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UK: Make heroin legal

Nick Davies

The Guardian

Thursday 14 Jun 2001

---
On April 3 1924, a group of American congressmen held an official hearing to
consider the future of heroin. They took sworn evidence from experts,
including the US surgeon general, Rupert Blue, who appeared in person to
tell their committee that heroin was poisonous and caused insanity and that
it was particularly likely to kill since its toxic dose was only slightly
greater than its therapeutic dose.
They heard, too, from specialist doctors, such as Alexander Lambert of New
York's Bellevue hospital, who explained that "the herd instinct is
obliterated by heroin, and the herd instincts are the ones which control the
moral sense ... Heroin makes much quicker the muscular reaction and
therefore is used by criminals to inflate them, because they are not only
more daring, but their muscular reflexes are quicker." Senior police, a
prison governor and health officials all added their voices. Dr S Dana
Hubbard, of the New York City health department, captured the heart of the
evidence: "Heroin addicts spring from sin and crime ... Society in general
must protect itself from the influence of evil, and there is no greater
peril than heroin."

The congressmen had heard much of this before and now they acted decisively.
They resolved to stop the manufacture and use of heroin for any purpose in
the United States and to launch a worldwide campaign of prohibition to try
to prevent its manufacture or use anywhere in the world. Within two months,
their proposal had been passed into law with the unanimous backing of both
houses of the US Congress. The war against drugs was born.

To understand this war and to understand the problems of heroin in
particular, you need to grasp one core fact. In the words of Professor
Arnold Trebach, the veteran specialist in the study of illicit drugs:
"Virtually every 'fact' testified to under oath by the medical and
criminological experts in 1924 ... was unsupported by any sound evidence."
Indeed, nearly all of it is now directly and entirely contradicted by
plentiful research from all over the world. The first casualty of this war
was truth and yet, 77 years later, the war continues, more vigorous than
ever, arguably the longest-running conflict on earth.

Drugs and fear go hand in hand. The war against drugs is frightening - but
not, in reality, for the reasons which are claimed by its generals. The
untold truth about this war, which has now sucked in every country in the
developed world, is that it creates the very problem which it claims to
solve. The entire strategy is a hoax, with the same effect as an air force
which bombs its own cities instead of its enemy's. You have to go back to
the trenches of Flanders to find generals who have been so incompetent, so
dishonest, so awesomely destructive towards those for whom they claim to
care.

The core point is that the death and sickness and moral collapse which are
associated with class A drugs are, in truth, generally the result not of the
drugs themselves but of the black market on which they are sold as a result
of our strategy of prohibition. In comparison, the drugs themselves are
safe, and we could turn around the epidemic of illness and death and crime
if only we legalised them. However, it is a contemporary heresy to say this,
and so the overwhelming evidence of this war's self-destructive futility is
exiled from almost all public debate now, just as it was when those
congressmen met.

Take heroin as a single example. And it's a tough example. In medical terms,
it is simply an opiate, technically known as diamorphine, which metabolises
into morphine once it enters its user's body. But, in terms of the war
against drugs, it is the most frightening of all enemies. Remember all that
those congressmen were told about "the great peril". Remember the Thatcher
government's multimillion pound campaign under the slogan "Heroin screws you
up". Think of Tony Blair at the 1999 Labour party conference fulminating
about the "drug menace" or of William Hague last year calling for "a
stronger, firmer, harder attack on drugs than we have ever seen before". And
now look at the evidence.

Start with the allegation that heroin damages the minds and bodies of those
who use it, and consider the biggest study of opiate use ever conducted, on
861 patients at Philadelphia General hospital in the 20s. It concluded that
they suffered no physical harm of any kind. Their weight, skin condition and
dental health were all unaffected. "There is no evidence of change in the
circulatory, hepatic, renal or endocrine functions. When it is considered
that some of these subjects had been addicted for at least five years, some
of them for as long as 20 years, these negative observations are highly
significant."

Check with Martindale, the standard medical reference book, which records
that heroin is used for the control of severe pain in children and adults,
including the frail, the elderly and women in labour. It is even injected
into premature babies who are recovering from operations. Martindale records
no sign of these patients being damaged or morally degraded or becoming
criminally deviant or simply insane. It records instead that, so far as harm
is concerned, there can be problems with nausea and constipation.

Or go back to the history of "therapeutic addicts" who became addicted to
morphine after operations and who were given a clean supply for as long as
their addiction lasted. Enid Bagnold, for example, who wrote the delightful
children's novel, National Velvet, was what our politicians now would call
"a junkie", who was prescribed morphine after a hip operation and then spent
12 years injecting up to 350mg a day. Enid never - as far as history
records - mugged a single person or lost her "herd instinct", but died
quietly in bed at the age of 91. Opiate addiction was once so common among
soldiers in Europe and the United States who had undergone battlefield
surgery that it was known as "the soldiers' disease". They spent years on a
legal supply of the drug - and it did them no damage.

We cannot find any medical research from any source which will support the
international governmental contention that heroin harms the body or mind of
its users. Nor can we find any trace of our government or the American
government or any other ever presenting or referring to any credible version
of any such research. On the contrary, all of the available research agrees
that, so far as harm is concerned, heroin is likely to cause some nausea and
possibly severe constipation and that is all. In the words of a 1965 New
York study by Dr Richard Brotman: "Medical knowledge has long since laid to
rest the myth that opiates observably harm the body." Peanut butter, cream
and sugar, for example, are all far more likely to damage the health of
their users.

Now, move on to the allegation that heroin kills its users. The evidence is
clear: you can fatally overdose on heroin. But the evidence is equally
clear, that - contrary to the claims of politicians - it is not particularly
easy to do so. Opiates tend to suppress breathing, and doctors who prescribe
them for pain relief take advantage of this to help patients with lung
problems. But the surprising truth is that, in order to use opiates to
suppress breathing to the point of death, you have to exceed the normal dose
to an extreme degree. Heroin is unusually safe, because - contrary to what
those US congressmen were told in 1924 - the gap between a therapeutic dose
and a fatal dose is unusually wide.

Listen, for example, to Dr Teresa Tate, who has prescribed heroin and
morphine for 25 years, first as a cancer doctor and now as medical adviser
to Marie Curie Cancer Care. We asked her to compare heroin with paracetamol,
legally available without prescription. She told us: "I think that most
doctors would tell you that paracetamol is actually quite a dangerous drug
when used in overdose; it has a fixed upper limit for its total dose in 24
hours and if you exceed that, perhaps doubling it, you can certainly put
yourself at great risk of liver failure and of death, whereas with
diamorphine, should you double the dose that you normally were taking, I
think the consequence would be to be sleepy for a while and quite possibly
not much more than that and certainly no permanent damage as a result."
Contrary to the loudly expressed view of so many politicians, this
specialist of 25 years' experience told us that when heroin is properly used
by doctors, it is "a very safe drug".

Until the American prohibitionists closed him down in the 20s, Dr Willis
Butler ran a famous clinic in Shreveport, Louisiana, for old soldiers and
others who had become addicted to morphine after operations. Among his
patients, he included four doctors, two church ministers, two retired
judges, an attorney, an architect, a newspaper editor, a musician from the
symphony orchestra, a printer, two glass blowers and the mother of the
commissioner of police. None of them showed any ill effect from the years
which they spent on Dr Butler's morphine. None of them died as a result of
his prescriptions. And, as Dr Butler later recalled: "I never found one we
could give an overdose to, even if we had wanted to. I saw one man take 12
grains intravenously at one time. He stood up and said: 'There, that's just
fine,' and went on about his business."

Heroin can be highly addictive - which is a very good reason not to start
taking it. In extreme doses, it can kill. But the truth which has been
trampled under the cavalry of the drug warriors is that, properly
prescribed, pure heroin is a benign drug. The late Professor Norman Zinberg,
who for years led the study of drug addiction at Harvard Medical School, saw
the lies beneath the rhetoric: "To buttress our current programme, official
agencies, led originally by the old Federal Bureau of Narcotics, have
constructed myth after myth. When pushers in schoolyards, 'drug
progression', drugs turning brains to jelly, and other tales of horror are
not supported by facts, they postulate and publicise others: 'drugs affect
chromosomes'; 'drugs are a contagious disease'. Officials go on
manufacturing myths such as the chromosome scare long after they are
disproved on the self-righteous assumption that if they have scared one kid
off using drugs, it was worth the lie."

Take away the lies and the real danger becomes clear - not the drugs, but
the black market which has been created directly by the policy of
prohibition. If ever there is a war crimes trial to punish the generals who
have gloried in this slaughter of the innocent, the culprits should be made
to carve out in stone: "There is no drug known to man which becomes safer
when its production and distribution are handed over to criminals."

Heroin, so benign in the hands of doctors, becomes highly dangerous when it
is cut by black-market dealers - with paracetamol, drain cleaner, sand,
sugar, starch, powdered milk, talcum powder, coffee, brick dust, cement
dust, gravy powder, face powder or curry powder. None of these adulterants
was ever intended to be injected into human veins. Some of them, such as
drain cleaner, are simply toxic and poison their users. Others - sand or
brick dust - are carried into tiny capillaries and digital blood vessels
where they form clots, cutting off the supply of blood to fingers or toes.
Very rapidly, venous gangrene sets in, the tissue starts to die, the fingers
or toes go black and then have only one destiny: amputation. Needless
suffering - inflicted not by heroin, but by its black-market adulterants.

Street buyers cannot afford to waste any heroin - and for that reason, they
start to inject it, because smoking or snorting it is inefficient. The
Oxford Handbook of Clinical Medicine records that a large proportion of the
illness experienced by black-market heroin addicts is caused by wound
infection, septicaemia, and infective endocarditis, all due to unhygienic
injection technique. Street users invariably suffer abscesses, some of them
of quite terrifying size, from injecting with infected needles or drugs.
Those who inject repeatedly into the same veins or arteries will suffer
aneurisms - the walls of the artery will weaken and bulge; sometimes they
will start to leak blood under the skin; sometimes, these weakened arteries
will become infected by a dirty needle and rupture the skin, leaving the
user to bleed to death.

In the mid 90s, the World Health Organisation estimated that 40% of recent
Aids cases internationally had been caused by drug users sharing injecting
equipment. The British record on Aids is better because in the late 80s the
government quietly broke with its prohibition philosophy and started to
provide clean needles. Nevertheless, by June last year, 1,000 black-market
drug users in this country had died of Aids which was believed to have been
contracted from dirty needles. More needless misery and death.

Far worse, however, is the spread of hepatitis C, which can kill by causing
cirrhosis and sometimes cancer in the liver. The official estimate is that
300,000 people in this country are now infected. Dr Tom Waller, who chairs
Action on Hepatitis C, says the truth is likely to be much worse. And almost
all of these victims are black-market drug users who contracted the disease
by sharing dirty injecting equipment. Dr Waller says there is now a "major
epidemic", threatening the lives of "a great many people". Needlessly.

Street buyers buy blind and so they will overdose accidentally: they have no
way of telling how much heroin there is in their deal. Dr Russell Newcombe,
senior lecturer in addiction studies at John Moores University in Liverpool,
has found the purity of street heroin varying from 20% to 90%. "Users can
accidentally take three or four times as much as they are planning to," he
says. It is peculiarly ironic that governments set out to protect their
people from a drug which they claim is dangerous by denying them any of the
safeguards and information which they insist must apply to the consumption
of drugs which they know to be harmless. (Compare, for example, the
mandatory information on the side of a bottle of vitamin C tablets with the
information available to a black-market heroin user.)

Street buyers often run short of supplies - and so they mix their drug with
anything else they can get their hands on, particularly alcohol. Heroin may
be benign, but if you mix it with a bottle of vodka or a handful of
sedatives, your breathing is likely to become extremely depressed. Or it may
just stop. In any event, whether it is poisonous adulterants or injected
infection; whether it is death by accidental overdose or death by polydrug
use: it is the black market which lies at the root of the danger. The
healthiest route, of course, is not to take the drug at all: but for those
who are addicted, prohibition inflicts danger and death. Needlessly. Water
would become dangerous if it were banned and handed over to a criminal black
market.

The same logic applies to drugs which, unlike heroin, are inherently
harmful - such as alcohol, which is implicated in organic damage (liver) and
social problems (violence, dangerous driving). American bootleggers brewed
their moonshine with adulterants such as methylated spirits, which can cause
blindness. (Hence the proliferation of blind blues singers.) And there are
documented cases of drinkers during prohibition injecting alcohol, with all
of the attendant dangers. (It is instructive to look back on the
prohibitionists' efforts to justify their war against alcohol with hugely
inflated statements of its danger. In his book on the history of drugs,
Emperors of Dreams, Mike Jay records the claims that alcohol was an
"environmental poison" which generated cretinism and several otherwise
unrecognised syndromes including "blastophoric degeneration" and "alcoholic
diathesis".)

The risks of consuming LSD and ecstasy are increased enormously by their
illegal and unsupervised manufacture. Nobody knows what they are swallowing.
Yet, when a Brighton company developed a test to check the purity of
ecstasy, the government's drugs adviser, Keith Hellawell (whose contract has
just been suspended), condemned it and warned that the company risked
prosecution. It is the same with black-market amphetamines: speed alone may
not kill, but speed with a blindfold is highly likely to finish you off.

In the same way, the classic signs of social exclusion among addicts are the
product not of their drug but of the illegality of the drug. If addicts fail
to work, it is not because heroin has made them work-shy, but because they
spend every waking minute of the day hustling. If addicts break the law, it
is not because the drug has corrupted their morality, but because they are
forced to steal to pay black-market prices. If addicts are thin, it is not
because the drug has stripped away their flesh, but because they spend every
last cent on their habit and have nothing left for food. Over and over
again, it is the black market, which has been created by the politicians,
which does the damage.

Keith Hellawell, the man to whom the government turned for advice on drugs,
appeared to know none of this. When we interviewed him for a television
programme, he insisted that heroin itself was dangerous and then repeatedly
dodged requests to come up with any evidence at all to justify his claim.
Subsequently, when we offered his department as much time as it would like
to find any evidence, it failed to come up with anything at all and passed
the question to the Department of Health, which also failed. It is fair to
conclude that the government's former drugs adviser did not know the first
thing about heroin.

The confusion between the effect of the drug and the effect of the black
market is exacerbated not only because of government policy but also because
government statistics completely ignore this distinction, with the result
that teams of researchers study drug policy, use compromised statistics and
simply recycle the confusion, thus providing politicians with yet more false
fuel for their fire. Home Office figures on drug deaths, for example, are
hopelessly compromised. Eighteen months ago, the Department of Health, which
might have been expected to know better, produced new guidelines for doctors
dealing with drug users and recorded the following: "Generally there is a
greater prevalence of certain illnesses among the drug misusing population,
including viral hepatitis, bacterial endocarditis, HIV, tuberculosis,
septicaemia, pneumonia, deep vein thrombosis, pulmonary emboli, abscesses
and dental disease." All of it true of the black market. None of it true of
the drug. No attempt to make the distinction.

The black market damages not only drug users but the whole community.
Britain looks back at the American prohibition of alcohol in the 20s and
shudders at the stupidity of a policy which generated such a catastrophic
crimewave. Yet in this country, now, the prohibition of drugs has generated
a crime boom of staggering proportions. Research suggests that in England
and Wales, a hard core of black-market users is responsible for some =A31.5b=
n
worth of burglary, theft and shoplifting each year - they are stealing =A33.=
5m
worth of property a day. As a single example, Brighton police told us they
estimate that 75% of their property crime is committed by black-market drug
users trying to fund their habit. And yet governments refuse to be tough on
the cause of this crime: their own prohibition policy.

The global version of this damage was put succinctly by Senator Gomez
Hurtado, former Colombian ambassador to France and a high court judge, who
told a 1993 conference: "Forget about drug deaths and acquisitive crime,
about addiction and Aids. All this pales into insignificance before the
prospect facing the liberal societies of the west, like a rabbit in the
headlights of an oncoming car. The income of the drug barons is an annual
$500,000m, greater than the American defence budget. With this financial
muscle they can suborn all the institutions of the state and, if the state
resists, with this fortune they can purchase the firepower to outgun it. We
are threatened with a return to the dark ages of rule by the gang. If the
west relishes the yoke of the tyrant and the bully, current drug policies
promote that end."

Having attacked and maimed and killed the very people they claimed to be
protecting; having inflicted a crime wave on the same communities which they
said they were defending; having run up a bill which now costs us some
=A31.7bn a year in this country alone: this war's generals might yet have=
some
claim to respect if they were able to show that they had succeeded in their
original objective of stopping or, at least, of cutting the supply of
prohibited drugs. They cannot.

In December 1999, the chief constable of Cleveland police, Barry Shaw,
produced a progress report on the 1971 Misuse of Drugs Act, which marked the
final arrival of US drugs prohibition in this country: "There is
overwhelming evidence to show that the prohibition-based policy in this
country since 1971 has not been effective in controlling the availability or
use of proscribed drugs. If there is indeed a war against drugs, it is not
being won ... Illegal drugs are freely available, their price is dropping
and their use is growing. It seems fair to say that violation of the law is
endemic, and the problem seems to be getting worse despite our best
efforts."

Mr Shaw was able to point to a cascade of evidence to support his view:
between 1987 and 1997, there had been a tenfold increase in the seizure of
illicit drugs, and yet the supply on the streets was so strong that the
price of these drugs had kept dropping; in 1970, only 15% of people had used
an illegal drug, but by 1995, 45% had; in 1970, 9,000 people were convicted
of a drugs offence but in 1995 94,000 were. The Home Office responded to the
chief constable's report with complete silence: they refused even to
acknowledge receiving it. Internal reports from the American Drugs
Enforcement Agency confirm the chief constable's conclusion. (They say
Britain now produces so much cannabis that we actually export it to
Holland.)

Prohibition has not merely failed to cut the supply of illicit drugs: it has
actively spread drug use. The easiest way for new users to fund their habit
is to sell drugs and consume the profit; so they go out and find new users
to sell to; so it is that when one child in the classroom starts using,
others soon join in; one user in the street and neighbours soon follow.
Black-market drug use spreads geometrically. The Health Education Authority
in 1995 found that 70% of people aged between 11 and 35 had been offered
drugs at some time. Pushers push. When Britain began to impose prohibition
of heroin, in 1968, there were fewer then 500 heroin addicts in Britain - a
few jazz musicians, some poets, some Soho Chinese. Now, the Home Office says
there may be as many as 500,000. This is pyramid selling at its most
brilliantly effective.

In private, the Home Office's best defence is that it is so short of
reliable intelligence on drugs that nobody can finally prove that the war is
lost: we simply don't know how much heroin or cocaine is imported, or how
many people are using it.

Keith Hellawell argued that the 30 years since the Misuse of Drugs Act do
not really count, because, until he took over, British governments did not
have a real strategy. He told us he was supporting new international tactics
(which he could not divulge) and was now seeing figures (which he could not
give us) to suggest finally they were going to succeed. This recalls earlier
declarations that "We have turned the corner on drug addiction" (President
Nixon, 1973), or "Heroin availability continues to shrink" (DEA, 1978). In
the meantime, world heroin production has tripled in the past decade,
cocaine production has doubled and, in the foreign secretary's Blackburn
constituency, police say drug use in the Asian community has soared by 300%
in four years.

But the underlying point is even more worrying: once you understand that the
real danger comes from the black market and not from the drug, you can see
that even if, with some magic formula, the generals started to cut the
supply of these drugs, the result would be disastrous. The price of heroin,
for example, would start to rise and, since there is no evidence at all that
heroin addicts cut their consumption to fit their wallets, they would have
to commit more crime to fund their habits. And if the dealers also responded
like good entrepreneurs, they would try to keep their prices down by adding
even more pollutants to the heroin, thus increasing the health risks to
users.

This government has not begun to consider legalisation. No matter the truth
about the danger and the death, no matter the truth about the cause of
crime, the position is, as Jack Straw put it to the 1997 Labour conference:
"We will not decriminalise, legalise or legitimise the use of drugs." Why?
The obvious answer was offered to us by Paul Flynn, Labour backbencher and
staunch opponent of prohibition: "It is being fuelled by politicians who are
vote gluttons, who believe that there is popularity and votes to be gained
by appearing to be tough on drugs."

While Keith Hellawell and other prohibitionists are embarrassed by their
screaming lack of success, those who want to legalise can point to clear
evidence that providing a clean supply of drugs will help with the physical
and mental health of users, will cut crime in the community and drain the
life out of the black market.

The Swiss, for example, in 1997 reported on a three-year experiment in which
they had prescribed heroin to 1,146 addicts in 18 locations. They found:
"Individual health and social circumstances improved drastically ... The
improvements in physical health which occurred during treatment with heroin
proved to be stable over the course of one and a half years and in some
cases continued to increase (in physical terms, this relates especially to
general and nutritional status and injection- related skin diseases) ... In
the psychiatric area, depressive states in particular continued to regress,
as well as anxiety states and delusional disorders ... The mortality of
untreated patients is markedly higher." They also reported dramatic
improvements in the social stability of the addicts, including a steep fall
in crime.

There are equally impressive results from similar projects in Holland and
Luxembourg and Naples and, also, in Britain. In Liverpool, during the early
1990s, Dr John Marks used a special Home Office licence to prescribe heroin
to addicts. Police reported a 96% reduction in acquisitive crime among a
group of addict patients. Deaths from locally acquired HIV infection and
drug-related overdoses fell to zero. But, under intense pressure from the
government, the project was closed down. In its 10 years' work, not one of
its patients had died. In the first two years after it was closed, 41 died.

There is room for debate about detail. Should we supply legalised drugs
through GPs or specialist clinics or pharmacists? Should we continue to
supply opiate substitutes, such as methadone, as well as heroin? Should the
supply be entirely free of charge to guarantee the extinction of the black
market? How would we use the hundreds of millions of pounds which would be
released by the "peace dividend"? But, if we have any compassion for our
drug users, if we have any intention of tackling the causes of crime, if we
have any honesty left in our body politic, there is no longer any room for
debate about the principle. Continue the war against drugs? Just say no.

 

 

 

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