Thursday June 14, 2001 The Guardian

Make heroin legal

Special report: drugs in Britain

On April 3 1924, a group of American congressmen held an official hearing
to consider the future of heroin. They took sworn evidence from experts,
including the US surgeon general, Rupert Blue, who appeared in person to
tell their committee that heroin was poisonous and caused insanity and that
it was particularly likely to kill since its toxic dose was only slightly
greater than its therapeutic dose.

They heard, too, from specialist doctors, such as Alexander Lambert of New
York's Bellevue hospital, who explained that "the herd instinct is
obliterated by heroin, and the herd instincts are the ones which control
the moral sense ... Heroin makes much quicker the muscular reaction and
therefore is used by criminals to inflate them, because they are not only
more daring, but their muscular reflexes are quicker." Senior police, a
prison governor and health officials all added their voices. Dr S Dana
Hubbard, of the New York City health department, captured the heart of the
evidence: "Heroin addicts spring from sin and crime ... Society in general
must protect itself from the influence of evil, and there is no greater
peril than heroin."

The congressmen had heard much of this before and now they acted
decisively. They resolved to stop the manufacture and use of heroin for any
purpose in the United States and to launch a worldwide campaign of
prohibition to try to prevent its manufacture or use anywhere in the world.
Within two months, their proposal had been passed into law with the
unanimous backing of both houses of the US Congress. The war against drugs
was born.

To understand this war and to understand the problems of heroin in
particular, you need to grasp one core fact. In the words of Professor
Arnold Trebach, the veteran specialist in the study of illicit drugs:
"Virtually every 'fact' testified to under oath by the medical and
criminological experts in 1924 ... was unsupported by any sound evidence."
Indeed, nearly all of it is now directly and entirely contradicted by
plentiful research from all over the world. The first casualty of this war
was truth and yet, 77 years later, the war continues, more vigorous than
ever, arguably the longest-running conflict on earth.

Drugs and fear go hand in hand. The war against drugs is frightening - but
not, in reality, for the reasons which are claimed by its generals. The
untold truth about this war, which has now sucked in every country in the
developed world, is that it creates the very problem which it claims to
solve. The entire strategy is a hoax, with the same effect as an air force
which bombs its own cities instead of its enemy's. You have to go back to
the trenches of Flanders to find generals who have been so incompetent, so
dishonest, so awesomely destructive towards those for whom they claim to
care.

The core point is that the death and sickness and moral collapse which are
associated with class A drugs are, in truth, generally the result not of
the drugs themselves but of the black market 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 multimillion pound campaign under the slogan "Heroin
screws you up". Think of Tony Blair at the 1999 Labour party conference
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 20s. 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 20 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 12 years injecting up to 350mg 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 unusually 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
paracetamol, 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 20s, 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
programme, 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 publicise 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 black market 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 black-market dealers - with paracetamol, 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, such as
drain cleaner, are simply toxic and poison their users. Others - 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 black-market
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 black-market 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
aneurisms - 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 90s, 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 80s the
government quietly broke with its prohibition philosophy and started to
provide clean needles. Nevertheless, by June last year, 1,000 black-market
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 black-market 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 black-market 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 black market 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 black market.

The same logic applies to drugs which, unlike heroin, are inherently
harmful - such as alcohol, which is implicated in organic damage (liver)
and social problems (violence, dangerous driving). American bootleggers
brewed their moonshine with adulterants such as 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 book on the 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 "blastophoric degeneration" and "alcoholic
diathesis".)

The risks of consuming LSD and ecstasy 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 ecstasy, the government's drugs adviser, Keith Hellawell (whose
contract has just been suspended), condemned it and warned that the company
risked prosecution. It is the same with black-market 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 work-shy, 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 black market, which has been created by the
politicians, which does the damage.

Keith Hellawell, the man to whom the government turned for advice on drugs,
appeared to know none of this. When we interviewed him for a television
programme, 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 it would like
to find any evidence, it failed to come up with anything at all and passed
the question to the Department of Health, which also failed. It is fair to
conclude that the government's former drugs adviser did not know the first
thing about heroin.

The confusion between the effect of the drug and the effect of the black
market is exacerbated not only because of government policy but also
because government statistics completely ignore this 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 among the drug misusing population, including viral hepatitis,
bacterial endocarditis, HIV, tuberculosis, septicaemia, pneumonia, deep
vein thrombosis, pulmonary emboli, abscesses and dental disease." All of it
true of the black market. None of it true of the drug. No attempt to make
the distinction.

The black market damages not only drug users but the whole community.
Britain looks back at the American prohibition of alcohol in the 20s and
shudders at the stupidity of a policy which generated such a catastrophic
crimewave. 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 black-market users is responsible for some £1.5bn
worth of burglary, theft and shoplifting each year - they are stealing
£3.5m worth of property a day. As a single example, Brighton police told us
they estimate that 75% of their property crime is committed by black-market
drug users trying to fund their habit. And yet governments 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
$500,000m, 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
£1.7bn 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 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. Black-market drug use spreads geometrically. The Health Education
Authority in 1995 found that 70% of people aged between 11 and 35 had been
offered drugs at some time. Pushers push. When Britain began to impose
prohibition of heroin, in 1968, 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 500,000. This is pyramid selling
at its most brilliantly effective.

In private, the Home Office's best defence is that it is so short of
reliable intelligence on drugs that nobody can finally prove that the war
is lost: we simply don't know how much heroin or cocaine is imported, or
how many people are using it.

Keith Hellawell argued 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 past decade, cocaine production has doubled and, in the foreign
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 black market 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 black market.

The Swiss, for example, in 1997 reported on a three-year experiment in
which they had prescribed heroin to 1,146 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
Luxembourg 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 10 years' work, not one of
its patients had died. In the first two years after it was closed, 41 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, such as methadone, as well as heroin? Should the
supply be entirely free of charge to guarantee the extinction of the black
market? 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 reporting by Jane Cassidy.

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