this is actually how drugs were dealt with in america before the 1950s:
The long road that led Henry to this conviction began one day in 1931 when a man shivered into the clinic run by Henry’s brother, Edward Williams. He was suffering all the obvious symptoms of heroin withdrawal, so he was in the right place: Edward was the one of the most distinguished experts 7 on opiate addiction in the world. “The man is a wreck, at the verge of collapse,” Henry wrote. “He is deathly pale. Sweat pours from his skin. He is all a tremor. His life seems threatened.” Both brothers had seen people like this in their offices for many years. Henry believed, in his Social Darwinist way, that they were weaklings who had survived only because they had been stupidly coddled by society; in a state of nature, they would have died to make way for stronger men with better genes. Yet Edward couldn’t bear to see their suffering—not when he knew there was a way to stop their pain. That is why he had helped to set up this clinic—and why he was about to be ruined. “Can the doctor do nothing? Oh yes, the doctor knows just what should be done,” he explained. “He knows that he has but to write a few words on the prescription blank that lies at his elbow, and the patient, tottering to the nearest drug store, will receive the remedy that would restore him miraculously to a semblance of doctors agree that pure opiates do no harm to the flesh or the organs. The patient, after taking the drug, will become calm. He will be able to function again. 9 He will be able to work, or support a family, or love. So Edward Williams wrote the prescription. He had done it many times, and he was confident he had the law on his side. He was given even more confidence when the Supreme Court ruled in 1925 10 that the Harrison Act didn’t give the government the authority to punish doctors who believed it was in the best interests of their addicted patients to prescribe them heroin. But on this particular day in 1931, the addict was not what he seemed. He was, in fact, working for Harry Anslinger, as one of a flock of “stool pigeons” the Bureau was sending out across the country to trick doctors. They were desperate addicts tossed a few dollars by the bureau to con doctors into treating them. Once the prescription was written, the police burst in to the room, and Edward Williams was busted, alongside some twenty thousand other doctors across the country, in one of the biggest legal assaults on doctors in American history. Most of the people the bureau had picked on up to now—addicts and African Americans—were in no position to fight back. But Henry Smith Williams was one of the most respected medical authorities in the United States. He was said to know more about the chemistry and biology of the blood cells than any other man in America, and he had written a thirty-one-volume history of science and many entries in the Encyclopedia Britannica, all in his spare time left over from treating more than ten thousand patients. 11 So in the aftermath of his brother’s arrest, 12 Henry started to investigate—and he uncovered something he didn’t expect.
As he watched his brother’s career being destroyed by the police, Henry remembered something that now seemed to him, for the first time, to be significant. Before it became a crime to sell drugs, he had many patients who used them—but things had been very different then. They had bought their opiates, including morphine and heroin, at a low price from their local pharmacist. They were sold in bottles as “remedies” or “little helpers,” for everything from a chest infection to the blues. One of the most popular was called “Mrs. Winslow’s Soothing Syrup,” 13 of which each ounce you bought contained 65 milligrams of pure morphine. 14 The vast majority of people who bought them, he recalled, used them without a problem. 15 Most people, even addicts, used them in low doses. “No one thought of the use of these medicines as having any moral significance,” he explained. One famous campaigner used opiates in the form of “syrups” every day who, he said, “would have gone on their hands and knees to pray for a lost soul had they seen cigarette stains on the fingers of a daughter.” 16 Just as a large majority of drinkers did not become alcoholics, a large majority of users of these products did not become drug addicts. They used opiates as “props for the unstable nervous system,” 17 like a person who drinks wine at the end of a stressful day at work. A small number did get hooked—but even among the addicted, the vast majority continued to work and maintain relatively normal lives. An official government study 18 found that before drug prohibition properly kicked in, three quarters of self-described addicts (not just users—addicts) had steady and respectable jobs. Some 22 percent of addicts were wealthy, 19 while only 6 percent were poor. They were more sedate as a result of their addiction, and although it would have been better for them to stop, they were rarely out of control or criminal. 20 But in 1914, the Harrison Act was passed, and then Anslinger arrived sixteen years later to rapidly ratchet it up. Doctors saw the results of the policy changes. “Here were tens of thousands of people, in every walk of life, frantically craving drugs that they could in no legal way secure,” 21 Henry wrote. “They craved the drugs, as a man dying of thirst craves water. They must have the drugs at any hazard, at any cost. Can you imagine that situation, and suppose that the drugs will not be supplied? … [The lawmakers] must have known that their Edict, if enforced, was the clear equivalent of an order to create an illicit drug industry. They must have known that they were in effect ordering a company of drug smugglers into existence.” The drug dealer could now charge extortionate prices. In the pharmacies, morphine had cost two or three cents a grain; the criminal gangs charged a dollar. 22 The addicts paid whatever they were told to pay. The world we recognize now—where addicts are often forced to become criminals, in a desperate scramble to feed their habit from gangsters—was being created, for the first time. The Williams brothers had watched as Anslinger’s department created two crime waves. First, it created an army of gangsters to smuggle drugs into the country and sell them to addicts. In other words: while Harry Anslinger claimed to be fighting the Mafia, he was in fact transferring a massive and highly profitable industry into their exclusive control. Second, by driving up the cost of drugs by more than a thousand percent, the new policies meant addicts were forced to commit crime to get their next fix. “How was the average addict—revealed by the official census as an average person—to secure ten or fifteen dollars a day to pay for the drug he imperatively needed?” Henry Smith Williams asked. “Can you guess the answer? The addict could not get such a sum by ordinary means. Then he must get it by dubious means—he must beg, borrow, [anti-drug] officers,” Henry explained, had just become “the greatest and most potent maker of criminals in any recent century.” 23 And every time Harry Anslinger created new drug criminals, he created new reasons for his department to be saved—and to grow.
The road to Edward Huntington Williams’s arrest had begun when he became slowly convinced that there was a better way to respond to the problem of drug addiction—one that was already perfectly legal. When the Harrison Act banning heroin and cocaine was written in 1914, it contained a very clear and deliberately designed loophole. 24 It said that doctors, vets, and dentists had the right to continue giving out these drugs as they saw fit—and that addicts should be dealt with compassionately in this way. Yet the loophole was tossed onto the trash heap of history, as if it didn’t exist—until Edward Williams decided to dig it out and act on it. He helped to build a free clinic for addicts, and he volunteered his own time there. He wrote his prescriptions for whoever needed them. And he waited to see the results. Even he was surprised by what he saw. Patients who had come in as unemployed physical wrecks 25 were able, slowly and steadily, to go back to work, support their families, and look after themselves again, just as they had before drugs were criminalized. The order and calm that had existed before narcotics prohibition started to return to their neighborhoods. The mayor of Los Angeles 26 came out and celebrated the clinic as a great gift to the city, and the local federal prosecutor announced that these clinics accomplished “more good … in one day than all the prosecutions in one month.” Thousands of miles away, the Federal Bureau of Narcotics was furious. 27 Harry kept picturing the addicts he had seen in his childhood, and in Europe, and he wanted to stop this contagion from spreading. Or did he—as Henry Smith Williams was beginning to suspect—have darker motives? Harry said that building clinics for heroin addicts was like providing “department stores for kleptomaniacs” 28 where they could steal whatever they wanted. The tabloid newspapers, after briefings from the bureau, savaged the clinics as dens of sin, 29 and the stool pigeons began their flight. In Portland, Oregon, a doctor stood in his clinic as Anslinger’s men forcibly shut its doors and asked them pleadingly, was there anything he could legally do to help all these addicts? “Yeah, sure: there’s plenty you can do,” the agent told him. “Run the whole bunch of them down to the ocean and kick ’em in. They’ll make fair fish food. That’s all any of them are good for.” 30 After the clinic in Los Angeles closed and doctors like Edward them died. 32 The bureau was defying the clear ruling of the Supreme Court 33 that the Harrison Act allowed doctors to prescribe to addicts, but “the Supreme Court has no army to enforce its decisions,” 34 the press noted with a shrug. Some twenty thousand doctors were charged with violating the Harrison Act alongside Edward Williams, and 95 percent were convicted. 35 Most were charged massive fines, but some faced five years in prison 36 for each and every prescription written. In many places, horrified juries 37 refused to convict, because they could see the doctors were only treating the sick as best they could. But Anslinger’s crackdown continued with full force. Harry wanted Edward Williams to be broken more than any other doctor, because he was widely respected and many people listened to him. “The moral effect of his conviction,” 38 Anslinger wrote, “will most certainly result in greater circumspection.” You only have to destroy a few doctors to silence the rest. Go for the top. Maximum intimidation. This was always Harry’s way. “Anybody that came out with any academic work that could be critical of him, his Bureau, or his philosophy, had to go to prison,” 39 Howard Diller, one of his agents, said later. “Or be beheaded.”
It’s also how drugs were dealt with in some areas of the UK until the 1990s:
John knew that there would be plenty of addicts waiting for him, because Merseyside in the 1980s was the site of one of the most charged class wars in British history. Margaret Thatcher’s Conservative government had pledged to kick the north of England off what they saw as subsidy-sucking nationalized industries, and her ministers were privately proposing to abandon Liverpool, saying that reviving its economy would be like “trying to make water flow uphill.” 3 The people of Merseyside saw their workplaces shuttered, their houses become dilapidated, and their streets set on fire as riots began to rip through the inner cities. Now heroin was spreading in the wake of the flames. John could see that the hopelessness sinking over the region would breed even more addiction, and he sighed. Every Thursday, a slew of addicts came into the clinic, and it was John’s job to write them prescriptions—for heroin. They sat down. They answered a few questions. Then they were given enough heroin to last them until the following Thursday. And that was it. At first, John was bemused, thinking this a bizarre idea. Free heroin for addicts? He had unwittingly inherited the last crease in the legal global drug supply system that Harry Anslinger had never been able to iron out.
Before my journey home, I believed Britain’s war on drugs had been like most of our foreign policy: a cry of “Me too!” in a bad American accent. We jail huge numbers of people, but a little less than the United States. 4 We back the drug wars abroad, but not quite so intensely. It turns out I was a little right and a little wrong. There is one significant area in which we are worse: black men are ten times more 5 likely to be imprisoned for drug offences than white men in Britain, a figure beating both the United States and apartheid South Africa. This is partly because—just as in the United States—our drug war began in a race panic. As the book Dope Girls by Marek Kohn explains, on the twenty-seventh of November 1918, 6 a young white showgirl called Billie Carleton stayed up until five in the morning with her friends in her flat behind the Savoy Hotel, with a large amount of cocaine in front of her. She was found dead later that day. There was a press furor about how two sinister forces were bringing these chemicals into the British Isles—the “sickening crowd 7 of under-sized aliens” who made up the wave of Chinese immigrants, and the “nigger ‘musicians’ ” 8 playing jazz. (They put quotation marks around the word “musician,” not the word “nigger.”) Drugs were banned to save the country from these racial poisons. After the ban, the News of the World reported with relief: EVIL NEGRO CAUGHT , 9 and added “the sacrifice of the souls of white women” would finally stop—and it was all cheered on by the U.S. government, delighted to see that other nations shared its concerns. But for a long time, there was one loophole. Back when the United States was ordering its doctors to block up all legal supplies of heroin and breaking Henry Smith Williams’s brother, doctors in Britain flatly refused to fall into line. They said addicts were ill and that it was immoral to leave them to suffer or die. The British government, unsure of how to proceed, appointed a man called Sir Humphrey Rolleston, 10 a baronet and president of the Royal College of Physicians, to decide what our policy should be. After taking a great deal of evidence, he became convinced that the doctors were right: “Relapse,” 11 he found, “sooner or later, appears to be the rule, and permanent cure the exception.” So he insisted 12 that doctors be left the leeway to prescribe heroin or not, as they saw fit. And so for two generations, Henry Smith Williams’s policies prevailed in Britain, and nowhere else on earth. The result was that while heroin addiction was swelling into the hundreds of thousands in the United States, the picture in Britain was different. The number of addicts never exceeded a thousand, and, as Mike Gray explains, 13 “the addict population in England remained pretty much as it was—little old ladies, self-medicating doctors, chronic pain sufferers, ne’er-do-wells, ‘all middle-aged people’—most of them leading otherwise normal lives.” British rather than the exception. When Billie Holiday came 15 to London in the 1950s, she was amazed. They “are civilized about it and they have no narcotics problem at all,” she explained. “One day America is going to smarten up and do the same thing.” Whenever Anslinger was challenged about this evidence in public, he simply denied the British system existed. His evidence was that they didn’t have it in Hong Kong, 16 which he said “is a British city.” In private, however, he worked hard to shut down the British system. In 1956, the British health secretary told the House of Commons that, under pressure from the United States, he was going to have to cut off the manufacture of heroin. British doctors were outraged, explaining that “the National Health Service exists for the benefit of the sick and suffering citizen.” They would not back down, and Anslinger couldn’t crush them 17 the way he did his own country’s doctors, and so the policy stayed. But then, in the 1960s, this system was suddenly ruptured. The British government announced that there had been a catastrophic increase in the number of heroin addicts, because it had gone up 18 from 927 to 2,782. This appeared to be happening for two reasons. The swinging sixties were changing attitudes across the world, prompting more drug experimentation—and it turned out that in London specifically, a handful of doctors in the West End had been effectively selling heroin prescriptions to recreational users. So the British government moved closer to the American model—but not all the way. The power to prescribe heroin was kept, but it was restricted to a smaller cadre of psychiatrists.
That’s hardly unreasonable, John thought, as he surveyed the addicts who came into his clinic. They were “maybe a few dozen lads, the occasional girl, who came and got their pot of junk. Workers, bargemen, all walks of life really.” He told them to stop 19 using, and they argued back, telling him they needed it. He decided after a few years to shut the program down so he could move on to exploring schizophrenia and manic depression and genuinely interesting conditions. “I found this a bit of a headache,” he said to me, “and I had bigger fish to fry.” But as he prepared to do this, there was a directive from Margaret Thatcher’s government, inspired by her friend Ronald Reagan’s intensified drug war across the Atlantic. Every part of Britain had to show it had an antidrug strategy, it said, and conduct a cost-benefit analysis to show what worked. So John commissioned the academic Dr. Russell Newcombe to look into it. He assumed Newcombe would 20 come back and say these patients were like heroin addicts in the United States, and like heroin addicts everywhere, at least in the cliché—unemployed and unemployable, criminal, with high levels of HIV, and a high death Newcombe found that none of these addicts had the HIV virus, even though Liverpool was a port city where you would expect it to be rife. Indeed, none of them had the usual problems found among addicts: overdoses, abscesses, disease. They mostly had regular jobs and normal lives. After receiving this report, John looked again at these patients. There was a man named Sydney, who was “an old Liverpool docker, happily married, lovely couple of kids,” John recalled. “He’d been chugging along on his heroin for a couple of decades.” He seemed to be living a decent, healthy life. So, in fact, now that John thought of it, did all the people prescribed heroin in his clinic. But how could this be? Doesn’t heroin inherently damage the body? Doesn’t it naturally cause abscesses, diseases, and death? All doctors agree 21 that medically pure heroin, injected using clean needles, does not produce these problems. Under prohibition, criminals cut their drugs with whatever similar-looking powders they can find, so they can sell more batches and make more cash. Allan Parry, who worked for the local health authority, saw that patients who didn’t have a prescription were injecting smack with “brick dust in it, coffee, crushed bleach crystals, anything.” He explained to journalists 22 at the time: “Now you inject cement into your veins, and you don’t have to be a medical expert to work out that’s going to cause harm.” You could immediately see the difference between the street addicts stumbling into the clinic for help for the first time, and the patients who had been on legal prescriptions for a while. The street addicts would often stagger in with abscesses that looked like hard-boiled eggs rotting under their skin, and with open wounds on their hands and legs that looked, as Parry recalls, “like a pizza of infection. It’s mushy, and the cheese you get on it is pus. And it just gets bigger and bigger.” A combination of contaminated drugs and dirty needles had given a home to these infections in the addicts’ flesh and they “can go right through the bone and out the other side, so you’ve got a hole going right through you. You have that on both legs and your body’s not strong enough—it’ll cut right through. You had situations where people were walking and their legs snapped.” They often looked like survivors of a war, with amputated limbs and flesh that looked charred and scarred. The addicts on prescriptions, by contrast, looked like the nurses, or the receptionists, or John himself. You couldn’t tell them apart. Harry Anslinger thought this contamination of drugs was a good thing, because it would discourage people from using. By 1942, he was boasting: 23 “The addict is now using heroin which is over 99 percent adulterated.” But Allan Parry saw the effects in this clinic. “These shitty drugs—when you try to inject them they block up [your veins] and they really make a mess of you,” he tells me. “The trouble is, with dirty heroin, one vein more or less goes destroying your body as you go. Faced with this evidence, John Marks was beginning to believe that many “of the harms of drugs are to do with the laws around them, not the drugs themselves.” In the clinic, they started to call the infections and abscesses and amputations “drug war wounds.” So he “slowly got,” he told me, “that this clinic was working wonders” by bypassing criminality and providing safer forms of the drug. John began to wonder: If prescription is so effective, why don’t we do it more? If it is preventing people from getting HIV, and injecting poisons into their veins, and dying in the gutters, why not expand it? He decided to embark on an experiment. He expanded his heroin prescription program from a dozen people to more than four hundred, and with a local pharmacist, he pioneered the prescription of “heroin reefers”—cigarettes soaked in heroin. 24 He also prescribed cocaine, 25 including smokable cocaine, for a small number of people who had become addicted to street crack. He knew that, like alcohol, cocaine is harmful to your health over time, but he explained: “If you were an alcoholic 26 in the Chicago of the 1930s, and had just stolen your grandmother’s purse to buy a tot of adulterated methylated spirits at an exorbitant price from Mr. Capone, I would have a clean conscience in prescribing for you a dram of the best Scotch whisky.” The first people to notice an effect were the local police. Inspector Michael Lofts studied 27 142 heroin and cocaine addicts in the area, and he found that in the eighteen months before getting a prescription from Dr. Marks, they received, on average, 6.88 criminal convictions, mostly for theft and robbery. In the eighteen months afterward, that figure fell to an average of 0.44 criminal convictions. In other words: there was a 93 percent drop 28 in theft and burglary. “You could see them transform in front of your own eyes,” Lofts told a newspaper, 29 amazed. “They came in in outrageous condition, stealing daily to pay for illegal drugs; and became, most of them, very amiable, reasonable law-abiding people.” It was just as Henry Smith Williams had said, all those years before.
One day, a young mother named Julia Scott came into his clinic and explained she had ended up working as a prostitute to support her habit. Confronted with patients like this, John told an interviewer, he was starting to feel “anger. It makes me furious that a group of young able people … should suffer from the same death rate as people with smallpox, between 10 and 20 percent. I’m not a bleeding heart, and I don’t think there’s anything glamorous about drugs; I try to make my clients realize that what they are doing is boring, boring, boring.” 30 later to Ed Brantley of CBS’s 60 Minutes when they came to report on the Liverpool experiment. “I went back once 31 just to see, and I was almost physically sick just to see these girls doing what I used to do.” Now she was working as a waitress, and able to be a mother to her little girl. As Julia pushed her daughter on a swing, Bradley asked her: “Without that prescription, where do you think you’d be today?” “I’d probably be dead by now,” she said. “I need heroin 32 to live.”
The changes taking place as John Marks expanded his prescription program weren’t limited to his patients. On the streets of the neighborhood, the drug gangs started to recede. John overstated it 33 at the time when he said drug dealing had been totally wiped out—the writer Will Self, reporting on the ground, asked around and learned there were still dealers to be found. But the police said there were far fewer than before—Inspector Lofts explained at the time: “Since the clinics opened, 34 the street heroin dealer has slowly but surely abandoned the streets of Warrington and Widnes.” It was as if time was running backward—to the era before the drug war. In a small brick building by the River Mersey, a California dream was being reborn. But John Marks differed from Henry Smith Williams in one important way. Henry thought that drug addicts would need to be given their prescription for the rest of their lives. That was the part of his story that most disconcerted me. It seemed that the only alternative to the drug war forever was being prescribed a drug forever. But since then, a discovery had been made about addiction—one that Henry Smith Williams couldn’t have foreseen. It was first spotted by a psychologist named Charles Winick, who set up a free clinic for addicted musicians in New York in the 1950s. Winick, like everyone else, used to believe that once you were a heroin addict, you were a heroin addict until you died, but what he found was something very different. “Heroin use was concentrated 35 in the 25 to 39 group, after which it tapered to very little,” he wrote. Most addicts simply stopped of their own accord. They “mature out of addiction … possibly because the stresses and strains of life are becoming stabilized for them and because the major challenges of adulthood have passed.” This process—the fancy names for it are “maturing out” or “natural recovery”—is 36 not the exception: it’s what happens to almost all of the addicts around you. This finding is so striking I had to read about it in slews of studies before I really took it on board: Most addicts will simply stop, 37 whether they are given a matter of keeping them alive long enough to recover naturally. That’s why every week, the addicts of Widnes turned up at John’s office for a meeting, and left with a prescription for smokable heroin or—in a small number of cases, as we will see shortly—cocaine. John explained to the public: “If they’re drug takers determined 39 to continue their drug use … the choice that I’m being offered, and society is being offered, is drugs from the clinic or drugs from the Mafia.”
There was one obvious reason why people were worried by John’s experiment. If there is no punishment—if you give people drugs for free—surely they will use them more? This was one of Harry Anslinger’s most reasonable objections. If you reintroduce prescription, he warned, “drug addicts would multiply 40 unrestrained.” It seems like common sense. But John, by contrast, thought the rate of use would hold steady: 41 If being ostracized by your family, riven with disease, and plunged into poverty didn’t affect your decision to use, how would a few free heroin reefers make a difference? It turns out both sides were wrong. Drug use didn’t rise, and it didn’t hold steady. It actually fell—including among the people who weren’t being given a prescription. Research published in the Proceedings of the Royal College of Physicians of Edinburgh compared Widnes, which had a heroin clinic, to the very similar Liverpool borough of Bootle, which didn’t. In Bootle, there were 207.54 drug users per hundred thousand people; in Widnes it was just 15.83—a twelvefold decrease. 42 But why? Why would prescribing heroin to addicts mean that fewer people became addicts? Dr. Russell Newcombe, working out of John Marks’s clinic, discovered what he believes is the explanation. 43 Imagine you are a street heroin addict. You have to raise a large sum of money every day for your habit: £100 a day 44 for heroin at that time in the Wirral. How are you going to get it? You can rob. You can prostitute. But there is another way, and it’s a lot less unpleasant than either of them. You can buy your drugs, take what you need, and then cut the rest with talcum powder and sell it to other people. But to do that, you need to persuade somebody else to take the drugs too. You need to become a salesman, promoting the experience. So heroin under prohibition becomes, in effect, a pyramid selling scheme. 45 “Insurance companies would love to have salesmen like drug addicts,” with that level of motivation, John remarked. Here’s why drug use went into reverse in John Marks’s clinic. prescribe cocaine, fewer people are recruited to use cocaine. As Russell Newcombe tells me this, I can’t help but think of a weird little twist of history. Harry Anslinger always said drug addiction was infectious. It isn’t, in normal circumstances—but the system of prohibition he built makes it so after all.
John Marks expected that the news of these results would spur people across the country, and across the world, to do the same. Who would turn down a policy that saves the lives of drug users and leads to less drug use and causes dealers to gradually disperse? At last, this ripple effect seemed to have begun. He was asked to set up a bigger version of the Widnes clinic at the Metropolitan Centre in Liverpool, and then it was decided that every health district in the region from Southport in the north to Macclesfield in the east would have a prescribing clinic of its own. There was a drop in shoplifting so massive that the department store chain Marks and Spencer’s 46 publicly praised the policy and decided to sponsor the first World Conference on Harm Reduction and Drug-Taking in Liverpool in 1990. There, one of the police officers inspired by John’s experiment, Derek O’Connell, explained: “As police officers, 47 part of our oath of office is to protect life … Clearly, we must reach injectors and get them the help that they require, but in the meantime we must try and keep them healthy, for we are their police as well.” But John was about to whack into the same wall as Henry Smith Williams.
With a few of his colleagues, John was invited to tour the United States to explain how this policy could save American lives. Everywhere they went, at the end of the meeting, they were told the same thing—that the Republican congressman Jesse Helms had been pressuring the organizers to shut them down and shut them up. Helms didn’t want anybody to interfere with the war on drugs. A few years later, on a CNN phone-in show, 48 a caller thanked him for “everything you’ve done to help keep down the niggers,” and he replied by saluting the camera and saying: “Well, thank you, I think.” After an item about John’s clinic was broadcast on one of the top-rated news shows in the United States, 60 Minutes , in 1991, John was phoned by Bing Spear, the chief inspector of the Drugs Branch of the Home Office. “We’ve got a lot of heat 49 from our embassy in Washington,” he warned. “They’ve got on to [the government] saying, ‘What’s this about somebody in Liverpool giving out crack cocaine? Close it down immediately!’ ” The Conservative government decided to “merge” John’s clinic with a new health trust, run by evangelical Christians who opposed prescription on principle. The patients panicked, because they knew what being cut off would mean—a return to abscesses and overdoses and scrambling for drugs from gangsters. John was powerless 50 to help them. The results came quickly. In all the time Dr. Marks had been prescribing, from 1982 to 1995, 51 he never had a drug-related death among his patients. Now Sydney, the Liverpool docker, went back to buying adulterated crap on the streets and died. Julia Scott, who said she would be dead without her prescription, was proved right: she died of an overdose, leaving her daughter without a mother. Of the 450 patients 52 Marks prescribed to, 20 were dead within six months, and 41 were dead within two years. More lost limbs and caught potentially lethal diseases. They returned to the death rate for addicts under prohibition: 10 to 20 percent, 53 similar to smallpox. Dr. Russell Newcombe, who had worked in the clinic, tells me the survivors “were immediately forced back onto the street … People who had jobs lost them. It split relationships up. People rapidly went back into debt and crime. The average person thrown off John Marks’s prescription regime would have been back in acquisitive crime within a month.” Whenever he’d see one of them in the street, he’d ask them what they were doing now. “Grafting,” they’d say—the local word for stealing to support your habit. Today, Merseyside is riddled with drug addiction, and drug gangs are killing each other in the war for drugs.
and it’s currently policy in Switzerland
In the white corridor of the heroin clinic, I find a young man with big headphones and an old man in a tweed suit with leather elbow patches sitting in chairs next to each other. They are waiting patiently to shoot up. The older man follows a nurse into the injecting room, and he emerges a little while later to sit for twenty minutes alone, and then he agrees to talk to me, in a room, to one side. He looks like the secretary of state for a minor Central European nation, with his carefully polished shoes and lined, distinguished face. After we were changed. I will call him Jean. 61 “I was sick, I was dirty,” when he first came here, he says. “I was really quite a typical addict.” He couldn’t concentrate to watch a film for more than a few minutes; he couldn’t eat fruit or anything even vaguely greasy, because his digestive system was so curdled by the street contaminants. He had been shooting up for thirty-five years. “When you are using on the street, you feel death already hiding inside you. You can feel it and you can see it,” he says. “You have death inside yourself, and death is progressing.” He tried methadone, but it did nothing for him. He still craved heroin all the time. He would wake each morning in a flop-sweat of panic, asking himself: How am I going to get the money I need to buy my smack today? He was trapped in the constant misery-go-round of get money, buy heroin, inject, get money, buy heroin, inject, all day, every day. “It’s not just an addiction. It’s a job,” he says. He survived only by being involved in drug trafficking—he doesn’t want to give the details, except to say that he was a “middleman”—until one day, he heard about the prescription program established by Ruth Dreifuss. This is the last option in the system for people who cannot be helped any other way. To be eligible, you need to meet three conditions: you have to be over eighteen, you have to have gone through at least two other treatment programs without success, and you have to hand in your driver’s license. “It wasn’t easy to accept and see at first,” he says. “All addicts are in a total confusion.” Suddenly, his constant scrambling for his drugs was taken away, and he had a day ahead of him he had to fill. He tells me patients here “have to reinvent our lives. We have to reinvent the imagination.” The heroin program is built around helping the patients to slowly rebuild: to get therapy, to get a home, and to get a job. One of Jean’s fellow patients, for example, owns a gas station, while another works in a bank. He discovered that “once you have stability, the speed of events decreases, and you come back into a normal life, and you say—okay, what am I going to do now?” It’s hard to do this, after being addicted for so long, but Jean says “the pain I have now isn’t the pain of a sickness. It’s the pain of being reborn.” For the first time in decades, “I feel well and happy, to have recovered things I had completely forgotten.” He has started to eat fruit and watch films and listen to music again. “You can come back,” he says, “to reality.”
Harry Anslinger believed he had spotted the crucial flaw in heroin prescription programs like this. Addicts’ bodies gradually develop a tolerance for their drug, so he said they would need higher and they called the First Law of Addiction: “A person in the condition of 63 opiate addiction, with free access to opiates, will continue in that condition at an accelerated rate of consumption unless the course of addiction is deterred by some extraneous force.” That observation seems to make sense. Yet at this clinic, they tell me, they have discovered something that contradicts it. If you are an addict here and you want a higher dose of heroin, you can ask for it, and they’ll give it to you. So at first, most addicts demand more and more, just as Anslinger and his agents predicted. But within a few months, most addicts stop asking for more and choose, of their own free will, to stabilize their doses. 64 After that, “most of them want to go always down,” explains the psychiatrist here, Dr. Rita Manghi. Jean, for example, started at the clinic taking heroin three times a day—80 mg in the morning, 60 mg in the afternoon, and 80 mg in the evening. Now, he takes only 30 mg in the morning and 40 mg in the evening, and he says, “I’m on the brink of saying to my doctor I don’t want any more.” He is a typical user here. Suddenly, the slightly depressing debate at the start of the drug war between Harry Anslinger and Henry Smith Williams—prohibition forever versus prescription forever—seems bogus. But in this clinic, they have discovered that that isn’t the real choice. If you give hard-core addicts the option of a safe legal prescription and allow them to control the dose, the vast majority will stabilize and then slowly reduce their drug consumption over time. Prescription isn’t an alternative to stopping your drug use. It is—for many people—a path to it. 65 “This program,” Jean says, “gives you the chance to recover the control you have lost,” step by step, day by day. A Portuguese psychiatrist who treats people here, Dr. Daniel Martin, tries to explain it to me by giving me a visual image. Most addicts here, he says, come with an empty glass inside them; 66 when they take heroin, the glass becomes full, but only for a few hours, and then it drains down to nothing again. The purpose of this program is to gradually build a life for the addict so they can put something else into that empty glass: a social network, a job, some daily pleasures. If you can do that, it will mean that even as the heroin drains, you are not left totally empty. Over time, as your life has more in it, the glass will contain more and more, so it will take less and less heroin to fill it up. And in the end, there may be enough within you that you feel full without any heroin at all. Users can stay on this program for as long as they want, but the average patient will come here for three years, and at the end of that time, only 15 percent 67 are still using every day. Before, being a heroin addict was violent and thrilling—you were chasing and charging around. In Switzerland today, it is rather dull. It involves sitting in clinics, and being offered cups of tea. The subculture is gone. The streets became safer. The people on heroin prescriptions carry out 55 percent fewer vehicle thefts and 80 percent 68 fewer muggings and burglaries. This fall in crime was “almost immediate,” 69 the most detailed academic study found. The HIV epidemic among drug users stopped. In 1985, some 68 percent of new HIV infections in Switzerland were caused by injection drug use, but by 2009, it was down to approximately 5 percent. 70 The number of addicts dying every year fell dramatically, 71 the proportion with permanent jobs tripled, and every single one had a home. 72 A third of all 73 addicts who had been on welfare came off it altogether. And just as in Liverpool, the pyramid selling by addicts crumbled to sand: people on the heroin prescription program for a sustained period were 94.7 percent 74 less likely to sell drugs than before their treatment. Jean tells me the drug dealers he used to work for are “completely against this program. They can control people in weak states and make money from them. If I was still in the criminal milieu, they could make me a killer, I would do anything.” As he said this, I thought of Chino and Rosalio. “But now? No. I am lost for them.” The program costs thirty-five Swiss francs 75 per patient per day, but it spares the taxpayer from having to spend forty-four francs a day 76 arresting, trying, and convicting the drug user. So when people ask “Why should I pay for this?” the pragmatic Swiss answer is: This doesn’t cost you money. It saves you money.
all quotes from johann hari, chasing the scream