What's wrong with the war against drugs

The Guardian, February 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, like 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 on the planet. 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, it still goes on, more vigorous than ever, arguably the longest-running conflict on the planet.

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 blackmarket 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 multi-million pound campaign under the slogan 'Heroin Screws You Up'. Think of Tony Blair at the 1999 Labour Party 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 1920s. 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 twenty 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 twelve years injecting up to 350 mgs 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 ununusally 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 paracetomol, 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 1920s, 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 program, 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 publicize 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 blackmarket 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 blackmarket dealers - with paracetomol, 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, like drain cleaner, are simply toxic and poison their users. Others - like 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 blackmarket 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 blackmarket 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 aneurysms - 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 1990s, 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 1980s, the government quietly broke with its prohibition philosophy and started to provide clean needles. Nevertheless, by June last year, one thousand blackmarket 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 blackmarket 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 blackmarket 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 blackmarket 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 blackmarket.

The same logic applies to drugs which, unlike heroin, are inherently harmful - like alcohol, which is implicated in organic damage (liver) and social problems (violence, dangerous driving). American bootleggers brewed their moonshine with adulterants like 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 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 'blastopthoric degeneration' and ‘alcoholic diathesis'.)

The risks of consuming LSD and Ecstacy 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 Ecstacy, the government's drugs advisor, Keith Hellawell, condemned it and warned that the company risked prosecution. It is the same with blackmarket 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 workshy, 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 blackmarket, which has been created by the politicians, which does the damage.

The man to whom the government turns for advice on drugs, Keith Hellawell, appears to know none of this. When we interveiwed him for Channel Four, 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 they would like to find any evidence, they failed to come up with anything at all and passed the question to the department of health, who also failed. It is fair to conclude that the government's drugs adviser literally does not know the first thing about heroin.

The confusion between the effect of the drug and the effect of the blackmarket is riddled not only through government policy but also through government statistics which completely ignore the 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 amongst the drug misusing population, including viral hepatitits, bacterial endocarditis, HIV, tuberculosis, septicaemia, pneumonia, deep vein thrombosis, pulmonary emboli, abscesses and dental disease." All of it true of the blackmarket. None of it true of the drug. No attempt to make the distinction.

The blackmarket damages not only drug users but the whole community. Britain looks back at the American prohibition of alcohol in the 1920s and shudders at the stupidity of a policy which generated such a catastrophic crime wave. 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 blackmarket users is responsible for some £1.5 billion worth of burglary, theft and shoplifting each year - they are stealing £3.5 million worth of property a day. As a single example, Brighton police told us they estimate that 75% of their property crime is committed by blackmarket drug users trying to fund their habit. And yet goverments 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 five hundred thousand million dollars, 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 £1.7 billion 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 more 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. Blackmarket drug use spreads geometrically. The Health Education Authority in 1995 found that 70% of people aged between eleven and thirty five had been offered drugs at some time. Pushers push. When Britain began to impose prohibition of heroin, in1968, 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 five hundred thousand. This is pyramid selling at its most brilliantly effective.

In private, the Home Office's best defence is that they are so short of reliable intelligence on drugs that nobody can finally prove that the war is lost: they simply don't know how much heroin or cocaine is imported, or many peope are using it. At the Cabinet Office, Keith Hellawell argues 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 last decade, cocaine production has doubled and, in the Home 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 blackmarket 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 blackmarket.

The Swiss, for example, in 1997 reported on a three-year experiment in which they had prescribed heroin to1,146 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 Luxemburg 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 ten years' work, not one of its patients had died. In the first two years after it was closed, forty one 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, like methadone, as well as heroin? Should the supply be entirely free of charge to guarantee the extinction of the blackmarket? 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.

Additional research by Jane Cassidy

See below for quotes on prohibition of drugs and alcohol

"All penalties for drug users should be dropped ... Making drug abuse a crime is useless and even dangerous ... Every year we seize more and more drugs and arrest more and more dealers but at the same time the quantity available in our countries still increases... Police are losing the drug battle worldwide." Raymond Kendall, secretary general of Interpol, January 1994

"The prestige of government has undoubtedly been lowered considerably by the prohibition law. For nothing is more destructive of respect for the government and the law of the land than passing laws which cannot be enforced. It is an open secret that the dangerous increase of crime in this country is closely connected with this."
Albert Einstein "My First Impression of the U.S.A.", 1921

"The current policies are not working. We seize more drugs, we arrest more people, but when you look at the availability of drugs, the use of drugs, the crime committed because of and through people who use drugs, the violence associated with drugs, it's on the increase. It can't be working." Keith Hellawell, Guardian 23 May 1994, three years before he was appointed drugs adviser to the government.

"Our emphasis here is based not only on the growing seriousness of drug-related crimes, but also on the belief that relieving our police and our courts from having to fight losing battles against drugs will enable their energies and facilities to be devoted more fully to combatting other forms of crime. We would thus strike a double blow: reduce crime activity directly, and at the same time increase the efficacy of law enforcement and crime prevention." Milton Friedman "Tyranny of the Status Quo"

When the tyrant has disposed of foreign enemies by conquest or treaty, and there is nothing to fear from them, then he is always stirring up some war or other in order that the people may require a leader. -- Plato

Prohibition is an awful flop.
We like it.
It can't stop what it's meant to stop.
We like it.
It's left a trail of graft and slime
It don't prohibit worth a dime
It's filled our land with vice and crime,
Nevertheless, we're for it.
-- newspaperman Franklin P. Adams, 1931, in the New York World, on the release of the Wickersham Commission report

I am against Prohibition because it has set the cause of temperence back twenty years; because it has substituted an ineffective campaign of force for an effective campaign of education; because it has replaced comparatively uninjurious light wines and beers with the worst kind of hard liquor and bad liquor; because it has increased drinking not only among men but has extended drinking to women and even children. -- William Randolph Hearst, initially a supporter of Prohibition, explaining his change of mind in 1929. From "Drink: A Social History of America" by Andrew Barr (1999), p. 239.

"There is thus general agreement throughout the medical and psychiatric literature that the overall effects of opium, morphine, and heroin on the addict's mind and body under conditions of low price and ready availability are on the whole amazingly bland." Edward M. Brecher, 1972

"The available evidence indicates that heroin, when provided in pure form, is a relatively safe drug. Hence it is primarily the illegal nature of the drug, rather than its pharmacological properties, which leads to the health and social problems associated with its use." Ostini, Bammer, Dance and Goodwin. 'The Ethics of Experimental Heroin Maintenance.' Journal of Medical Ethics, 1993.

"When heroin-dependent persons have been provided with daily maintenance doses under medical supervision, marked physiological deterioration or significant psychological impairment has not been observed. In fact, most of the serious adverse consequences of chronic heroin use are generally related to lifestayle and factors involving needle administration." Cox et al, Toronto Addiction Research Foundation

"Heroin is very addictive but does not in itself cause any serious illnesses, nor does it harm any organs or tissues." Dr Ben Goldacre Dr Ben Goldacre, 'Methadone and Heroin: An Exercise in Medical Scepticism'

"To our surprise we have not been able to locate even one scientific study on the proved harmful effects of addiction. Earlier investigators had apparently assumed that the ill effects were so obvious as not to need scientific verification. " Dr. George H. Stevenson, British Columbia, 1956.

Dr Van den Brink, in charge of Duthc research into prescription of heroin for drug users, preparing report for Dutch Health Minister Borst, press interview: "We can only do what is within our reach. But if we thought that treating heroin addicts with heroin was nonsensical and dangerous, we would not make these recommendations."

"The addict when not deprived of his opium showed no abnormal behavior which distinguished him from a nonaddict." yielded similar findings. Dr. George B. Wallace on two studies at Bellevue Hospital in New York City

"It has not been possible to maintain that addiction to morphine causes marked physical deterioration per se." Dr Harris Isbell, director of the Public Health Service's Addiction Research Center in Lexington, 1958,

"The addict under his normal tolerance of morphine is medically a well man." Dr Walter G. Karr, University of Pennsylvania biochemist,1932

"Given an addict who is receiving (adequate) morphine ... the deviations from normal physiological behavior are minor (and) for the most part within the range of normal variations." Dr. Nathan B. Eddy, after reviewing the world literature on morphine, 1940

"Medical knowledge has long since laid to rest the myth that opiates inevitably and observably harm the body." Drs Richard Brotman, Alan S. Meyer, and Alfred M. Freedman, 1965:

"The incidence of insanity among addicts is the same as in the general population." Dr Marie Nyswander, 1956.

"As to possible damage to the brain, the result of lengthy use of heroin, we can only say that neurologic and psychiatric examinations have not revealed evidence of brain damage.... This is in marked contrast to the prolonged and heavy use of alcohol, which in combination with other factors can cause pathologic changes in brains, and reflects such damage in intellectual and emotional deterioration, as well as convulsions, neuritis, and even psychosis." Dr. George H. Stevenson, British Columbia 1956.

"Morphine does not cause any permanent reduction in intelligence." Drs Harris Isbell and H. F. Fraser, Public Health Service addiction center, Lexington, Kentucky, 1950.

"In spite of a very long tradition to the contrary, clinical experience and statistical studies clearly prove that psychosis is not one of 'the pains of addiction.' Organic deterioration is regularly produced by alcohol in sufficient amount but is unknown with opiates." Deputy Commissioner Henry Brill, New York State Department of Mental Hygiene, chairman of the American Medical Association's narcotics committee, after a survey of 35,000 mental hospital patients. 1963.

"That individuals may take morphine or some other opiate for twenty years or more without showing intellectual or moral deteriorationis a common experience of every physician who has studied the subject." Dr Lawrence Kolb, US assistant surgeon general, 1925.

The politics of the drug war

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

System failure: How to lose the fight for law and order

The Guardian June 2003

Right there. That's where they got the Yardie guy. He was in that pub, the Jolly Roger, over on the corner of All Hallows Road and, although it's dark now and our van is racing, we can still catch a glimpse of the lamplit pavement where he lay with his blood pooling over the kerb and onto the tarmac street.

There were people standing all around, but it was one of those times when nobody saw anything. It seems like the men with the knives sent a message into the pub - "Tell Chrissie to come outside" - and for some reason (maybe he was stupid, maybe he was just too cool to be scared) he went out to them, and they slashed him 24 different times, tore open his belly and stabbed him through the skull on the neatly swept pavement of a quiet street in a city in south west England.

The inspector in the van says they never caught the people who did it. They tried. They arrested something like 19 different men including a former police officer - most of them Yardies from East Kingston, which is the original home of the Hype Crew and the Mountain View Posse and the Back to Back Gang and of most of the other Jamaican gangsters who have moved into this part of Bristol. But they couldn't prove anything against anybody. They just didn't have the evidence.

And that's how it is. The inspector knows it. Any police officer of any rank knows it. What see you on The Bill is not what you get in real life. Most of the time, most criminals get away with most of their crimes. The Home Office know it too. They crunched together their best statistics and analysed a hundred typical offences and then they worked out how many of them were actually brought to justice (which means a conviction, a caution, or being 'taking into consideration' for sentencing). And the answer they found was..... three. To put it the other way around: as far as we know, from the best research available, 97% of offences are never brought to book.

And that's the strange thing about this criminal justice system. It has power and, ever since Sir Robert Peel first picked up a truncheon, it has been gathering more. It has money. It is the one and only limb of the public sector which escaped the cuts of the Tory years. Even defence took a dip with the 'peace dividend' after the fall of the Soviet Union. But all through the years of the cuts, the funding of the enforcement of the law grew, from less than £5 billion in the early 1980s until, by the end of the last Major government, we were spending £16.2 billion a year on chasing and punishing criminals, most of whom were not Yardie gangsters but pimply adolescents armed with nothing more sophisticated than the sawn-off top of a Pepsi bottle (they use it to prise open Yale locks). And they were still getting away with 97% of their crime. The criminal justice system bristles with questions. There is only one that really matters. Who's winning?

An hour ago, the inspector addressed the troops. They were in the old police gym, 40 men and women in white shirts and black stab-proof vests, sitting on crooked rows of plastic chairs in amongst the battered punch bags and weight-lifting machines. A rusty bucket collected rainwater at the bottom of the concrete steps. It was very quiet while the inspector spoke, and they sat with their arms folded and their chins on their chests. "This is a really serious situation," he told them.

He described how the Yardies were being attacked by Bristol-born dealers who call themselves the Aggi Crew. The Aggis used to run the St Paul's area in the city centre, which is a magnet for drug deals, but a few years ago, the police busted them, and they all went to prison. Now they're out again and they want their turf back. A few weeks ago, five of them put on balaclavas and picked up guns and made a personal tour of the local bars - the Black Swan, the Malcolm X Centre, Lebeqs and the Caribbean Club - and announced that they were taking over. They offered the Yardies a deal: they could stay and work in St Paul's, but they'd have to pay a tax for the privilege. £50 a day for each Yardie and £100 a day for any business they were running.

The Yardies didn't like that idea. They met in one of the local cafes that has an illegal gambling room in the back, carrying their Mag 9 automatic pistols and their Brocock Magnum air pistols converted to fire live rounds, and they agreed that, first, they would not be paying the tax, and second, they would take on the Aggis. But one of the Yardies changed sides and went over to the Aggis (for a fee). The next night, in Badminton Road, he caught up with one of his former mates and shot him through the back of the knee with a 9mm handgun. The main man in the Aggi Crew repeated the message in the Caribbean Club, where he started jeering at a bunch of Yardies; he attacked one of them, a guy called Dufus, and hit him across the face with his pistol; Dufus went home and got his gun and came back and shot the Aggi (didn't kill him.)

So, naturally, the Aggis attacked the Yardies' street-dealing operation, staged some rip-off robberies, stole their drugs at gun point, and kidnapped one of them - they hauled this guy out of his home, locked him up in the boot of their car and drove him off somewhere quiet where they pistol-whipped him. And just to make the point that they were in charge now, two Aggis walked into the Black and White Cafe on Grosvenor Road and robbed every single Yardie in there at gun point.

If tonight's the night that the Yardies hit back, there is going to be blood on the streets. The inspector tells his officers: "The danger is that there are people out there who have killed before, in other countries." He tells them their priorities: above all, community reassurance; apprehend drug dealers; take firearms off the street; public safety; flexible response to whatever goes off. In one corner of the gym, a group of the officers are carrying handguns. For the first time in the history of Bristol (and for almost the first time in the history of any British city) there will be armed police on the streets - not covertly in plain cars, but overtly where the people of St Paul's can see the protection and where the gangsters can see the threat.

But the rest of them will be unarmed. The inspector tells them how to contact the special intelligence cell, to check car numbers and IDs; how to link up with the 24-hour charging unit who will handle all the paperwork on arrests. He shows them mugshots of the Aggis and warns them to look out for the mixed-race male with the burgundy scarf who shot and pistol-whipped a man on Saturday night. He has a silver revolver, his mate has a seven-inch knife. He tells them not to use their radios - there are scanners out there, so stick to mobile phones. "And don't self-deploy," he tells them. "This is about your safety as well as public safety."

There has never been a human community without crime. There are thousands of specialist academics around the world who have tried to put their finger on why some communities generate so much more than others, why some individuals are so criminal, why some victims are so vulnerable. Some thought that crime was linked to consumption: more goods, so less need to steal. Then they discovered the opposite: more goods, so more opportunity to steal. Then they discovered the opposite again: more goods, so lower prices, so less that is worth stealing. No theory fits. Not poverty, or inequality, or maternal deprivation or paternal absence. They all have some impact - big sources and small sources, all constantly shifting in power and in relationship to each other. It's like trying to map the wind - infinitely complex.

And crime control is just as complicated. Councils put up street lights: the night crime falls; but the day crime falls too. Nobody knows why. New York police clamped down on their first generation of crack dealers, imprisoned masses of them, but gun crime soared: the second generation were younger, more impulsive and they had seen what had happened to their older brothers. People carry credit cards instead of cash; mugging falls. They get mobile phones; mugging rises. The police chase around behind them. Governments hire more police officers to cut crime; the extra officers discover more offences; so recorded crime rises. Crime has risen almost constantly for many decades, and yet the criminal justice system now delivers fewer detections and fewer convictions than it did only 15 years ago.

An hour after the briefing, the inspector in the van prowls St Paul's, his ear-piece crackling with updates from the men on the women on the street. This is the police at maximum force - manpower, fire power, intelligence back-up. Who's winning? At the moment, it's quiet on the streets - on Foster Street where a man had his car stolen from him at gun point, on Denbigh St where they stabbed a man in the street before they robbed him, outside the St Nicholas pub where somebody absent-mindedly left a fistful of shotgun cartridges on the bar. The inspector cruises past the Black and White Cafe and automatically glances up at the roof of the council flats across the road. The Aggis were up there the other day, firing giant fireworks like mortar rounds at the cafe door, to oust the Yardies. They've fired them direct at his van too, from close range.

Tonight is just the latest crisis. This has been building up for two years. The night they murdered Chrissie Hewitt outside the Jolly Roger was more or less the beginning. That was in June 2001 and the police knew then that something strange and terrible was happening in St Paul's. There was crime bubbling out of the ground like swamp water. Some of it was hideous - vicious assaults and kidnappings - and, when they looked back at the end of the year, they found their 'major and serious' crime had shot up by 72%. And the ordinary everyday crime had shot up with it - robberies nearly doubled that year. People breaking into cars, breaking into houses, snatching bags in the street.

That summer, the St Paul's Carnival turned into a shooting match. The Burga Crew came down from Birmingham; one of the Bristol Yardies shot one of them with a nail gun; the Burga Crew pulled out their guns; the Bristol guys got theirs; somebody had a machete. That night, there were at least five separate gun attacks. Nobody even really knew what it was all about - might have been a squabble about a drugs deal, might have been a ripple from some turf war over in Kingston, where the Yardie gangs are locked into alliances with local politicians, controlling whole neighbourhoods with corruption and fear.

The police were ahead of the game. As early as February 2001, they had spotted the Yardies coming in and set up a special team to gather intelligence. They found there were Yardies crawling all over St Paul's, maybe 200 of them, some of them well-known in East Kingston as killers. Within a week of that first Yardie murder, they had pulled in 19 more officers to tackle the open drugs market which was now booming around Grosvenor Road and to target the Yardies who were behind it - who had been giving away crack cocaine and selling 'snowballs' of heroin and crack combined, expanding their client base. On Grosvenor Road, the dealers had started wearing bullet-proof vests.

That autumn, 2001, the police were all over them. They found a local guy was running a phony college on Lower Ashley Road, selling enrolment to non-existent courses so that gangsters and their smugglers could slide through immigration controls - 300 of them in less than a year. They set up a new unit to track their money, busted a greengrocer and a travel agent for money-laundering and followed streams of cash from Bristol back to Kingston - just under £10 million in their first year, some of it buying property in Jamaica, some of it funding new crack consignments to the UK. And they arrested hundreds of street dealers, something like 700 of them in a year.

By now they had set up a special unit, Operation Atrium, which pulled in officers from all over Avon and Somerset. All the divisional commanders lost men and women. They pleaded for replacements and eventually the local police authority agreed to backfill the lost manpower. It would take 18 months to fund, hire and train the new officers. The street dealers they were arresting were being backfilled in less than 24 hours.

This was a police force recognising a threat to one of its communities and defending it with all of the weapons of the criminal justice system, and... it made no difference. It was like trying to walk on water. Each day began with dozens of reported crimes; each day ended with most of them undetected. The police would arrest people; the courts would give them bail. They would deport people; the airports would let them straight back in again. One of the Yardies they arrested for the murder outside the Jolly Roger was a guy known as Mr C. He was here illegally, so they deported him. He came back; they caught him a few months later and deported him again. In October 2002, they found him a third time and deported him yet again. This time, he was slower to come back: he got shot by another gangster in Kingston. And all the time the Yardies were dealing, bringing in more users, who committed more crime.

Even when the courts did lock someone up, it was nothing more than a breathing space. The ones who were worth locking up - the 'prolific offenders' - came straight back out and carried on offending. Down the road, for example, the city centre car parks have just seen a surge in break-ins on cars, simply because one local lad has been released from prison and gone straight back to the life he knows best. (There's another lad down there who's also a specialist in car crime, but he lives on the job: he sleeps in a multi-storey car park, wakes up, robs a few cars, goes out for the day and drifts back to base when he's tired or needs some more cash. He's been arrested more times than they can count, only to pop out of one of the multiple exits in the system and carry on thieving.)

The inspector turns out of St Paul's and stops in a street full of shops on the edge of the City Centre. He wants to check the cells in the Bridewell. At the desk, he ticks charts and signs forms. Down in the cells, he tells the girl who's been done for shoplifting that he'll get her a light for her cigarette, tells the man who is sitting in total darkness in the next cell that he'll be seen by the doctor very soon. This is the 3% in real life, the offenders who have finally been brought into the system. This is where you begin to see that the machine whose neck is so narrow that it misses 97% of the offences it is aiming at, then lacks the equipment to change the behaviour of most of those it does manage to catch.

Sometimes, it makes no difference simply because it is too weak to enforce its will. Most of the offenders who are convicted will end up in magistrates court where the bench may solemnly fine them. And 41% of those fines will never be collected. We know that, because the Lord Chancellor's department, which is responsible for the courts, checked the numbers. They reckon it would take four years just to collect the backlog even if there were not something like 320,000 new fines being doled out each year. In the financial year to April 2001, the courts wrote off £74 million of fines which they had failed to collect. The offenders simply shrugged and walked away.

It's the same with community sentences. The courts handed out 169,000 of them last year (and they are much fiercer than they used to be), but tens of thousands of offenders simply don't turn up to be punished. With the most severe - the Community Punishment and Rehabilitation Order - the Home Office's records show that 47% of offenders who were supposed to serve community punishments simply didn't bother. Of course, their breach was eventually reported to the court which duly issued a warrant for their arrest, but we know from the Audit Commission that 56% of those breach warrants were never executed. They just piled up on a shelf somewhere.

And then there's prison. At least with prison, the sentences are usually enforced; very few inmates now escape. But here is the radical contemporary critique of its impact: "Prison sentences are not succeeding in turning the majority of offenders away from crime. Of those prisoners released in 1997, 58% were convicted of another crime within two years... The system struggles particularly to reform younger offenders. Eighteen-to-twenty-year-old male prisoners were reconvicted at a rate of 72% over the same period.... At a conservative estimate, released prisoners are responsible for at least one million crimes per year... In terms of the cost to the criminal justice system of dealing with the consequences of crime, recorded crime committed by ex-prisoners comes to at least £11 billion a year." That is the verdict not of some maverick commentator but of the Prime Minister's Social Exclusion Unit.

The inspector ticks the last form in the Bridewell and drives back to St Paul's. And we drift through the dark together, the inspector and the reporter, surrounded not so much by the life of crime as by the near-death of the criminal justice system. In the dark shadows of Brunswick Square, a pimp sprawls across the front seat of a Mercedes, smoking and eye-ballling the inspector. Not five yards from him, there is a bright yellow sign, posted by the inspector, warning punters that their car numbers may be recorded by CCTV if they cruise the square. The pimp's girls are working just around the corner, standing there as thin as string and using the old graveyard behind the unitarian meeting house to deal with their customers. The inspector could arrest dozens of working girls every night: he'd tie up multiple hours of manpower to send them to court where they'd just be fined, and then they'd be back again, working even longer hours to pay the magistrates as well as the pimp.

The failure of the system is mirrored by the complacency of many of those who talk about it. The government will tell you it is hitting its key targets, right-wing pundits still cheer the idea that prison works, liberals twist themselves around statistics like beans running up a pole, to prove that all is well. The truth is that the evidence that crime is falling is about as solid as mist (see sidebar). Even if, behind the veil of numbers, the truth is that nationally crime is coming down, communities like St Paul's - always the most impoverished - are nevertheless pockmarked with streets which tell a different story.

There's a family who live not far from here with five adolescent boys. All of them are thieves. They all steal almost every day. One of them was at it on Christmas Day. Another brother recently was arrested and released on bail - he was caught at it again within an hour. There's another lad whose routine is to go out screwing houses each night - at least three of them. Every night. And they steal from here. They don't go off into the middle class areas - that's foreign territory, they'd stand out on the street, and they don't know the houses or the routines of the people. Thieves steal from their neighbours.

Those who raise their claret to the success of law enforcement should talk to the primary school teacher here who has to tell her ten-year-olds that it is not cool to carry guns, that the flash lads who parade on the pavement with the rolls of cash and the chunky gold jewellery are not role-models; to the parents of those children, trying to get to school in the morning without stepping on bloody syringes; to the man who says he can't reach the corner shop to buy a paper without being hassled by some toerag with a hood over his face; to the old woman clutching her handbag like a baby as she takes her pension home from the post office. The council street sweeper here the other day was stopped in his work by a guy who jammed a gun up against his head: it turned out that the dealers had been stashing rocks of crack cocaine in old milk cartons on the pavement, so that they could sell their drugs without actually holding them, and the sweeper was demolishing their business.

Most of all they should talk to the police, who really know who's winning out there. Those on the right might learn that a lot of these officers have zero faith in their zero tolerance gospel. The left might learn that something important has changed. Twenty years ago, this country's police were led by a generation of chief officers who had left school at 15 and learned their lessons in life from the army. Frequently, they were crude and unsophisticated. A lot of them didn't like hippies or lefties or queers. Some of them were racists. But a great deal has changed. Partly, this is about one of the great success stories of state education. In 1976, the Edmund Davis report gave the police better pay and far better pensions than anybody else in the public sector, and so - slowly at first - the police service began to attract working class men and women who were the cream of comprehensive education. They joined a force which was then battered by a series of traumatic scandals - ruthless corruption in London and Birmingham, the miscarriages of justice around IRA bombing trials, urban riots spawned by clumsy and sometime vicious street policing, the Yorkshire Ripper inquiry, Stephen Lawrence. They had to change.

Of course, there are still police officers who abuse their power, who are idle and incompetent and dripping with prejudice, but far more than ever before, there are officers who are neither the lapdogs of the right nor the demons of the left. And they are losing. It is not for want of trying. They work in a system that bristles with power, that is rich in individual effort and (relatively) rich in resources. Every day, they win battles and yet overwhelmingly they are still defeated in the war.

That's not because they are all idle or corrupt or racist. It's not even primarily because of the practical difficulties of their work - that most victims (55% of them) do not even tell the police that they have suffered a crime; that it is simply very difficult to detect an offender whose crime was not witnessed; that more witnesses now are intimidated and unwilling to come to court; that courts which demand proof beyond reasonable doubt necessarily release some of the guilty. The real problem is that these officers are running a system which has a design fault on the scale of the Maginot Line: it confronts a problem of infinite complexity with a response of gross simplicity. It approaches all crime with the same rigid routines - patrolling, detecting, imprisoning. They were born in the distant past; they are strikingly ineffective (see sidebar). Those antique rituals are themselves based on one rigid underlying idea which is equally weak: that all criminals will behave in the same rational and predictable fashion; that they will all be deflected by the prospect of arrest and the threat of punishment.

Conventional law enforcement does not fail completely. Its great achievement is that it regulates the behaviour of law-abiding people, who do pick up the signals it sends and react to them. Its great failure is in dealing with criminals. Think about those Yardies, about the five brothers burgling each day away. Conventional law enforcement rarely catches them and scarcely deters them. It controls them to the precise and limited extent that it can lock them up and incapacitate them - about a tenth of the 3%. But that's more or less it.

The government relentlessly ratchets up public expectation for law enforcement. And yet: "Despite all the changes of recent years, the signals sent out are ones of weakness in critical areas: too few criminals brought to justice; too many defendants who offend on bail; too slow to bring them to trial; too many guilty go unconvicted; too many without the sentence they and society need..... Far too many offenders escape justice, creating the ‘justice gap' between the number of crimes recorded by the police and the number where an offender is brought to justice." That is from the same government's preamble to its most recent criminal justice white paper. They put more money into more officers following the same rigid rituals. And yet: "There is very little correlation between levels or changes in funding and crime rates, or between changes in police numbers and crime rates." That is from the Audit Commission.

We spoke to a civil servant who has spent most of his working life in the criminal justice sytem. He put it this way: "The point is that the old Benthamite theory of a rational system producing results has collapsed. We are left with a different set of objectives which are really to do with pleasing people - the electorate, the civil servants, the prison officers.... The public and the press sing a contant mantra about putting more police back on the streets. It doesn't work. Same with long prison sentences in unpleasant conditions - they don't work. But they do work as ways of making people happy. So that's what we do." And we spoke to people at one level or another of every law-enforcement agency in the country and, over and over again, they came up with a version of the same wry line: "The criminal justice system doesn't catch criminals, it doesn't dispense justice, and it's certainly not a system."

Any government which confronts this reality is faced with a fork in the road: go down one route and increase the power and funding of the existing system in the hope that it may do a little better and in the knowledge that every new power for the police is a potential threat to the public co-operation on which they rely; or take a new route, recognising that a complex problem requires subtle solutions, and break out of the boundaries of conventional law enforcement in search of intelligent alternatives. Since April 1997, generally without public recognition, this government has done both.

It has made far more noise about its journey on law enforcement. It has taken the criminal justice system and shaken it like a Victorian nanny used to shake an insolent child. It has injected the whole system with an almost dizzyingly energetic programme of reform and used criminal justice bills for the hazardous purpose of giving it new muscle. But, behind the almost ceaseless flow of law-enforcement rhetoric, they have also looked outside the system. They have taken the advice of some of the most radical criminologists in the country and embarked simultaneously on a completely new approach, trying to link up all the agencies of social welfare to draw the criminal poison out of impoverished communities. The effect of this twin strategy has been electrifying. The great question is whether, as a result, the police have started winning.

In a small way, the inspector won tonight. The streets of St Paul's are quiet, and they stay that way - until two in the morning, when he has to pull back his officers, and the dealers and the gangsters will come out to work. They are working even now, around the corner on the pavements in St Jude's, and in their cars using mobile phones to find their buyers. The drug-buyers who have been robbing and burgling in St Paul's to find the cash for the dealers, have moved up the hill temporarily to St Lawrence's where they have been mugging the prostitutes and unleashing a mini epidemic of burglary.

Success is hard to find. This wave of crime, which has now become a shooting war, was almost certainly triggered by what looked like a law-enforcement victory: it was only because the police, through diligence and skill, arrested the Aggis a few years ago, that the drugs market in St Paul's had no owner, and the power vacuum sucked in the Yardies with their crack and their guns. The best available tactic for stopping the war now - quicker than arrest and prosecution - is for the police to link up with probation, using minor offences and intelligence to revoke the parole licences of the leading Aggis. That will put them back behind bars. For a little while.

The inspector has stopped the van for a moment in a dark side street. The radio plug in his left ear is babbling with feedback about Yardies and Aggis. There's another radio hooked into his right ear feeding him with reports of ordinary life on his sector. Somebody can't find the charging unit to handle an arrest. There's a 15-year-old girl wandering through the middle of the operation. The mental hospital has lost a patient, and they think she may be headed for the river. There's a battered woman and child at Trinity Road police station, looking for a refuge. The inspector needs his mobile to get the helicopter to look for the hospital woman. Another mobile in his pocket starts to ring; he's eating a sandwich; he can't read his notes; he reaches for the light, accidentally hits the siren and for a moment or two, we just sit there, wailing in the darkness.

Who's winning?

Additional research by Tamsen Courtenay

The futility of punishment

The Guardian, April 2004

There is order in the court. There is chaos on the streets. And they meet in the main hall of Thames magistrates court in the East End of London. It is busting with people - this guy made of muscle yelling at his tiny female lawyer "This is MY case, this is MY life"; the elegant Somali man with the beautiful black suit cruising quite lost through the crowd without a word of English to find his way; the young Bengali lad who just blew a spliff in the toilets; the prosecutor reading "God Knows" by Joseph Heller; the little knot of regular defence lawyers, Charlie and Teresa and Denis and Keith, swapping the gossip and wondering how long it will be before somebody tells them the new security code for the door to their room so they can finally start work for the day.

The courtrooms open. Here come the overnights - the people who've been arrested by Hackney police and held in the cells for this morning's hearing.

Case One: male, white, aged 26, charged with theft of eight packets of bacon from Londis supermarket - tested postive for heroin and cocaine. Case Two: male, Bengali, aged 19, charged with theft of £59.63 of food from Tesco - tested positive for heroin and cocaine. Case Three: male, white, aged 32, charged with harrassing his mother and stepfather by kicking down their door, breaking their window, threatening them in persistent search for money - tested positive for heroin and cocaine.

The cases blur. Amost all male, almost all young, almost all of them trailing a string of other cases that have just been dealt with or are about to be dealt with, almost all of them already serving one or more community punishments, many of them with unpaid fines. And over and over again, the magistrates' mantra, "tested positive for heroin and cocaine". (Finally, an overnight defendant appeared who had not tested positive for drugs. He was an alcoholic.) Most of them plead guilty and are adjourned for reports.

This is the story of a week in court - the story of what happens when the criminal justice system finally deals with the mere 3% of offences which it manages to capture. The courtroom is the crossroads for all the players in the system. Here is where the police send those they have arrested. Here are the prosecutors with the evidence they have collected. Here are the probation officers and the prison escort officers waiting to dispose of the guilty. Here are the offenders "brought to justice". And here is the question: what does it achieve?

It is a question of acute importance in a system which now more than ever relies on court-sanctioned punishment as its mechanism for controlling crime. As this series has already described, the Home Office has quietly compromised its innovative crime-reduction programme, including its support for problem-solving policing; and the National Treatment Agency has taken the promising initiative to give treatment to drug users and smothered it in misconception and mismanagement. In the background, the probation service, which was once the world leader in tackling the causes of crime, has been sliding into a state of demoralised chaos - restructured, mismanaged, starved of funds, overburdened and now on the verge of being restructured yet again. With its best efforts at rehabilitation struggling, this government now presides over a system which is overwhelmingly devoted to punishment, handing out more jail sentences and more community punishments than ever before in the history of this country. What does it achieve?

Look at this man here, standing in the dock, fiddling with his fingers. There is something Victorian about him. It might be the respectable best suit he is wearing - white shirt, black tie and a black jacket that's so big he must have borrowed it. It might be his supplicant posture, his hands neatly folded in front of him, his head hung down on his chest. It might just be the sheer frailty of the man. He is as thin as a whippet, his face is as pale as paper, and he is quivering slightly as the district judge and the clerk of the court assemble the facts about him.

At first, the case of Mathew King sounds simple enough. On January 17 last year, in this same court, he admitted driving whilst disqualified and trying to syphon petrol out of somebody else's car. He tested positive for heroin and cocaine. He was given a 12-month community rehabilitation order which meant he had to keep regular appointments with a probation officer, but in September, he failed to turn up twice, and now he is charged with breaching the order. He admits it, and the judge adjourns the case for three weeks so that probation can prepare a pre-sentence report on him.

Mathew King turns and slips quickly out of the court and, just as the door swings shut behind him, there is a fleeting glimpse of his life - a small woman with long blond hair and a face like a snapshot from another world. It is slightly frightening and immediately haunting and somehow familiar, the way her skin is stretched so tight across her cheeks that it has made her eyes grow large: this woman has the face of a starving child. Again, there is something Victorian here. And she is pulling at Mathew's black-jacket sleeve - no time to lose. Why the urgency? Where are they going with their pale, skinny bodies? What goes on in the private world of Mathew King?

Tracing him was easy enough: he had given his address at the start of the hearing. It turned out to be a tower block in the backwash of a motorway in the heart of what was once the teeming bustle of the London docks. The lift was busted. The stone stairs smelled of piss and garbage. On the fifth floor, just outside his flat, somebody had smeared something brown and nasty on the wall. And when the door finally cracked open on the security chain, there was Mathew and his world, shaped by chaos.

He was just back from Bethnal Green Road. He had gone there with the woman with the hungry face, who turned out to be his girlfriend, Lisa, and with John, who turned out to be the father of Lisa's two oldest children. The three of them live here together and every day they go to Bethnal Green Road to buy their gear. Everybody does. But today it went wrong. John gave £70 to this black lad on a bike. The black lad's mate kept Mathew and Lisa talking round the corner. The black lad rode off and just didn't come back, but Mathew knows him from a year ago and he's got a mate of his coming round - he's well over six foot and built out of bricks - and they're going to go back down there and sort him out. But just now they've got no gear.

Lisa sweeps the carpet. She is 29, although she looks nearly twice that. John fiddles with his fingers, which are mangled and maimed by bad injections. Mathew says he's had a letter from probation about preparing his pre-sentence report, and John gets it for him and - just look at this - it says "Please come and see me at this office. See address below." But there is no address below! And no phone number. So Mathew's going to miss another appointment. At least this letter reached him. The last lot got sent to his mum's house, and he can't go round there because he doesn't get on with his step dad. He's had all this with probation before. The last time he went, he said "What time have I got to be here?" and they're "You haven't got to be here." Then he tells the story of how he missed the appointments in September.

It's all about him and Lisa and the terrible business with the baby. But then again, it's not - it's all about their whole life. Mathew is 29, the oldest of two brothers, born around the corner in Mile End. His father was a drunk, used to smash the house up, and, when Mathew was five, he left. His mum gave him a chance to come back, but he just turned up and stole the stereo. Soon afterwards, his dad's mate came out of prison and came round to see him and found he wasn't there, so he moved in with Mathew's mum, and he's still there. His dad is still in the East End somewhere, still drinking. As far as Mathew is concerned, that man doesn't exist.

He went to Hackney Down school and he was no good at it, he still can't read or write except for his name, and the teachers picked on him, so he swore at them, and they sent him home, so he carried on swearing and didn't do no more school. The first time he was nicked was for breaking into a car when he was 13; he got a caution. He is good at breaking into cars. His crime was just silly stuff, though, until he started using gear when he was about 18. Then he got into nicking cars - he's sold a lot of taxis that way - and he was doing burglaries too (shops, not houses).

Lisa and John both came up the same broken ladder. Lisa's dad left, and she doesn't get on with her stepdad. John's dad died of cancer when he was young and then he got teased for wearing crap clothes because they were poor. Both of them were no good at school. John beat up a teacher and left early. Lisa ran away from home and by the time she was 12, she was selling herself down Aldgate to businessmen on their way home from the City, then she ended up in foster homes and secure units. She was 15 when she met John and got pregnant with their first child, a boy. The social workers didn't like the look of them, but John thought it would be OK: he was 20 then, working as a site supervisor down at Canary Wharf, and they had a room at a bed and breakfast on the Romford Road. But the social workers took the baby away, so that same day Lisa went and found her mate Nicola (she's dead now) and she smoked £50 of heroin in one afternoon. She'd never done it before. She's been doing it ever since. John was soon at it too - he just wanted to know where all his money was going.

Mathew didn't meet them until five years later. By that time, Lisa and John had just had a second son. Lisa was still selling herself, and John was on three kinds of medication for a paranoid obsessive disorder. He was committing crimes every day of the week to fund their heroin habit, so the social workers took this little boy away as well, although in the end Lisa's mum went to court and got custody of both Lisa's kids. Lisa and John sort of drifted apart. Mathew was arguing with his step dad and so he moved out to live with Lisa, and John stayed around.

Now, the three of them spend their days ducking and diving and trying to find gear. Most days, they'll spend £100 down on Bethnal Green Road for the three of them. They can get some of that in benefits, but most of it, they have to hustle, so they have to break the law. Most of the time, nobody knows about it. Then, once in a while, they get caught. Mathew has only been done half a dozen times. The worst one was when he and a mate broke into a car in the West End without noticing there was a police car parked right there in the road, so the cops chased them, and Mathew started driving like a maniac, going through red lights, heading the wrong way up a one-way street until finally the police cornered him on the Embankment. He got 30 days in Wandsworth for that and a driving ban, so he lost his job driving for a haulage firm (Mind you, he never had a real licence in the first place.)

Lisa and John also get away with most of what they do, although Lisa's criminal record fills six pages. She's had fines, community orders, five or six jail sentences. John's been done for theft, burglary, fraud, bits of violence including battering a cop, driving whilst disqualified. He's done 19 prison sentences. Nothing changes. It might have been different if there was real treatment around, if they could get a decent prescription for methadone or diamorphine, instead of the rations and rudeness they get from NHS clincis. Most of the time, no court even tried to help them. So, they still need £100 a day - and, by the time you allow for the prices the fences will pay, that means laying their hands on more like £500 of property. John says it's simple: going without gear is not an option; you do what you have to do; the law doesn't come into it.

It all bent out of shape last summer. Lisa was pregnant. She and Mathew really wanted the baby, but they were afraid the social workers would move in again, so they kept it a bit quiet. Then one day in June, Lisa fainted in the street - she can't afford money for food so she'll often go two or three days at a time without eating - and the hospital told the midwife, and the midwife told the social workers, and so Lisa and Mathew cut a deal with them: they would give up gear, they would sign on at the local NHS drugs clinic for some methadone, and so the social workers would let them keep the baby. They had to wait two weeks to get the methadone. When they got it, they were only allowed 40 mill a day, which wasn't enough. And they were refused injectible methadone, which was bad for Lisa, who is a fixer. But they stuck to the deal more or less. For the sake of their baby. Because they already loved the baby.

He was born in August. They named him after Mathew. They were proud and happy, and the baby was healthy - he wasn't addicted to anything - and they spent just about all day every day in the hospital, like real parents. And after two weeks, the social workers took the baby away from them. It did their heads in. Lisa says it really did Mathew's head in. He thought they had a deal. He just couldn't see the fucking point of doing anything any more. Then, Lisa and John got into a row with the staff at the drugs clinic, and they got banned - except that John was wearing Mathew's hat, so they banned Mathew instead of him. Mathew wasn't that bothered. They just went back down Bethnal Green Road.

And that's how Mathew ended up back in court. Not that they got nicked down there, just that Mathew couldn't see the point of keeping his probation appointments, so he ended up with a letter telling him to turn up at Thames magistrates court. That's a hassle. He's got to find this probation officer with the secret address. But before he does that, he's got to go back down Bethnal Green Road and get their £70 back off the little toe rag that rode off with it this morning.

And then what will this court hearing achieve? At what point in a typical day do Mathew and Lisa and John stop and quietly consider the impact of their behaviour on anybody else or on themselves? At what point do they consider anything at all beyond finding some way to get hold of £100 a day? Born and raised in chaos, they have been punished before by the system, often for good reason, but never changing their behaviour, occasionally becoming much worse. Surviving now in chaos, at what point does the threat of punishment stop them committing a crime?

There are signs of the government changing its track. Following January's Carter report, it is setting up the new National Offender Management System, which is supposed to cut the rise in the prison population. It wants to use new day fines - geared to the income of offenders - and also its Sentencing Guidelines Council to encourage courts to use more fines for petty offenders. The Crown Prosecution Service has plans to extend the use of cautions by adding conditions to them. But these moves are designed to take the pressure off the prisons and the courts. None of them challenges the underlying assumption that punishment is the primary tool of crime reduction.

If they had been born 40 years earlier, Mathew and Lisa and John would have been allowed to get clean drugs from their GP. John would not have lost several fingers and half a lung from blood clots. Lisa would not be suffering from malnutrition in the heart of one of the richest cities in the world. None of them would be involved in stealing something like £500 of property a day. As it is, they can turn to the NHS which will offer them long delays, lots of paperwork, tight rations and lectures about abstinence, or they can come to court to be punished.

The courthouse is busy again when Mathew and Lisa turn up there a week or so later. An ulcerated old man whose boot laces are tied up round the ankles of his trousers, totters around the hall looking for a lawyer. A fog of nicotine rolls out along the ceiling from the smoking area. There are two televisions mounted on the walls: the studio audience are clapping, the caption says "Leave my lover alone". Outside court number three, a baby in a buggy is crying its lungs out.

Mathew has got his act together and found the probation officer who needed to see him, even without an address. And the pre-sentence report is OK. It explains that Mathew missed the two appointments because he was so upset about losing the baby and it recommends another community sentence. Mathew's lawyer is good at his job. Lisa and John sit in the public gallery, while Mathew takes his place in the dock.

The district judge has a dark suit, gold-framed glasses on the bridge of her nose and pearl ear-rings. For two or three minutes, she reads the report from probation. The court is quiet. "Yes," she says finally, in a voice just like the Queen's.

Mathew's lawyer starts: "I think it's worth noting - "

But the judge cuts across him: "He was fortunate, wasn't he, to be given a probation order in the first place?" She seems irritated. The lawyer continues, reciting all the appointments which Mathew did keep before he missed just two. She sits with her eyes shut and then cuts in again: "He was given the opportunity but he doesn't seem to have taken it." The lawyer quotes from the probation report and explains that Mathew has had his baby taken from him. "Because he is a heroin addict," says the judge as though that explained everything. The lawyer keeps making his points, the judge keeps interrupting, Mathew is looking paler than ever. Then suddenly, the judge has heard enough.

"Mr King, will you stand please? You were given the opportunity of doing a community penalty and you chose to lose contact with -"

Now Mathew interupts: "I been in contact with them. I give them my new address. I give them my mobile number. I been down there before this court business started."

"You have had your opportunity. Now you will go to prison." Mathew stares blank at her, as she hits him with it: "Three months on each count."

He turns towards the public gallery, breathless. Lisa is on her feet. She knows in an instant that the prison is not the problem - it's having no gear that is going to hurt him. And she knows he hasn't even got a pack of cigarettes in his pocket to help him get through it: he was never expecting to go to jail. Two security men are closing in on the dock. Lisa leans out of the public gallery, her cigarette pack in her hand, Mathew reaches out to grab them, the security men close in, Mathew stretches quickly, Lisa strains towards him, can't reach, the cigarettes fall on the floor. Lisa goes berserk, barges into the court, shouts that the judge is a scumbag, but the judge has gone. And so has Mathew. Mathew has been brought to justice.

Minutes later, Lisa and John slip away into the streets. They are in a hurry, just like they were when Lisa tugged Mathew away from court a few weeks ago. They have to get down to Bethnal Green Road. On the way, they have to find £100 from somewhere. Justice has been done today. Chaos has encountered order. And what did we achieve?

* At his request, Mathew King's name has been changed.

See below for background statistics

How the courts increased their sentences:
During 2002, all courts gave immediate prison sentences to 111,600 offenders - a record and 53,500 more than in 1992.
During 2002, all courts gave community sentences to 186,500 offenders - a record and 84,100 more than in 1992.

How the magistrates made community sentences more punishing:
In 1992, rehabilitation orders (then known as probation orders) accounted for 41.5% of all community sentences. In 2002, they accounted for only 31% of community sentences.
In 2002, rehabilitation orders accounted for only 2.2% of all magistrates sentences.

How magistrates moved from fines to prisons:
In 1992, magistrates fined 1,074,800 offenders. In 2002, they fined only 894,300.
In 1992, magistrates jailed 10,300 offenders. In 2002, they jailed 26,500.

Outcomes in London magistrates courts:
81.7% of defendants plead guilty;
8.9% are found guilty in their absence;
7% are convicted after summary trial;
2.1% are acquitted after trial;
0.3% are dismissed with no case to answer.

Note: A community rehabilitation order (formerly known as a probation order) requires the offender to stay in regular contact with a probation officer for up to three years. In some cases, the court may also require attendance for treatment or other courses.
A community punishment order (formerly known as a community service order) requires the offender to perform up to 240 hours of unpaid work.

Madness behind bars

The Guardian, December 2004

On the evening of Thursday August 19 this year, a prisoner was locked into his cell in the segregation unit of Wormwood Scrubs prison in west London. This man had been sent to the seg to be held in solitary confinement as a punishment because he had threatened a cellmate. But that was three weeks earlier and, since then, he had settled down and been quite easy to manage. Everything was normal.

On the following morning, August 20, an officer called Dickie Hampson unlocked the door of the the cell, and, without warning, the prisoner pounced on him and stabbed him in the back of the shoulder with a toothbrush which he had sharpened into a rigid blade. Hampson was rushed to hospital where doctors found that the epaulette on his shirt had saved him from the worst of the wound.

Nobody could understand why this prisoner had suddenly turned violent. Immediately after the attack, a group of officers with a riot shield restrained him, handcuffed him and removed him to the 'safe cell', designed to prevent self-harm, while they searched his possessions to make sure he had no other weapon concealed in there. That afternoon, the prisoner was calm again, remorseful and worried about Hampson's condition, and soon he was taken back to his normal cell.

On the next morning, Saturday August 21, a second officer, John Leadley, unlocked the same prisoner to take him to the governor for an adjudication for the assault on Dickie Hampson. As Leadley approached him, the prisoner slipped another sharpened toothbrush out of his shirt sleeve - nobody ever found out where he had got it from - and clawed at Leadley's face: the spike cut down through his eye brow and into his cheek bone, missing his eye ball by less than an inch.

With blood flowing from his face, Leadley too was taken to hospital. The prisoner was moved again to the safe cell. It was several days before the prisoner spoke to the senior officer on the seg, whom he trusted, and explained what had happened: soon after he was locked into his cell on that first night, he said, a black cat had slipped through his window and sat on the bed next to him. This cat had been following him for some time. Now, it handed him a card, the ace of spades, and then dropped down to the floor where it danced for him. There was music. The dance went on for hours, the prisoner watched, and then the cat turned to him to warn him that the next person who came into the cell would be his enemy: the prisoner must kill him. The cat had promised to stay with him to make sure he was all right. The prisoner had started sharpening the toothbrubush.

This man was psychotic, he had already been diagnosed as paranoid schizophrenic. None of the officers who work at Wormwood Scrubs is trained in psychiatry. Yet routinely, they deal with mentally-disordered men. When John Leadley was stabbed in the face, it was the fifth time he had been attacked in three months; every one of his attackers was suffering from a severe mental illness.

There is nothing unusual about Wormwood Scrubs. Every prison in the country now warehouses the mentally disordered: the numbers have been spiralling upwards since the closure of the old asylums. This has reached a point which beggars the imagination: figures from the Office of National Statistics show that, if we diverted to treatment all those prisoners who are mentally disordered and/or addicted to alcohol or drugs, 90% of inmates would no longer be held in jail.

There are now some 75,000 men and women behind bars in this country. The findings of the Office of National Statistics suggest that nearly 50,200 of them have personality disorders; 6,175 are psychotic; and more than 35,000 of them have neurotic disorders. Several tens of thousands of them suffer a combination of disorders. More than 75% of them are intellectually impaired, with IQs below the national average. And these are not figures that the government denies. The prisons minister, Paul Goggins, himself describes these ONS statistics as "our principal source of knowledge about the extent of mental ill health in the prison population." Most mentally disordered people do not end up in prison; but overwhelmingly most prisoners are mentally disordered.

And every one of our prisons suffers from the 'treatment gap' - the gulf between the care that is needed for the mass of mentally disordered men or women within its walls and the care that is actually provided. After years of neglect, when there was no effective mental health care in prisons, the government is finally tackling the crisis, but resources are short, there are real limits to what can be achieved in a prison regime and, worst of all, as the health minister, Dr Stephen Ladyman, told the parliamentary mental health group this year: "It is generally accepted that mental health will deteriorate in prison."

The results are deeply worrying. It is not simply that mentally-disordered prisoners may be violent to staff or other inmates. Indeed, they are far more likely to be violent to themselves. On average: every single week in prisons in England and Wales, two prisoners take their own lives and two or three others are resuscitated after trying; and every day, some forty prisoners cut or gouge themselves in their cells. Beyond this, the fact is that we are herding disordered men, women and children into our prisons, storing them there for months and years, and then processing them back into the community with every prospect that their disorder has not been addressed and so they will offend again. They suffer. Those around them in prison suffer. Everybody suffers.

Every afternoon at Wormwood Scrubs, the white prison vans queue up outside the gate, ferrying men back from the courts - the young and surly, the old and confused, the crackhead who was caught shoplifting yet again, the homeless man who set fire to an empty building, the man who thumped a stranger because he looked at him in a funny way, the old Rasta who screams at himself in the park. The reception officers process them and give them a bedroll, a nurse takes them through a health questionnaire: "Have you ever received treatment from a psychiatrist outside prison? Have you ever received medication for any mental health problems? Have you tried to harm yourself?"

Once, several tens of thousands of mentally-disordered men and women were held behind the high walls of the old asylums, but they failed and, in the late 1980s, they were all closed down. Now, those who would have been their patients rely on a network of community care which is notoriously overstretched and, if they fall through its gaps, they are scooped up by police and sent back behind high walls. Those walls protect a crooked structure.

We now have139 prisons. We are already committed to building five more. By the end of the decade, the Home Office plans to incarcerate at leaste 80,000 men and women. If the Office of National Statistics is right, some 56,000 of them will suffer from at least two types of mental disorder. Yet we have only just over 4,000 secure psychiatric beds, which are already full, and no plans to increase them. The whole structure is crooked, because it is built on a crooked foundation - the emotionally satisfying but deeply ineffective idea that if we hurt these people enough, they will obey the law. Hospitals are built with bricks of care, prisons with the plans of politicians.

The old Rasta who screams in the park was arrested for trying to steal a handbag and for exposing himself in a public place. He is soon processed and taken down to A wing. Nobody realises he has lied about his psychiatric history, nor that he has been arrested, charged and now remanded in custody under a false name. Lots of new prisoners conceal their psychiatric history: they don't want the stigma, they are afraid it will count against them, they have forgotten. On the wing, the old Rasta is soon marking himself out as an odd ball, muttering to himself, eating just about nothing, refusing to wash himself or to clean his cell. It gets so bad that one day the officers force him to take a shower: nobody can stand the smell any more.

By chance, a visiting nurse recognises him from the hospital where she works and remembers his real name. The prison doctors contact the hospital's community mental health team for his notes and persuade the old man to take some medication while they wait for them to arrive. Three weeks later, the notes finally reach Wormwood Scrubs, detailing his long history of schizophrenia, but by that time, he has been taken back to court where he is given bail or a non-custodial sentence - nobody bothers to tell the prison - and he is back out on the streets again.

The number of mentally-disordered men and women who are held in our prisons has increased seven-fold since the old asylums were closed. We have talked to staff at every level of the prison service who are alarmed and depressed to find themselves warehousing the sick. The former director general, Martin Narey, now in charge of probation as well as prisons, has publicly described the strain as 'overwhelming'. A senior manager told us it was 'a bloody awful problem'.

The cutting edge of the government's response has been to create 'inreach teams', to deliver care-in-the-community on prison wings. In Wormwood Scrubs, the team consists of one consultant psychiatrist, one social worker and one community psychiatric nurse. They care for a prison holding some 1,167 men at any one time, with some 3,900 coming and going over an average year - 90% of whom they reckon to be mentally disordered. The simple reality is that the Scrubs team spend so much time assessing new patients that they rarely have time to deliver a care plan.

There is also a new Day Care Centre which borrows money from the education budget to run courses in relaxation, art and acupuncture, but staff are so short that sessions sometimes have to be cancelled. An unpaid counsellor comes in once a week, but there is no psychotherapy at all. There are signs that the centre has helped some of the low-end patients, but the service is limited and helpless to deal with the most severely ill who need beds in outside hospitals, which are extremely hard to find. In a special report on nursing in prisons, the Department of Health itself acknowledged that, while staff may do their best, there is a level of care which "prison health care does not and can not provide".

Even at the lowest end of the scale of mental disorder, this leaves the neurotics with their phobias and anxieties and panic attacks hiding quietly in their cells, not eating and/or not sleeping and/or being punished for low-level disobedience. In the outside world, they might end up on the general ward of a local hospital; here, their disorders frequently pass unnoticed in the muddle of daily life. Sometimes, they are prescribed something to help them; sometimes it is stolen by other prisoners. The parliamentary mental health group has taken evidence on the victimisation of mentally-disordered prisoners who report being robbed, bullied and indecently assaulted.

Others with neurotic disorders are screamingly obvious. A man was shipped into the Scrubs from Highbury magistrates in north London a few months ago. Suffering from depression after the break-up of a relationship, he had slapped a police officer. Within four hours of arriving, he had cut his throat from ear to ear including his jugular and slit both wrists. All the prison could do was to rush him into Hammersmith Hospital to tend his wounds for four days and then beg the Home Office to allow them to transfer him to a local psychiatric ward to treat his anxiety. They refused: the courts had ordered that the man be held in custody awaiting trial and they deemed the security in the local hospital was inadequate.

Some of the psychotics too can be withdrawn - "quietly mad" in the language of doctors - and likely to remain undiagnosed and untreated. To untrained prison officers, they may seem irritating, asking the same question over and over again, or simply weird, like the man who was frightened of water. He would sit on one of the wings at the Scrubs staring at a splash of water on the floor, worrying that it was evaporating too quickly. It was two weeks before he clumped a member of staff, triggering a process that diagnosed his paranoid schizophrenia and eventually transferred him to an outside hospital. (His worry about water was that it was poison and he would die if he drank it.)

Once they are spotted, the psychotics can often be stabilised. There is a young schizophrenic in the Scrubs at the moment: his father lives abroad; his mother has been evicted from her home and is sleeping rough somewhere; he ended up living on the streets, cold, hungry, hallucinating and finally trying to steal a woman's handbag. He is on remand awaiting trial and he is now stable and relatively secure in a single cell with a television. His main worry is that the court may take pity on him and put him out. The big problem with psychotics is that, if they refuse medication, the prison - unlike a hospital - has no right to treat them against their will.

One of the staff at the Scrubs told us about a psychotic man who refused to be treated. The prison wanted to transfer him to an outside hospital, but there was no bed. Without medication, the man's condition started to deteriorate. Soon, he took to standing on the sink in his cell, holding his arms out sideways and swallow-diving head first on to the concrete floor. His face was soon broken and bleeding, and staff were then able to use their limited power under common law to tranquilise him by force for long enough to stitch his wounds. Then the law required them to stand back and let him carry on swallow-diving. At one point, they got special permission from the Home Office to hold him in a padded cell in a strait-jacket (something which officially is no longer done in UK prisons). Finally, an outside hospital bed was found for him.

The most disruptive are those with personality disorders. Technically, they are not suffering from a mental illness, but their behaviour is distorted by traumatic experience, usually in childhood: one out of every three men who is remanded into custody by our courts has been in care as a child; one in three women has been sexually abused; one in ten men has been sexually abused. They may be withdrawn, mistrustful, aggressive, anti-social. At the top end of the scale, they may be grossly callous and cruel. In prison cells, they cut themselves, they bang their heads against the wall, they manipulate, they protest, they swallow pills like sweets. But, from the doctors' point of view, although they may be mentally disordered, they are not 'ill' and are often dismissed as untreatable. The daily strain of the treatment gap, dealing with so much mental disorder without the resources or skills to match the challenge, produces some real tensions in the prison.

On Saturday August 21 - the same day that John Leadley was stabbed in the face - there was another prisoner on the segregation unit who was causing trouble. He had been moved there from B wing, where he had been cutting himself, and now he was standing on the water pipes of his cell with a ligature around his neck, threatening to hang himself. Just a fortnight earlier, a prisoner had succeeded in committing suicide in the seg, so the senior officer there was in no doubt about what he wanted: this man had to be transferred immediately to the prison's health care centre, where there are seventeen cells for acutely ill prisoners. He called the centre, and one of the doctors came down.

To the senior officer's horror, the doctor refused to take the prisoner. He said the man was suffering from a personality disorder, which was not treatable, and that this behaviour was simply a self-harming gesture. The senior officer became agitated, reminding the doctor that two weeks earlier, they had cut down a body which had then laid in the cell all day while the investigators did their work: "I'm not going to engage in semantics with you. Suppose it happens again. You just can't take the chance." The doctor stood his ground. The senior officer reluctantly backed down but told the doctor: "If this goes wrong, I guarantee you I will stand up in coroners court and point the finger at you". Then he recorded all that had happened in the seg's observations book.

In the event, the man did not hang himself. The friction passed. But the problem remains. Just like the officers in the seg, the staff in the health care centre see themselves struggling to deal with an impossible problem. Apart from the shortage of specialist psychiatric help, the prison has12 unfilled vacancies for general nurses, leaving only 28 to cover the whole prison, day and night, for all forms of illness. Sometimes, they try to fill some of the gaps with agency nurses, but they are expensive and can wait up to a month for security clearance. They have only 17 in-patient beds for the whole prison. And, running through all this, they are medical staff working in a prison which has different priorities and understandings and even language.

Are these men prisoners or patients? Who should win the argument if prison officers want to search a man's cell but health staff say it will aggravate his mental disorder? What should happen when health staff want half-a-dozen prisoners out of their cells for some group activity, and security staff say they cannot do that without three officers - who are not available? How can prison officers be expected to understand the mental disorders of the men they are looking after, if generally they have no psychiatric training and are not even allowed to read their medical notes? How can health staff provide regular care when their patients are suddenly snatched from their surgeries and sessions because there has been an incident and prison officers are locking down the wing?

The diagnosis of mental disorder is difficult - and made more difficult by the possibility of prisoners trying to manipulate the system. Certainly, there is some manipulation: a prisoner at the Scrubs this summer repeatedly evaded his court appearances, because he knew that if he got into the prison van and cut himself - even superficially - the security company would refuse to transport him. It was a prison nurse - not an officer - with years of experience who told us that some prisoners manipulate the regime for preventing suicides: "Let them hurt themselves, let them cut themselves, it's their responsibility. I have stood outside a cell and watched an inmate tear up his clothes and make a noose and put it round his neck; And I've said 'Yeah? Go on then, do it.'"

The bottom line is that, with difficult patients, poor resources, and the culture clash between security and care, prison staff can be stretched to breaking point by some of the people in their care. Look at what happened in September with Terry Moreton. He has a history of violent crime, including a serious attack on a teenaged girl at a railway station, but he was in the Scrubs awaiting trial for a fairly minor offence. The Inreach team had spotted him and diagnosed him as suffering from bipolar illness (manic depression) as well as personality disorder and they had given him some medication. But he had stopped taking it. For several days, he had been thumping his head against his cell wall in B wing, and officers had opened an F2052SH form, which is kept for any prisoner who is deemed to be at risk of self-harm. That Friday night, Moreton ran out of tobacco, threatened to kill himself if he was not given some, assaulted his cell mate and barricaded the cell.

During the night, officers managed to get in and took him down to the seg. On Saturday morning, the senior officer came in and said Moreton did not belong there: only 48 hours earlier, the doctors had said his illness was so bad that he was not fit for segregation, and there had been no doctor on duty the previous night to 'fit' him. He called health care and, before long, a doctor came along with the duty governor. By now, Moreton had sharpened the end of a metal flask, which is used to give the prisoners hot water, and was threatening to slash anybody who came into his cell. The duty governor wanted him restrained. The seg officers said they could not do that: if he was not deemed fit for the seg, they would be guilty of assault if they restrained him. The doctor suggested he could now fit him, and so the officers went in.

Moreton was taken to the seg's safe cell and strip-searched. The doctor then suggested that he might not be fit for seg after all, which was bad news for the seg officers if it meant that they had committed an assault, but good news if it meant they got rid of him. Late that Saturday, Moreton was finally taken to the in-patient health care cells where he proceeded to tear the plastic lid off the toilet, break it into shards, wrap one of them in a torn shirt an