Heroin Addiction and 'The British System': Understanding the Problem: Policy and the British System

210 Pages·2005·1.56 MB·English

by  John Strang

Heroin Addiction and the British
System, Volume I
Origins and Evolution
The ‘British System’ of dealing with opiate addiction has, for half a century, been notable
for its flexibility and its capacity to adapt to changing circum-stances. Because of this it
has attracted considerable international interest, although it is rarely fully understood or
accurately represented.
Presenting a comprehensive account of the development of policies and treatments,
Heroin Addiction and the British System brings together the perspectives of policy-
makers, practitioners, researchers and social commentators. These two volumes
contribute to a proper understanding of how policy and practice have evolved so that
lessons for future policy and practice may be identified.
Volume I of Heroin Addiction and the British System deals with the ‘Origins and
Evolution’ of the drugs problem in the UK, examining the personal, social and political
phenomena from historical and contemporary perspectives. It is a unique source of
reference for students, researchers, healthcare professionals and drug agencies both in the
UK and overseas.
Professor John Strang is Director of the National Addiction Centre at the Institute of
Psychiatry, King’s College London and is Clinical Director of the Addictions Treatment
Services for South London and the Maudsley. Professor Michael Gossop is a leading
researcher at the National Addiction Centre at the Institute of Psychiatry, King’s College
London and Head of Research, Addictions, at the Maudsley Hospital.

Heroin Addiction and the British
System, Volume I
Origins and Evolution
Edited by John Strang and Michael Gossop

LONDON AND NEW YORK
First published 2005 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
Simultaneously published in the USA and Canada by Routledge 270 Madison Ave, New York,
NY 10016
Routledge is an imprint of the Taylor & Francis Group
This edition published in the Taylor & Francis e-Library, 2005.
“ To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection of
thousands of eBooks please go to http://www.ebookstore.tandf.co.uk/.”
© 2005 John Strang and Michael Gossop, selection and editorial matter;
individual chapters, the contributors
All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or
by any electronic, mechanical, or other means, now known or hereafter invented, including
photocopying and recording, or in any information storage or retrieval system, without permission
in writing from the publishers.
British Library Cataloguing in Publication Data A catalogue record for this book is available from
the British Library
Library of Congress Cataloging in Publication Data A catalog record has been requested
ISBN 0-203-64338-0 Master e-book ISBN
ISBN 0-203-67522-3 (Adobe e-Reader Format)
ISBN 0-415-29814-8 (hbk)
ISBN 0-415-29815-6 (pbk)
Contents

List of illustrations vii
List of contributors ix

1 Misreported and misunderstood: the ‘British System’ of drug policy 1

JOHN STRANG AND MICHAEL GOSSOP
2 The ‘British System’ and its history: myth and reality 6

VIRGINIA BERRIDGE
3 The early years of Britain’s drug situation in practice: up to the 1960s 15

BING SPEAR
4 The drugs problem of the 1960s: a new type of problem 37

THOMAS BEWLEY
5 Crawley New Town: case study of a local heroin epidemic in the 1960s 46

N.H.(RAJ) RATHOD
6 Intravenous and oral street use of barbiturates: the ‘epidemic’ of the 57
1970s and early 1980s
ANGELA BURR
7 Heroin epidemics and social exclusion in the UK, 1980–2000 71

HOWARD PARKER
8 Flexible hierarchies and dynamic disorder: the trading and distribution 81
of illicit heroin in Britain and Europe
ROGER LEWIS
9 Drug epidemics in space and time: local diversity, subcultures and social 91
exclusion
GEOFFREY PEARSON AND MARK GILMAN
10 The arrival of HIV 108

J.ROY ROBERTSON
11 The great Mersey experiment: the birth of harm reduction 122

PETER MCDERMOTT
12 Different types of heroin in the UK: what significance and what 137
relationship to different routes of administration?
JOHN STRANG, PAUL GRIFFITHS AND MICHAEL GOSSOP
13 Use of illegal drugs in Northern Ireland: the strange case of a 148
surprisingly small problem
DIANA PATTERSON
14 The relationship between the state and local practice in the development 154
of national policy on drugs between 1920 and 1990
GERRY V.STIMSON AND RACHEL LART
15 The development of the voluntary sector: no further need for pioneers? 163

DAVID TURNER
16 AIDS and drug misuse in the UK: achievements, failings and new harm 171
reduction opportunities
JOHN STRANG
17 Hepatitis C, the sleeping giant and the sleeping ‘British System’ 183

TOM WALLER

Index 191
lllustrations
Figures

5.1 The spread from the Crawley epidemic 52
6.1 Proportions of deaths attributable to barbituates and other drugs, 59

1967–1993
7.1 Speculative model of Wirral first heroin epidemic, 1979–95 75
12.1 Heroin purity and price (street), 1984–2004 138
12.2 The decision to inject heroin 142
16.1 HIV awareness poster (‘It only takes one prick to give you 174

AIDS’)
16.2 How to clean injecting equipment if it must be reused 174
Tables

4.1 The increase of non-therapeutic heroin addicts in the 1960s 38
6.1 Barbiturate-related deaths among notified addicts 1967–93 65

(n=316 deaths)
12.1 Heroin recovery rates by ‘chasing the dragon’ 140

Contributors
The editors
John Strang Professor John Strang is Director of the National Addiction Centre
(Institute of Psychiatry, King’s College London), where he leads the multi-disciplinary
treatment and policy research activities and also a Masters degree in the Addictions
within the University of London. He is also Clinical Director of the Drug, Alcohol and
Smoking Cessation Services of the South London and Maudsley NHS Trust. He was the
special consultant advisor on drug treatment services to the Department of Health
(England) from 1986 to 2003.
Michael Gossop Professor Michael Gossop is a leading researcher at the National
Addiction Centre (Institute of Psychiatry, King’s College London), and heads the
addictions treatment research at the Maudsley and Bethlem Royal Hospitals. In the mid-
1990s, he was responsible for devising and initiating the influential NTORS (National
Treatment Outcome Research Study) studying long-term outcome from selected key
modalities of treatment in the addictions field.
Chapter authors—Volume I
Virginia Berridge Professor Virginia Berridge is Professor of History at the London
School of Hygiene and Tropical Medicine and Head of the History Centre. Her work as a
historian has always included a special interest in opiate use in Britain from the Victorian
era onwards, as well as changing perceptions of drug and alcohol problems and related
public health challenges, notably the development of HIV/AIDS policy.
Thomas Bewley Dr Thomas Bewley was a key figure in the establishment of the drug
clinics during the 1960s and worked for many years as a consultant psychiatrist in the
substance misuse services at St Thomas’s Hospital in the centre of London. He is also a
past President of the Royal College of Psychiatrists.
Angela Burr Dr Angela Burr conducted some of the earliest work in the UK into the
new patterns of drug use amongst disaffected youth in the 1970s and 1980s. As an
anthropologist, she contributed a distinct perspective to understanding of these changes,
and she became actively involved in the work of local action responses.
Mark Gilman Mark Gilman is North East Regional Manager of the National
Treatment Agency for Substance Misuse in England. Prior to this, he was a research
worker, before moving to work, for the next 15 years, with the Lifeline Project in
Manchester with whom he was actively involved in new harm-reduction developments.
Paul Griffiths Paul Griffiths is a sociologist who worked at the National Addiction
Centre in London during the 1980s and 1990s, where he coordinated new research
projects into routes of drug administration, and particularly into the spread of chasing the