment. If the British trend continued, of course, that country could expect several thousands of addicts during the 1970s.
In the United States, the Federal Bureau of Narcotics seized on this modest increase with great interest. Before 1960, the official United Kingdom statistics bad been dismissed as worthless. Now they were taken as gospel, and word was spread that addiction in Britain had doubled in four years. Before 1960, the bureau had insisted that the British experience was not relevant to American conditions. Now the bureau reversed its field. It pointed to the "failure" of the British system as proof positive that supplying heroin to addicts would fail in the United States as well.
The British, too, reversed their field. Since 1924 they had prided themselves that by avoiding American methods they had avoided the American heroin disaster. Now they began to study American methods, in part because Britain had few experts of its own. With only a few hundred addicts spread through the country a few years before, most British physicians had never treated an addict, had never been concerned with addition, and had only a hazy understanding of the problem. Since the United States had such an enormous number of addicts, the British naturally concluded that our experts knew better.
The British newspapers and other mass media, moreover, followed American mass-media precedents with alacrity. During the 1960s, they published the same stories with which Americans are so familiar-the annual rise in number of addicts, the arrests of drug pushers, the teen-age boy or girl caught shooting heroin into his arm, a mother's plaintive first-person story of how heroin had ruined her child. Letters to the editor of the Times (London) sounded as vindictive as similar American letters in demanding that penalties be escalated. Prison was deemed too good for a heroin addict or pusher. A committee of distinguished physicians, under Lord Brain, recommended fresh measures to curb the heroin menace-which by now was claiming 162 new victims a year.
The 1966 Brain committee recommendations, which are currently in force, significantly improved the basic British system. The committee noted that a few physicians under the old system had been prescribing excessive amounts, that these few overgenerous physicians had naturally attracted many addicts as patients, and that the excess heroin had flowed to the black market. They also noted that many of the new addicts were consulting physicians who had never seen an addict before and who knew nothing about addiction. Accordingly, the prescription of heroin was taken out of the hands of the medical profession as a whole and was concentrated instead in a limited number of clinics staffed by trusted physicians, who would thus be able to gain expertise on drug abuse problems .27 As Dr. Thomas H. Bewley, the head of one large new London heroin-dispensing clinic, remarked on a visit to the United States, the British had gone back to the old 1912-1924 American system of clinics for dispensing heroin.
The new British restrictions, however, apply only to heroin. Any physician can continue to prescribe morphine or methadone a synthetic opiate that can take the place of heroin. Thus British addicts today are given a choice of drugs and drug sources. They can patronize an ordinary physician and get morphine or methadone, or they can go to one of the new clinics for heroin, morphine, or methadone. Britain never at any time seriously considered following the American policy of keeping opiates away from addicts and thus opening the door to a large-scale heroin black market. The disastrous effects of the American black-market system, and the beneficent effects of their own long-established system, were much too readily visible.
Once again, this British development was seriously misrepresented in the United States. Opponents of opiate dispensing here charged that even the British now conceded that their system was a failure and had abandoned it. American proponents of a better system of opiate distribution were condemned for proposing a plan that even the British had now abandoned. Few readers of this Consumers Union Report, it seems likely, are aware that in Britain today an addict can continue to get high-quality, low-cost heroin, morphine, or methadone legally from clinics-or, if he prefers, morphine or methadone from any medical practitioner.
