The Guardian, February 2001
It is a strange but revealing fact that hundreds of thousands of people in this country are currently afflicted by a dangerous and highly infectious disease and that, even though the government has been warned repeatedly that many thousands of these people will die, the current position of the Department of Health is that they are reviewing the report of an advisory group to decide whether they might then set up a special working group which might then develop a strategy to deal with it.
The disease is Hepatitis C, which attacks the liver. Even though there are probably at least 300,000 sufferers in the UK; even though specialist doctors say that 100,000 of them will suffer cirrhosis or cancer of the liver in the next five or ten years; even though the infection is still spreading: the position remains that the Department of Health has set up no system to monitor the epidemic, has failed to fund any kind of public information campaign, refuses to offer systematic screening or testing for potential carriers, has established no prevention strategy at all and refuses even to treat many sufferers.
The explanation for this extraordinary lack of action appears to be that almost all of the victims of Hepatitis C belong to one of the least popular political minorities in Britain - drug users, who contracted the illness by using dirty injection equipment. Dr Tom Waller, who chairs the medical pressure group Action on Hepatitis C, says it is 'a distinct possibility' that this is the cause of the problem: "This is life threatening to a large number of people. You'd think the Department of Health would want to stand on its head if necessary to prevent it." As it is, many health authorities simply refuse to fund the best available treatment, which involves a combination of interferon and ribavirin.
There is no arm of British health care which has been so perverted by politics as the treatment of drug users. In the early days of American prohibition, this was the politics of racism - spics and niggers smoked marijuana, chinks smoked opium, and they would all get what was coming to them. In the 1960s, it was the politics of reaction - hippies smoked everything and attacked the establishment, so the establishment attacked them back. Now, it is simply the pure politics of power: you win votes by waging war on druggies.
You can see the politics perverting the health care with particular clarity in New Labour's adoption of Drug Treatment and Testing Orders. The problem here is not just the moral one of whether it is acceptable to compel drug users to undergo treatment under threat of punishment. Nor is it simply the practical problem of allowing those who have broken the law to jump the queue for treatment in front of those who have not. The real problem with DTTOs is that they are a political project built on a foundation of falsehood.
It was the Home Office minister Paul Boateng who last September announced that courts all over England and Wales would now be allowed to impose DTTOs to compel offenders to undergo treatment for their drug problems. Mr Boateng explained that his decision followed three pilot schemes, in Croydon, Liverpool and Gloucester which had proved to be successful. Among those who took part in the pilots, he said, there had been a 'dramatic' fall in the number of offences they committed and in the amount of money which they spent on drugs. The reality, however, was rather different.
One of the key questions for these pilots was whether drug users would co-operate with treatment which was being forced upon them. The researchers who were hired to study the three pilots found that, even though the 210 offenders had been handpicked, nearly half of them (46%) vanished or were thrown out of the scheme long before it finished its trial run; numerous others were warned for breaching its conditions; and the researchers found that "failure to meet conditions of the order was common in all three sites". Mr Boateng simply did not mention any of this.
One of the 'dramatic' results to which Mr Boateng referred was that within a month of being put on the order, offenders had cut their weekly spending on drugs from £400 to only £25. This was, indeed, a dramatic fall, which sat oddly with the conclusion of the researchers that "quite clearly, many offenders in all three pilot sites were continuing to use illegal drugs". It turns out that this supposedly dramatic result was based entirely on untested claims made by those offenders who had not already been thrown off the scheme and who knew that if they were caught taking drugs, they were liable to be sent back to court for a harsher punishment. Furthermore, these offenders who were claiming to have cut their spending on drugs by 94% had been failing urine tests throughout the scheme: they had failed 42% of their heroin tests, 45% of cocaine tests and 58% of methadone tests. In some cases, they were failing more urine tests at the end of the 18-month pilot than they had been at the half-way point. Indeed, their consumption of drugs remained so high that, by the end of the trial, all three schemes had stopped even requiring them to be drug free, asking only that they "make progress in addressing" their drug problems. Mr Boateng did not mention any of this either.
The other 'dramatic' result on which Mr Boateng relied for his success story was that, within a month, offenders were committing far less crime - only 34 offences a month compared to 137. But this, too, was based on nothing more than asking the offenders who stayed in the scheme whether they had been out thieving. Mr Boateng failed to mention that some of these law-abiding guinea pigs were actually arrested for committing new offences during the pilots. At the end of the 18-month scheme, the researchers could find only 27 of the 210 offenders who "seemed to emerge drug free" - and they were able to come to that conclusion only by a) overlooking the fact that only 13 offenders passed the final urine tests and b)ignoring their use of cannabis. The best that the researchers could say was that the scheme was "promising but not proven."
However, none of this troubled Mr Boateng. Even though these pilots had been set up explicitly "to enable the Home Office to decide whether or not to extend the order across the country" and even though the results were so equivocal, Mr Boateng went ahead and declared them 'successful' and invested £60 million of tax payers money in rolling them out nationally. He managed to square this with the results of the pilot studies with one brilliantly effective tactic: in a move which left his researchers 'flabbergasted', he simply did not wait to be told the bad news and made his decision months before the results of the research were known. And this really did not matter at all because even if the scheme does fail, its no-nonsense toughness on druggies has been a great success from the political point of view.
The real problem, however, lies deeper - in the profound and alarming ignorance of the power elite. There are vocal politicians and senior officials who make policy on drugs and there are leader writers and pundits who support them, and yet they genuinely do not know the first thing about them. Specifically, the politicians' love of prohibition identifies the drugs themselves as the source of danger to their users. As the Guardian showed yesterday, the truth is that the real dangers come from the blackmarket which has been created by prohibition. By refusing to acknowledge this medically verifiable fact, the politicians have created a treatment strategy which consistently pushes highly vulnerable drug users into extreme danger. Take heroin as an example.
Until the early 1970s, Britain was a haven of enlightenment: every doctor in the country had the right to prescribe heroin for the welfare of patients. This reflected the idea, powerfully proposed by the Rolleston Committee in 1926, that drug use should be seen as a problem which needed help, not as a sin which needed punishment. There were fewer than 500 addicts in the country, most of them musicians or Chinese. With a clean, legal supply of their drug, they remained healthy and were able to live normal lives. Then three London doctors were caught selling inflated prescriptions; there was a moral panic; and Britain's resistance to prohibition started to crumble under political pressure, some of it from the United States which was already committed to imposing a global policy of prohibition.
The result was that doctors generally were forbidden to prescribe heroin to addicts, who were thus forced to buy their supplies illegally: the blackmarket started to grow, inflicting illness and infection on addicts and embroiling them in theft and prostitution to find funds. A small detachment of common-sense realism slipped under the fence, but was soon pinned down by hostile political fire: the Home Office agreed to license specialist psychiatrists to continue to prescribe for heroin users. This might have saved addicts from disaster, but, as the babble of the prohibitionists drowned the voice of reason, the Home Office - apparently under more pressure from the United States - undermined the system by insisting that these licensed doctors should prescribe heroin substitutes, such as physeptone and methadone, instead of heroin. Furthermore, the Home Office insisted, these substitutes should be prescribed only in rationed and rapidly diminishing quantities.
This sealed the catastrophe: most heroin users did not like physeptone and methadone and sold their supplies; those who did like them found their supplies were rapidly cut off. In either event, to satisfy their addiction, they were pushed back onto the blackmarket, back to the dangers. The British System of support for addicts, which had been admired around the world, was dead.
Since then, it has emerged that the government's favourite heroin substitute, methadone, is more addictive than heroin and also more likely to cause fatal overdose. In a detailed study, 'Methadone and Heroin, an exercise in medical scepticism', Dr Ben Goldacre found that: "Methadone is a more dangerous drug than heroin, and causes more deaths than even adulterated street heroin". A study by Dr Russell Newcombe, senior lecturer at John Moores University, Liverpool found that methadone was four times more likely than heroin to cause fatal overdose. And yet - for entirely political reasons - this is the drug which the government insists be prescribed to heroin addicts.
The bottom line now is that after thirty years of prohibition, the number of heroin addicts has rocketed from less than 500 to as many as 500,000. Around 20,000 of them are being given the arguable benefit of a limited prescription for methadone. And the number of heroin addicts who are allowed a limited prescription for a safe supply of the drug to which they are addicted is less than 500. The hundreds of thousands of others are are thrown out onto the blackmarket, condemning them to precisely the dangers from which which the politicians claim to be saving them.
New Labour's strategy for the treatment of heroin users compounds all of these errors - consistently increasing the risk to addicts. So, for example, ignoring more than 15 years of medical warning on the relative danger of methadone, the department of health's new 1999 prescribing guidelines, known as the Orange Book, continue to advise doctors who care for heroin addicts to prescribe methadone instead of heroin. And, repeating the policy which for 30 years has pushed addicts into the dangers of the black market, the Orange Book continues to urge that doctors should generally prescribe only in rationed and rapidly diminishing quantities.
The Orange Book makes matters even worse by giving GPs an explicit responsibility not just to prescribe the approved quantity of methadone but then to ensure that "the drug is used appropriately and not diverted onto the illegal market". GPs have no such power. The result is that, spurred on by the government's ferocious rhetoric, police have moved in on doctors whose patients have sold their methadone or overdosed: GPs in Carlisle, Essex, London, Luton, Plymouth, Portsmouth, Suffolk and Surrey have found themselves in serious trouble. This, in turn, has had a chilling effect on other GPs who might have considered prescribing methadone to local users as a temporary refuge from the blackmarket. Professor Gerry Stimson, of Imperial College London, who has studied illicit drugs for 30 years, told us: "We're seeing court cases against doctors and other drugs workers or police attention to prescribing doctors which is actually scaring many doctors away."
Across the field, the government's professed desire to offer more treatment to drug users is being undermined by its hardline politics. Chemists who try to supply prescriptions of methadone or diamorphine report hostile visits from police. The All Party Parliamentary Drugs Misuse Group last year took evidence of a psychiatric ward where drug users seeking treatment had been confronted by police with sniffer dogs. A north London priest, Father Peter Anderson, found himself denounced by the local coroner for supposedly condoning criminal activity because he had allowed homeless drug users to sleep in the grounds of his church. A Release conference last year heard that, if a drug user overdoses, other users are often scared to call an ambulance for fear of being arrested.
Professor Stimson says the root of the problem is the government's ferocious rhetoric: "It sets the wrong tone. You are dealing with people who are already quite marginalised and stigmatised and, if you are having that sort of rhetoric, then you are pointing the finger, scapegoating people. But also politicians get carried away with that rhetoric and they become tougher, they dream up new legislation, they dream up tougher ways of doing things which can backfire and can have adverse effects."
So, for example, the government wants police to be able to deny bail to anyone they suspect of being involved with drugs (so users will be discouraged from carrying their own clean needles or drugs-advice leaflets); to introduce new licences to limit the number of doctors who can prescribe injectible methadone as opposed to the oral linctus (so users who like to inject will end up using blackmarket needles in dirty conditions); to remove the passports of anyone who has a drug offence (so no past user will ever be able to enjoy a normal life).
The drugs war is a political war. It was political when, as Edward Jay Epstein recorded, President Nixon gave a shot in the arm to his election campaign by fiddling the figures to create a non-existent heroin epidemic, from which he could then promise to rescue the electorate. It was political when Tony Blair announced his plans to appoint a 'drugs czar' - in a secondary school full of sweet, vulnerable children in the middle of the 1997 election campaign.
The masters of the war have always been American politicians. When the Swiss held a referendum on limited heroin legalisation in 1997/8, the US congressional subcommittee on national security, international affairs and criminal justice openly intervened. "We wholeheartedly oppose this sort of government gambit", the committee declared, as though it had some sort of jurisdiction in Switzerland. When Dr John Marks was forced to close Britain's most successful recent project to provide clean heroin for addicts, on Merseyside, the International Herald Tribune carried a report that American drugs agencies had been infuriated when they saw the project on CBS television: "Dr Marks was warned by friends in the Home Office that the US Embassy was exerting tremendous pressure to shut him down and, in the end, it was successful."
New Labour drugs policy has been shaped by political in-fighting. The Home Office tried to stop Keith Hellawell setting targets for reduction in drug use. Hellawell went off to Downing Street and got the Prime Minister on side. The Home Office then complained that the targets were too high. Hellawell persisted and then found reporters were being briefed that his targets were nonsense since nobody knew how many people were using drugs now, so there was no baseline to set a future target. In the meantime, the Prime Minister announced that anyone who is arrested will be urine-tested for drugs; Hellawell's people had a fit because they hadn't approved the plan and , very soon, reporters were being briefed that the PM's plan would be "kicked into the long grass". And in the background, Hellawell was falling out with the department of health who produced their Orange Book guidelines for doctors without consulting him. "I am the line," he announced.
In this politically-charged atmosphere, it is a heresy to question the value of prohibition. Transform, the only pressure group campaigning for legalisation, wants to commission an opinion poll which may show politicians that public opinion has moved ahead of them, but, at the moment, nobody with any power dares to break ranks. The interesting thing is that the group who in private are now most keen on legalisation are chief constables. We spoke to four of them who were passionately opposed to the war against drugs. None of them would speak publicly. What they can see, however, is that there is a way out. The war against drugs is unique in all conflict: we can win it, simply by ceasing to fight it.
The faith of well-meaning liberals in New Labour's plan to offer more treatment for drug users has all the moral force of well-meaning Christian folk in the nineteenth century who considered the use of child labour in Victorian coal mines, saw that it was wrong, lacked the political or intellectual courage to say that it must stop and suggested instead that their hours of work might be limited. No treatment strategy will succeed for as long as it is based on the medically false but politically popular idea that the nature of these drugs is such that they must be banned.
Future historians will look back on our treatment of drug users in the same way as we now look back on the Victorian treatment of those in Bedlam - beaten for their pain. Every victim of the war against drugs is a lesson in the futility of the war, a screaming message of contradiction to the politicians' errors. They may have become drug users for all kinds of reasons - the pursuit of pleasure, or obsessive flight from pain - but most of those who have lost their jobs or homes; most of those who have been driven into prostitution or thieving; most of those who have become ill or who have died, have been sacrificed to the ambition of politicians who never did have any reason to attack them but who continue to do so now only because they are too stupid or too ignorant or too callous or too plain scared to admit the truth, that, with their policy of prohibition, they are themselves the architects of this disaster.
Additional Research by Max Houghton