Heroin

What's wrong with the war against drugs

The Guardian, February 2001

According to Nick Davies in 1924 a group of congressmen "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". This expert testimony led "to 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".

Davies argues that:

"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".

"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

Resources

• Nick Davies, What's wrong with the war on drugs , The Guardian, February 2001
• Nick Davies, The politics of the drug war , The Guardian, February 2001