Collection of statistical data
A mini-heroin epidemic
Declining heroin addiction
Clinic attendance patterns
New addicts
Youthful addicts
Specific offences
Summary
Author: Bruce D. JOHNSON
Pages: 49 to 66
Creation Date: 1975/01/01
In the continuing debate over drug policy, the major alternative to America's heroin prohibition has been the British model of medical control. The British experience is impressive in part because of the quality of statistics issued by the British Home Office and the Department of Health and Social Security (DHSS). Yearly statistics issued by these agencies showed a threatening rise in heroin addiction from 1962 to 1968, provided the basis for a change in law and social policy toward heroin and cocaine, and documented the declining legal prescription of these drugs since 1968.
Publications presenting detailed statistical information about British opiate policy are not easily available. Yet procedures for counting addicts, data on the number of addicts, kinds of opiates prescribed, age of addicts, and number of opiate convictions are relevant toward an understanding of British and perhaps American drug policy. Therefore, this article will present detailed British drug statistics available as of 30 November 1973, 1 to a wide audience of professional readers. It will also describe changes in British opiate use and policy during the past 25 years and illustrate some areas of controversy about this policy.
Before turning to the data, two major caveats are in order. In the first place, interpretation of official statistics is difficult; statistics do not speak for themselves. Although some "official" commentaries are available (Spear, 1969; Glancy, 1972; Cahal, 1973), British statistics are presented by governmental agencies without comment or attempts at interpretation (Oatham, 1974). Various interpretations are possible. When confronted by the same data, Americans supporting the present heroin prohibition (Brill and Larimore, 1960, 1965, 1971; Bissell, 1971; BNDD, 1971; Glazer and Ball, 1971; Josephson, 1973; Lewis, 1973) arrive at very different interpretations than Americans urging changes in opiate policy (Brecher, 1972; Cuskey, Klein and Krasner 1972; King, 1972; Zinberg and Robertson, 1972; Cuskey and Krasner, 1973).
Secondly, American readers have different connotations for the term "addict" than do British readers. In British statistics (U.N. Reports, 1968-1972; British Information Service, 1973; DHSS, 1973; Home Office, 1973), the term "addicts" or "narcotic addicts" includes persons who use heroin or methadone, other medical opiates (morphine, pethidine (Demerol), etc.), or cocaine. For Americans, the term "addict" describes regular heroin users only. Those using methadone daily, especially patients in methadone maintenance programmes, are considered "ex-addicts" (Hughes, 1971, 391; Dole, 1972, 367). While this article will not attempt to determine whether persons stabilized on methadone are "addicts" or "ex-addicts", please note that many British "addicts" might be considered "ex-addicts" in the U.S.; if a stable dose of injectable methadone is considered as roughly equivalent to a stable dose of oral methadone, a majority of British addicts would be "ex-addicts" in American parlance.
1 The Home Offic,(1974) Press Release and U.N. Report for 1973 (1974) became available on Nov. 1, 1974, after this article had gone to press; however the 1973 data have been included in the tables presented herein. The trends noted in the text of the article generally continue in 1973. The number of addicts notified during 1973 increased about 80 cases above 1972. The number receiving prescriptions at year end increased by 200 (table 1), mainly because of increased prescribing of methadone-with a slight increase in heroin also. The number of addicts under 20 continues to decline (table 3). With the exception of heroin, convictions for almost all other drugs increased substantially during 1973 (tables 4-7). The particularly large increase in convictions for "other manufactured drugs" (table 6) tends to support the hypothesis of a continuing or increasing demand for opiates.
Furthermore, the British concept of "addict" includes persons addicted during medical treatment (therapeutic addicts) and physicians addicted to medical opiates (morphine, pethidine, etc.). While such persons are occasionally included in American statistics, drug and law enforcement agencies rarely count therapeutic addicts or prosecute physicians for drug law violations (Winick, 1962; O'Donnell, 1969; Brecher, 1972; Greenwood, 1972; BNDD, 1973). Thus, English statistics are more systematically inclusive than similar American statistics.
For the sake of clarity, this article will adopt the official British definition of addiction presented in the "Misuse of Drugs (Notification of and Supply to Addicts) Regulations 1973:" "a person shall be regarded as being addicted to a drug if, and only if, he has as a result of repeated administration become so dependent upon the drug that he has an overpowering desire for the administration of it to be continued." This definition is the same as the first official definition of addiction presented in the 1926 Rolleston Report (Interdepartmental Committee on Drug Addiction, 1926).
This article will use "heroin addict" to describe a person who repeatedly uses heroin (British approved name: diamorphine). A "methadone addict" will refer to the person who repeatedly uses methadone. The terms "addict" or "opiate addict" will refer to a person repeatedly administering heroin or methadone. The few regular users of other opiates (morphine, pethidine (Demerol)), smoking or eating raw opium) or cocaine will be referred to as "narcotic addicts." The American reader should note that most British "addicts" are not "heroin addicts" (table 1).
The following British data document ( a) how addiction statistics are collected; ( b) a striking rise, although small by American standards, in the use of heroin between 1960 and 1968; ( c) an even swifter reduction in the number of heroin addicts since 1968; ( d) a relatively stable number of new opiate addicts despite ( e) a continuing, and possibly increasing, demand for heroin, opiates, and other drugs.
Almost all American observers (Brill and Larimore, 1960, 1965, 1971; Glazer and Ball, 1971; Brecher, 1972; Josephson, 1973; Judson, 1973; Lewis, 1973) agree that the annual statistics issued by the British Home Office (1973) are of high quality and include a larger proportion of actual addicts than most American statistics. These Home Office statistics have historically been based upon two different collection techniques. Prior to the "Notification of Addicts" regulations (cited below) in 1968, the Home Office made periodic inspections of pharmacy records. During and after 1968, the statistics were mainly derived from data generated by the special drug treatment centres.
Since the early 1950s, what Cahal (1970), a Medical Officer of DHSS, calls "a persistent myth" has existed - that a person may become a "registered drug addict". This myth has been used by some addicts to coax physicians into providing them with opiates; these addicts have also demanded an approved or higher dosage and insisted that they have the "right" to obtain heroin. From the medical profession's and the public's point of view, being a "registered drug addict" has implicitly legitimized the addict's demand for opiates because he was receiving "treatment" by a doctor (Glazer and Ball, 1971, 1178) and possibly inflated the number of addicts reported to the Home Office.
In actual fact, the Home Office has never registered drug addicts; rather, addicts have been "known" or "reported" to the Home Office. A legal prescription is a privilege, not a right; doctors can refuse to prescribe to reported addicts. To a limited extent, the "registered addict" myth still persists because the Home Office has not publicly explained how its statistics are collected. Detailed explanations of data collection are usually provided by police (Jones, 1968) or American observers (Larimore and Brill, 1960; Judson, 1973; Johnson, 1975).
Before 1968, an addict could become "known" or "reported" to the Home Office from two basic sources. (l) A few voluntary reports were submitted by prison doctors and general practitioners when they detected addicts or began prescribing for them. (2) The main information came from biennial inspections of pharmacy registers by local police, or, in large cities, by special narcotics squads. The police were instructed to watch for regular supplies of opiates; such information was turned over to regional medical officers of the DHSS who investigated further and determined whether a person was addicted (Larimore and Brill, 1960; Jones, 1968). However, during the period 1963-1968, no more than six doctors provided large prescriptions of heroin and morphine to some addicts. Many of these addicts sold "surplus" heroin at £1 ($ 2.40) per 60 mgs, to others, both addicts and non-addicts (Second Brain Report, 1965; May, 1972; Judson. 1973). Those who became addicted to such diverted heroin would not be recorded in pharmacy registers and thus would not generally be included in Home Office statistics (de Alarcon and Rathod, 1968).
In response to growing heroin use and the Second Brain Report (1965), the Dangerous Drugs Act of 1967 was passed. To implement this law, the Home Office sent all medical practitioners the following "Notification of Addicts" Regulations which took effect on 22 February 1968:
"They require any doctor to notify in writing the Chief Medical Officer of the Home Office, within seven days of his attendance upon a patient, the name, address, sex, date of birth, National Health Service number, date of attendance and name of the drug(s) concerned if he considers or has reasonable grounds to suspect, that the person has as a result of repeated administration... become so dependent upon the drug that he has an overpowering desire for the administration to be continued." (Cahal, 1970, 35.)
In other words, physicians are required to notify the Home Office of persons whom they suspect of addiction. To ensure safety from legal penalties, some physicians report persons who are not addicted (U.N. Report, 1968; Connell, 1971; Lewis, 1973), thus inflating the statistics somewhat.
The "supply to addicts" regulations took effect on April 16, 1968; they prohibited general medical practitioners from providing heroin or cocaine to addicts for maintenance purposes (Cahal, 1970; Judson, 1973; Woodcock, 1973) unless the physicians obtained a special licence. The Home Office has generally given these licenses to doctors working in special Drug Treatment Centres (DTCs) or in special clinics or hospitals concerned with addiction (Cahal, 1970). General practitioners still have the right to prescribe maintenance doses of methadone, morphine, and pethidine to addicts; but most practitioners refer persons addicted to these drugs to the DTCs.
Since 1968, the DHSS has urged regional hospital boards to establish outpatient treatment centres; there are 16 DTCs in London, which treat almost 80 per cent of Britain's non-medical opiate addicts (DHSS, 1973; Blumberg, 1974). This has caused a major shift in methods of collecting addiction statistics. Those applying for admission to these clinics are examined by experienced psychiatrists for needle marks; the doctors also test for the presence of heroin and methadone in several urine samples (Connell, 1971; Blumberg, 1974). In addition, general practitioners, prison doctors, and the clinics phone the Home Office to determine whether an applicant is already known; he may be trying to obtain duplicate prescriptions or trick the doctor into providing additional drugs or dosages. If the person is proven addicted and admitted to treatment, he will visit the clinic at least every second week for further consultation, treatment, or change in dosage. Although there is some diversity in dispensing drugs, the psychiatrist usually mails an addict's biweekly prescription to a pharmacy in his neighbourhood; the pharmacist dispenses the indicated dosage to the addict on a daily basis, except on weekends when a two-day supply is provided (Connell, 1971; Judson, 1973; Johnson, 1974; 1975).
Although police still inspect pharmacy registers, few cases now come to light this way. Instead, the formal notification procedures and Home Office statistical routines (see Johnson, 1975) provide the basis for statistics on addiction since 1968-69.
Unfortunately, the annual data issued as a press release, "U.K. Statistics of Drug Addiction" (table 1), is very misleading because it confounds two reasonably different ways of counting addicts. In table 1, the heading "As at Dec. 31" refers to the number of addicts receiving prescriptions, valid on Dec. 31, for the indicated narcotic drugs (see footnote 1, table 1). Briefly, the Home Office, on a bimonthly basis, sends out a form to each DTC listing the names from the previous report of all addicts receiving prescriptions. For each addict, the DTC psychiatrist reports what drug(s) has been prescribed at the end of the period. In addition, he removes the names of those who have left the DTC and adds the names of new or recidivating patients. However, the heading "Year Total" (table 1) indicates the drug(s) a person is "last known to be taking" (Oatham, 1974) and includes: (1) those receiving prescriptions on Dec. 31; (2) those having received prescriptions at some time during the year but not on Dec. 31; and (3) those "notified" to the Home Office but never receiving a prescription. "Notification'' is probably best defined as the reported use of particular drugs. There are three major sources of official notification: DTC psychiatrists, prison physicians, and general practitioners. When any of these sources is confronted by a person who wishes to receive a legal opiate prescription, who claims to be using an opiate, who shows evidenoe of recent needle marks and/or provides a urine test which is opiate positive, the physician will phone the Home Office and submit the required written notification (see Notification of Addicts regulation above). However, in many cases the patient either will not return to the clinic or will be denied a prescription by the doctor (Connell, 1971; Judson, 1973; U.N. Reports, 1968-1972; Blumberg, 1974; Johnson, 1975). Nevertheless, such a notified, but not-prescribed-to person will be included as addict in the "Year Total" according to the drug(s) which the notifying physician reported him to be using.
Thus, the shift to formal notification and bimonthly reporting of DTC prescriptions has probably improved the quality, reliability, validity, and detail (Johnson, 1975) of British addiction statistics. These statistics, which have greatly impressed American visitors (Glazer and Ball, 1971; Brill and Larimore, 1971; Lewis, 1973; Judson, 1973; Josephson, 1973), are mainly based upon the efficient functioning and reporting of DTCs, which these same visitors ignore or feel have few implications for America ( British Medical Journal, 1971). Further, all British statistics depend upon reports of physicians and not upon the voluntary, and frequently suspect, reports of police statistical divisions as in U.S. federal statistics (BNDD, 1973).
British addiction statistics apparently include most of the long-term, daily users of heroin and methadone since few addicts first come to attention by opiate overdose death or by arrest. In 1969-70, there were 98 narcotic related deaths; only four were of users unknown to the Home Office (Lewis, 1973, 545). A similar comparison shows that about one out of two deaths by overdose occurs among persons unknown to New York City's Narcotic Register (Baden, 1970). It should be noted that there may be an unknown number of reasonably regular (fixing opiates on daily basis for a two-week period) users who are unknown to the Home Office (Blumberg, 1974), although it is difficult to ascertain whether they are addicted.
Table 1 shows statistics on addiction released by the Home Office for 1958 to 1972. These data illustrate how a minor problem developed into a mini-epidemic of heroin use but was apparently contained and decreased by the establishment of treatment centres and notification of addicts. The year 1960 probably represents the pattern of British opiate addiction tracing back to the Rolleston report of 1926. There were few addicts, 437, with less than a quarter using heroin; three-quarters were of therapeutic origin and generally addicted to morphine and/or pethidine (Demerol). More than half were female and a few were from the medical professions.
In the following years, there was no increase or decrease in addicts from the medical profession or of therapeutic origin. Nor was there a significant change in the number addicted to morphine or pethidine. Further, there was only a negligible increase in the number of addicts aged 35 and older.
As table 1 clearly shows, the mini-epidemic began in the early 1960s. In 1962, the first signs of increasing narcotic addiction occurred; from 532 in 1962 to 927 in 1965 and 1,729 in 1967. This increase was due to the non-therapeutic use of heroin, which rose from 175 to 1,299 between 1962 and 1967. Cocaine use also increased, but not as rapidly as heroin.
In 1962, heroin use was mainly confined to those aged 20-34. But thereafter, addiction to heroin among those under 20 increased rapidly. In 1962, less than 2 per cent of all heroin addicts were young; by 1965, it was 25 per cent, and in 1967 about 30 per cent. Furthermore, the male-female ratio changed from 1:1 in 1962 to 3:1 in 1967. Thus, the data provide striking documentation of a mini-epidemic of heroin use between 1962 and 1967. Although the numbers of addicts are small by American standards, the rise was sufficient to alarm the English public and cause a change in British heroin policy (Zinberg and Robertson, 1972; Josephson, 1973; Judson, 1973).
In the spring of 1968, the Notification of Addicts and the Supply to Addicts regulations came into effect. In March and April of 1968, most non-therapeutic addicts were transferred to drug treatment centres from private prescribing physicians. These two regulations and the transfer to DTCs had the effect of identifying many previously unknown addicts in the 1968 statistics; the number of heroin users increased by about 1,000 between 1967 and 1968 (U.N. Report, 1968, 9). But since 1968, the number of opiate addicts known to the Home Office has remained relatively stable, between 2,600 and 3,000.
TABLE 1
United Kingdom statistics of drug addiction
Drug addicts |
1958 |
1959 |
1960 |
1961 |
1962 |
1963 |
1964 |
1965 |
1966 |
1967 |
---|---|---|---|---|---|---|---|---|---|---|
TOTAL NUMBER
|
442 | 454 | 437 | 470 | 532 | 635 | 753 | 927 | 1349 | 1729 |
DRUGS
a
|
||||||||||
No. taking heroin
|
62 | 68 | 94 | 132 | 175 | 237 | 342 | 521 | 899 | 1299 |
No. taking methadone
|
12 | 60 | 68 | 59 | 54 | 55 | 61 | 72 | 156 | 243 |
No. taking cocaine
|
25 | 30 | 52 | 84 | 112 | 171 | 211 | 311 | 443 | 462 |
No. taking morphine
|
205 | 204 | 177 | 168 | 157 | 172 | 162 | 160 | 178 | 158 |
No. taking pethidine
b
|
117 | 116 | 98 | 105 | 112 | 107 | 128 | 102 | 131 | 112 |
ORIGIN
|
||||||||||
No. of therapeutic origin
|
349 | 344 | 309 | 293 | 312 | 355 | 368 | 344 | 351 | 313 |
No. of non-therapeutic origin
|
68 | 98 | 122 | 159 | 212 | 270 | 372 | 580 | 982 | 1385 |
No. of unknown origin
|
25 | 12 | 6 | 18 | 8 | 10 | 13 | 3 | 16 | 31 |
AGES
|
||||||||||
Under 20
|
-
|
-
|
1 | 2 | 3 | 17 | 40 | 145 | 329 | 395 |
Under 20 taking heroin
c
|
-
|
-
|
1 | 2 | 3 | 17 | 40 | 134 | 317 | 381 |
20-34
|
-
|
50 | 62 | 94 | 132 | 184 | 257 | 347 | 558 | 906 |
20-34 taking heroin
c
|
-
|
35 | 52 | 87 | 126 | 162 | 219 | 319 | 479 | 827 |
35-49
|
-
|
92 | 91 | 95 | 107 | 128 | 138 | 134 | 162 | 142 |
35-49 taking heroin
c
|
-
|
7 | 14 | 19 | 24 | 38 | 61 | 52 | 83 | 66 |
50 and over
|
-
|
278 | 267 | 272 | 274 | 298 | 311 | 291 | 286 | 279 |
50 and over taking heroin
c
|
-
|
26 | 27 | 24 | 22 | 20 | 22 | 16 | 20 | 24 |
Age unknown
|
-
|
34 | 16 | 7 | 16 | 8 | 7 | 10 | 14 | 7 |
Age unknown taking heroin
c
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
1 |
SEX
|
||||||||||
No. of male addicts
|
197 | 196 | 195 | 223 | 262 | 339 | 409 | 558 | 886 | 1262 |
No. of female addicts
|
245 | 258 | 242 | 247 | 270 | 296 | 344 | 369 | 463 | 467 |
PROFESSIONAL CLASSES
(Medical or Allied)
|
||||||||||
Total number
|
74 | 68 | 63 | 61 | 57 | 56 | 58 | 45 | 54 | 56 |
Year Total |
As at 31 December |
||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Drug addicts |
1968 |
1969 |
1970 |
1971 |
1972 |
1973 |
1969 |
1970 |
1971 |
1972 |
1973 |
TOTAL NUMBER
|
2782 | 2881 | 2661 | 2769 | 2944 | 3025 | 1466 | 1430 | 1555 | 1619 | 1818 |
DRUGS
a
|
|||||||||||
No. taking heroin
|
2240 | 1417 | 914 | 959 | 868 | 866 | 499 | 437 | 385 | 339 | 380 |
No. taking methadone
|
486 | 1687 | 1820 | 1927 | 2171 | 2247 | 1011 | 992 | 1160 | 1280 | 1440 |
No. taking cocaine
|
564 | 311 | 193 | 178 | 178 | 194 | 81 | 57 | 58 | 46 | 51 |
No. taking morphine
|
198 | 345 | 346 | 346 | 292 | 268 | 111 | 105 | 103 | 90 | 84 |
No. taking pethidine
b
|
120 | 128 | 122 | 135 | 98 | 81 | 83 | 80 | 73 | 59 | 50 |
ORIGIN
|
|||||||||||
No. of therapeutic origin
|
306 | 289 | 295 | 265 | 244 | 207 | 247 | 231 | 218 | 180 | 174 |
No. of non-therapeutic origin
|
2420 | 2533 | 2321 | 2457 | 2659 | 2631 | 1196 | 1177 | 1313 | 1413 | 1505 |
No. of unknown origin
|
56 | 59 | 45 | 47 | 41 | 187 | 23 | 22 | 24 | 26 | 139 |
AGES
|
|||||||||||
Under 20
|
764 | 637 | 405 | 338 | 279 | 253 | 224 | 142 | 110 | 96 | 84 |
Under 20 taking heroin
c
|
709 | 598 | 365 | 304 | 260 | 226 | 221 | 136 | 111 | 95 | 83 |
20-34
|
1530 | 1789 | 1813 | 2010 | 2262 | 2368 | 897 | 959 | 1123 | 1221 | 1415 |
20-34 taking heroin
c
|
1390 | 1709 | 1705 | 1912 | 2178 | 2262 | 872 | 921 | 1088 | 1195 | 1375 |
35-49
|
146 | 174 | 158 | 156 | 178 | 185 | 116 | 112 | 112 | 120 | 137 |
35-49 taking heroin
c
|
78 | 101 | 95 | 94 | 126 | 129 | 69 | 69 | 73 | 87 | 95 |
50 and over
|
260 | 241 | 253 | 226 | 204 | 214 | 204 | 195 | 179 | 165 | 181 |
50 and over taking heroin
c
|
20 | 46 | 50 | 47 | 42 | 49 | 40 | 39 | 35 | 36 | 42 |
Age unknown
|
82 | 40 | 32 | 39 | 21 | 5 | 25 | 22 | 23 | 17 | 1 |
Age unknown taking heroin
c
|
43 | 26 | 18 | 19 | 7 | 3 | 13 | 10 | 9 | 5 | 1 |
SEX
|
|||||||||||
No. of male addicts
|
2161 | 2295 | 2071 | 2134 | 2272 | 2345 | 1067 | 1053 | 1135 | 1197 | 1371 |
No. of female addicts
|
621 | 586 | 590 | 635 | 672 | 680 | 399 | 377 | 420 | 422 | 447 |
PROFESSIONAL CLASSES
(Medical or Allied)
|
|||||||||||
Total number
|
43 | 43 | 38 | 44 | 33 | 29 | 26 | 26 | 22 | 23 | 15 |
The most important facts intable 1 concern the number of heroin users in Britain since 1968. There has been a decline in the numbers of notified heroin users; 2,240, 1,417, 914, 959, and 868 between 1968 and 1972. But the decline in heroin use is even more striking when one examines data at the end of each year. The statistics in table 1 do not provide information about the number of persons receiving heroin at the end of 1968. However, a government report, The Rehabilitation of Drug Addicts (Advisory Committee, 1968, 25), shows that 950 persons were receiving heroin prescriptions on 31 May 1968 (the end of the first full month in which clinics began treating all heroin addicts). Thus, although 2,240 heroin users were notified to the Home Office attention in 1968, the number of persons receiving heroin prescriptions in any one month probably did not exceed 1,000. This figure had been cut almost in half (to 499) at the end of 1969, with continuous but lesser decreases on 31 December 1970, 1971, and 1972.
Of course, most heroin addicts have not been "cured"; they have been switched to methadone as the result of intentional substitution by most prescribing doctors in the clinics (Glatt, 1972; Judson, 1973; table 1, footnote). As in the United States, the use of methadone is a relatively recent phenomenon. Through 1965, less than 100 addicts were using methadone (called physeptone in Britain); only about 500 addicts were using the drug during 1968. (There is a discrepancy, see Johnson, 1975.) It was in late 1968 and 1969 that the clinic doctors began to substitute methadone for heroin. The number of persons reported to be taking methadone increased from 486 in 1968 to almost 1,700 in 1969 and to almost 2,200 in 1972. Methadone was actively being prescribed to 1,000 persons on 31 December 1969, and to about 1,300 persons on 31 December 1972.
Table 2 provides detailed data about the number of outpatients receiving prescriptions in the DTCs. Since 1968, the number of patients receiving treatment remained relatively constant, between 1,100 and 1,200, from September 1968 to December 1970. The numbers were cut back by nearly 100 in 1971, but increased to over 1,400 by the end of 1973. Whether this cutback and the apparent increase in addicts is significant or represents a change in prescribing has yet to be determined (Johnson, 1975).
Table 2 also reports information about the number of "new" addicts. A "new" addict may be operationally defined as a written notification on a person not previously notified to the Home Office. Thus a person is a new opiate addict if an inspector of pharmacy records reports a new name, or if a general practitioner, prison physician, or treatment clinic submits a written notification (Connell, 1971; Bransby, 1971). The term "first notification" is usually employed by the Home Office to describe new addicts. The apparent disparity between columns B and C for 1968 is due to the fact that approximately a quarter or more of the 1,999 patients first entering the newly formed DTCs were previously known to the Home Office.
(Footnotes to table 1)
NOTE. - The statistical data from 1969 is presented differently from the preceding years. Previously these statistics had been based on the total number of addicts coming to the notice of the Home Office during the course of the year. New recording procedures have made it possible to give details of these addicts known to have been receiving supplies of drugs at the end of the year as well as the total number of cases coming to notice during the year.
a These figures refer to drugs used alone or in combination with other drugs. Thus an addict using both heroin and cocaine will be included under both drugs, and it must be pointed out that all but a handful of the cocaine addicts shown are also using heroin.
b U.S. proprietary name - Demerol.
c From 1969 this figure is for addicts to heroin and/or methadone. The reason for this is that as a result of a deliberate policy adopted by hospital clinics in the treatment of heroin addiction by weaning patients from heroin on to methadone, methadone has supplanted heroin as the drug most commonly used by addicts.
TABLE 2
A = Number of out-patients attending drug treatment centres/hospitals in England and Wales at the end of each period.
B = Number of in-and out-patients notified for the first time aby hospitals and private clinics in England and Wales.
C = Total number of first notifications in Britain (England, Wales, Scotland, and Northern Ireland) during each year. b
A Out-patients attending DTCs at end of each period |
B Patients first notified by clinics during period |
||||||
---|---|---|---|---|---|---|---|
Bi-monthly Year period |
London |
Elsewhere |
Total |
London |
Elsewhere |
Total |
C Yearly number of first notifications in Britain |
1961 | 129 | ||||||
1962 | 159 | ||||||
1963 | 209 | ||||||
1964 | 246 | ||||||
1965 | 332 | ||||||
1966 | 633 | ||||||
1967 | 664 | ||||||
1968 | |||||||
Jan.-Feb
|
325 | 83 | 408 | 287 | 56 | 343 | |
Mar.-Apr
|
687 | 111 | 798 | 533 | 87 | 620 | |
May-June
|
799 | 224 | 1023 | 310 | 97 | 407 | |
July-Aug
|
868 | 204 | 1072 | 182 | 65 | 247 | |
Sept.-Oct
|
896 | 234 | 1130 | 157 | 72 | 229 | |
Nov.-Dec
|
921 | 218 | 1139 | 103 | 50 | 153 | |
Total
|
DNA
|
DNA
|
DNA
|
1572 | 427 | 1,999 | 1476 |
1969 | |||||||
Jan.-Feb.
|
894 | 236 | 1130 | 11l | 54 | 165 | |
Mar.-Apr
|
927 | 232 | 1159 | 102 | 45 | 147 | |
May-June
|
936 | 234 | 1170 | 95 | 53 | 148 | |
July-Aug
|
924 | 212 | 1136 | 77 | 30 | 107 | |
Sept.-Oct
|
922 | 257 | 1179 | 88 | 51 | 139 | |
Nov.-Dec
|
903 | 243 | 1146 | 64 | 29 | 93 | |
Total
|
DNA
|
DNA
|
DNA
|
537 | 262 | 799 | 1030 |
1970 | |||||||
Jan..-Feb.
|
909 | 248 | 1157 | 68 | 21 | 89 | |
Mar.-Apr
|
947 | 227 | 1174 | 61 | 24 | 85 | |
May-June
|
966 | 170 | 1136 | 45 | 21 | 66 | |
July-Aug
|
992 | 168 | 1160 | 64 | 29 | 93 | |
Sept.-Oct
|
985 | 178 | 1163 | 55 | 34 | 89 | |
Nov.-Dec
|
956 | 177 | 1133 | 44 | 24 | 68 | |
Total
|
DNA
|
DNA
|
DNA
|
337 | 153 | 490 | 711 |
1971 | |||||||
Jan.-Mar
|
835 | 185 | 1020 | 73 | 39 | 1l2 | |
Apr.-June
|
817 | 181 | 998 | 75 | 36 | 111 | |
July-Aug
|
831 | 201 | 1032 | 62 | 37 | 99 | |
Sept.-Oct
|
828 | 214 | 1042 | 72 | 26 | 98 | |
Nov.-Dec
|
839 | 248 | 1087 | 64 | 28 | 92 | |
Total
|
DNA
|
DNA
|
DNA
|
346 | 166 | 512 | 777 |
1972 | |||||||
Jan.-Feb
|
894 | 277 | 1171 | 66 | 36 | 102 | |
Mar.-Apr
|
972 | 295 | 1267 | 50 | 30 | 80 | |
May-June
|
967 | 298 | 1265 | 59 | 30 | 89 | |
July-Aug
|
948 | 292 | 1240 | 58 | 19 | 77 | |
Sept.-Oct
|
969 | 308 | 1277 | 56 | 30 | 86 | |
Nov.-Dec
|
970 | 323 | 1293 | 42 | 37 | 79 | |
Total
|
DNA
|
DNA
|
DNA
|
331 | 182 | 513 | 801 |
1973 | |||||||
Jan.-Feb
|
997 | 332 | 1329 |
n.a.
|
n.a.
|
89 | |
Mar.-Apr
|
1010 | 332 | 1342 |
n.a.
|
n.a.
|
80 | |
May-June
|
1027 | 332 | 1359 |
n.a.
|
n.a.
|
119 | |
July-Aug
|
1050 | 346 | 1396 |
n.a.
|
n.a.
|
l03
|
|
Sept.-Oct
|
1079 | 330 | 1409 |
n.a.
|
n.a.
|
114 | |
Nov.-Dec
|
1106 | 336 | 1442 |
n.a.
|
n.a.
|
88 | |
Total
|
DNA
|
DNA
|
DNA
|
593 | 807 |
However, after 1968, as the DTCs settled into a normal routine, the mandatory check with the Home Office has apparently meant that most "patients" first notified by clinics are new addicts although the precise proportion is not indicated. An addict's ability to conceal his identity and receive duplicate prescriptions (Reeves, 1974), might reduce the number of actual new addict somewhat, but would probably not substantially affect change from year to year. Columns B and C of table 2 indicate that the clinics provide the first notification for over 60 per cent of all addicts; only 200 to 300 of the first notifications come from private or prison doctors, or inspectors of pharmacy records. The number of new outpatients has declined from over 160 in the first two months of 1969 to about 80 bi-monthly in 1972.
TABLE 3
Ages of "under 20" addicts known to Home Office (Home Office, 1974)
14 |
15 |
16 |
17 |
18 |
19 |
Total |
|
---|---|---|---|---|---|---|---|
1960 |
-
|
-
|
-
|
-
|
-
|
1 | 1 |
1961 |
-
|
-
|
-
|
1 | 1 | 2 | |
1962 | 1 |
-
|
-
|
2 | 3 | ||
1963 |
-
|
-
|
2 | 2 | 2 | 11 | 17 |
1964 | 1 |
-
|
1 | 8 | 11 | 19 | 40 |
1965 |
-
|
8 | 5 | 19 | 42 | 71 | 145 |
1966 | 1 | 17 | 26 | 68 | 111 | 106 | 329 |
1967 |
-
|
3 | 38 | 82 | 100 | 172 | 395 |
1968 |
-
|
10 | 40 | 141 | 274 | 299 | 764 |
1969 Total |
-
|
-
|
24 | 83 | 218 | 312 | 637 |
1970 Total |
-
|
1 | 9 | 49 | 117 | 229 | 405 |
1971 Total |
-
|
-
|
10 | 45 | 114 | 169 | 338 |
1972 Total | 1 | 1 | 7 | 27 | 85 | 158 | 279 |
1973 Total |
-
|
-
|
7 | 39 | 78 | 129 | 253 |
12/31/69
|
-
|
-
|
6 | 33 | 73 | 112 | 224 |
12/31/70
|
-
|
1 | 1 | 18 | 30 | 92 | 142 |
12/31/71
|
-
|
-
|
2 | 13 | 34 | 69 | 118 |
12/31/72
|
-
|
-
|
3 | 13 | 24 | 56 | 96 |
12/31/73
|
-
|
-
|
2 | 9 | 24 | 49 | 84 |
A major concern of both British and American observers is opiate addiction among adolescents. The Home Office (1973) reports detailed statistics on known addicts under the age of 20 (reproduced in table 3). The data show striking increases in the number of youthful addicts from three in 1962 to 395 in 1967, including an all-time high of 764 when the Notification of Addict regulations went into effect in 1968. Since that time, however, there has been a steady decline to 279 (1972) in the number of youthful addicts known to the Home Office; only a small proportion, about one-third, of notified youthful addicts were receiving opiate prescriptions at the end of the year. Home Office (1973) data not presented here show only 3 persons "under 20" receiving heroin prescriptions on 31 December 1972.
(Footnotes to table 2}
Sources: (DHSS, 1973; Derbyshire, 1974; U.N. Reports, 1968-73; British Information Services, 1973).
NOTE. - DNA = Does Not Apply; n.a. = not available.
a Addicts first notified by DTC, hospital or private clinic; they may have been previously notified from other sources.
b Column C apparently includes data which are not included in Column B from Scotland and Northern Ireland as well as notifications from general practitioners, prison physicians and inspectors of pharmacy records.
Drug convictions and continued demand for opiates
The British Criminal Justice System has three unique aspects. First, when a person is arrested on a drug charge, both the police and a magistrate (lower court judge) may fix bail. A suspect may be released in his own recognizance or be granted "police bail" (generally less than £50) at the station house if police trust him to appear before a magistrate at a later date. The police decision to grant bail is usually made on the defendant's stability of residence and/or job, the minor nature of his offence (e.g., drug possession), and the probability that the case will be settled in a court of "summary" jurisdiction. Schofield (1971) alleges that the police occasionally pressure the defendant to admit his guilt before granting police bail and/or opposing bail before a magistrate. As in the American system, magistrates have the right to set bail and do so in most cases. Nevertheless, some drug arrestees are held in jail because they cannot make bail. Thus, arrestees for minor possession cases may spend up to a month in jail while chemical tests on the seized drugs are performed (Schofield, 1971); although these cases are swiftly handled afterwards in a magistrate's court.
At the time of initial appearance before a magistrate, the police or prosecutor generally indicate whether they plan to seek an indictment against the defendant. An indictment means that the police consider the case to be a serious offence, carrying a maximum sentence of more than one year in prison, and that the case will probably be tried in a Crown Court (higher) by jury. However, even if the police indicate a willingness to seek a summary conviction, the defendant may elect to have a trial by jury.
The second unique feature of British law is the summary conviction. The Dangerous Drug Act of 1965 provides two different penalties for the same offence. Thus, a person arrested for unlawfully supplying (selling)heroin, (1)if tried and convicted in a cour of summary jurisdiction (usually a Magistrate'Court), could be imprisoned for up to 12 months and/or fined £250 ($625), but (2) if convicted at a jury trial after indictment could be sentenced to up to l0 years and/or fined £1000. Maximum penalties were raised in the Misuse of Drugs Act of 1971, which went into effect in July 1973: summary - £400 and/or 12 months; indictment - unlimited fine and/or 14 years. The apparent function of having two different penalties for the same offence is to keep most cases out of higher courts (Home Office, 1974). Since there is probably some reluctance by the Crown Court to accept all cases presented by police, many moderately serious cases are probably tried in the Magistrate's Court. Thus, most drug cases are resolved in the Magistrate's Court.
When the police are not seeking an indictment and the defendant does not insist upon a trial by jury, a summary conviction may occur in two ways. (1) if the defendant appears before a magistrate and admits his guilt, he is then found guilty by the court and sentenced. (2) If the defendant initially pleads not guilty, a later date for trial is set. On that date, a trial is held before the magistrate, who makes a finding of guilt or innocence; if the verdict is guilty, a variety of sentences may be imposed.
The third feature of British justice is the low potential and actual sentences imposed in British courts by comparison with American courts. There are no mandatory minimums and the maximum prison sentences are considerably less severe than prescribed by American federal laws and, especially, the recent Rockefeller drug law of 1972 in New York State. Even in "big" cases the maximum sentence in Britain (10 years) is seldom imposed (U.N. Reports, 1968-1972; tables 6 and 7): a seizure of nearly 7 kgs of heroin from Hong Kong in 1972 apparently resulted in a sentence of 4 years (U.N. Report,1972) for unlawful importation. Further, the low potential sentences of the summary conviction and sentencing policy of magistrates apparently makes plea and sentence bargaining (reduction or substitution of charges in exchange for a lesser sentence) relatively uncommon, speeds up court processing, minimizes defendant-inspired delays, etc. Unpublished statistics seen at the Home Office (1974) showed that there were 11,625 persons prosecuted under the Dangerous Drug Act of 1965 during 1972; of these, 864 were not convicted; 6,595 were fined only; 692 were imprisoned (and perhaps fined); and the rest received varying sentences (conditional discharge, probation, borstal-for a young offender, suspended sentences, etc.).
TABLE 4
Offences involving drugs controlled under the Dangerous Drug Act - 1965
(Home Office, 1974)
Cannabis |
Opium |
Manufactured Drugs |
Drugs (Prevention of Misuse Act 1964) |
|
---|---|---|---|---|
1945 | 4 | 206 | 20 | |
1946 | 11 | 65 | 27 | |
1947 | 46 | 76 | 65 | |
1948 | 51 | 78 | 48 | |
1949 | 61 | 52 | 56 | |
1950 | 86 | 41 | 42 | |
1951 | 132 | 64 | 47 | |
1952 | 98 | 62 | 48 | |
1953 | 88 | 47 | 44 | |
1954 | 144 | 28 | 47 | |
1955 | 115 | 17 | 37 | |
1956 | 103 | 12 | 37 | |
1957 | 51 | 9 | 30 | |
1958 | 99 | 8 | 41 | |
1959 | 185 | 18 | 26 | |
1960 | 235 | 15 | 28 | |
1961 | 288 | 15 | 61 | |
1962 | 588 | 16 | 71 | |
1963 | 663 | 20 | 63 | |
1964 | 544 | 14 | 10l | |
1965 | 626 | 13 | 128 |
958
a
|
1966 | 1,119 | 36 | 242 | 1,216 |
1967 | 2,393 | 58 | 573 | 2,486 |
1968 | 3,071 | 73 | 1,099 | 2,957 |
1969 | 4,683 | 53 | 1,359 | 3,762 |
1970 | 7,520 | 66 | 1,214 | 3,885 |
1971 | 9,219 | 55 | 1,570 | 5,516 |
1972 | 12,611 | 98 | 2,068 | 5,284 |
1973 | 14,119 |
244
b
|
8,497
c
|
NOTE. - From 1945 to 1953 inclusive the figures relate to prosecutions. From 1954 onwards the figures relate to convictions.
a This figure is in respect of the period 31 October 1964 to 31 December 1965.
b Includes Medicinal Opium.
cIncludes offences under the Dangerous Drug Act 1965, the Drugs (Prevention of Misuse) Act 1964 and the Misuse of Drugs Act 1971 which came into force on 1 July 1973 and which repealed the 1965 and 1964 Acts.
Thus, the fact that 11-12 per cent of all prosecutions end in no conviction (U.N. Reports, 1968-1972), that most cases are settled in a Magistrate's Court in a fairly rapid manner, and that defendants are usually convicted of the offence they are charged with probably means that the following conviction statistics provide a reasonably accurate indicator of contact between lawbreakers and police. Also, they may be the best reflection of trends in illicit drug use given the absence of representative drug surveys in England.
Previous tables have indicated a decrease in the legal prescription of heroin and increase in methadone. The following conviction statistics suggest there is probably an increasing use of and demand for cannabis (also see Journal, July 1973; Glatt, 1973), as well as a continuing or perhaps increasing demand for heroin and other opiates.
Table 4 shows a striking increase since 1960 in the number of cannabis convictions, possibly indicating a very strong demand for cannabis. There has been no increase in the number of convictions for "opium" (raw or smoking), but there was a significant increase in convictions for offences of laws regulating manufactured drugs (morphine,cocaine, heroin, methadone, and other synthetic opiates). There have also been sizable increases in offences of the Drugs (Prevention of Misuse) Act 1964 regulating LSD, some other hallucinogens, and amphetamines, with a slight decline in 1972.
TABLE 5
Numbers of personsa found guilty of an offence involving drugs or groups of drugs
(Home Office, 1974)
Drug |
1970 |
1971 |
1972 |
1973 |
---|---|---|---|---|
Raw opium
|
25 | 19 | 28 |
186
b
|
Prepared opium
|
32 | 33 | 60 | |
Heroin
|
226 | 500 | 532 | 460 |
Cannabis (including cultivation of plant) (Marihuana)
|
802 | 1922 | 2619 | 11246 |
Cannabis resin (Hashish)
|
5880 | 6290 | 6697 | |
Cocaine
|
112 | 107 | 179 | 194 |
Other drugs controlled under the Dangerous Drugs Act, 1965 (Metha-done, Morphine, etc.)
|
577 | 594 | 709 |
c
|
Lysergide (LSD 25)
|
744 | 1537 | 1306 | 1273 |
Other drugs controlled under the Drugs (Prevention of Misuse) Act 1964 (Mainly Amphetamines) (Other Controlled Drugs c)
|
2181 | 2810 | 2480 |
3286
c
|
a A number of persons were found guilty of one or more offences involving different types of drug. Such persons will appear in the table under each type of drug.
b Includes medicinal opium.
c Combined under the Misuse of Drugs Act, 1971.
Table 5 provides more detailed information about specific drug convictions. The number of persons guilty of "one or more" offences related to heroin increased from 226 to 532 between 1970 and 1972. Increases for other drugs are noted, particularly cannabis, cocaine, "other drugs" (morphine, methadone, and other synthetic opiates). Although large absolute increases are involved, the relative change in number of persons convicted for violations involving hashish (cannabis resin), LSD, and amphetamines is small or shows slight decreases in 1972.
Tables 6 and 7 contain very detailed data abstracted from reports to the United Nations which have been obtained from the Home Office. A few definitions seem indicated. Arrests for "possession" may occur when a suspect has: (1) a controlled, or illicit, drug on his person or nearby; (2) a prescribed drug but no proof that the drug was legally prescribed to him (i.e., a clinic doctor or general practitioner denies prescribing that particular drug to the suspect); or (3) a urine test which is positive for opiates or cocaine (Home Office, 1974). Prior to 1973, there were no laws regulating legally prescribed opiates; thus, no charges could be pressed if the police discovered a clinic patient holding a month's supply of legally prescribed heroin and presumably intended for illicit sale. However, the 1971 Misuse of Drugs Act--which went into effect on 1 July 1973-includes a new offence, possession with intent to supply unlawfully to another, which provides some controls over legally prescribed opiates. Unlawful "supply" occurs when the suspect is observed giving or selling drugs to others, including legally prescribed drugs. An occasional unlicensed doctor who prescribes cocaine or heroin may be prosecuted for unlawful supply (Home Office, 1974). Unlawful "import" occurs when someone smuggles in supplies of a controlled drug from a foreign country. "Theft" occurs when a suspect steals controlled drugs from a chemist's shop (pharmacy) or from a person legally supplied by a DTC. The "theft" entry in the table also includes "fraud" such as altering a legal prescription. "Procuring" is such a vague offence that it has been dropped under the Misuse of Drugs Act of 1971, but apparently included trying to trick a druggist or legally prescribed addict to provide a drug which the suspect is not authorized to have, as well as doctors who obtain a prescription for a patient but use it themselves. Arrests for unlawful "premises" occur when the occupier or person concerned in the management of any premises knowingly allows certain activities, including the smoking of cannabis or opium, to take place on the premises. (N.B. These "smoking" offences are the only ones which specifically involve the actual consumption of a controlled drug.) "Other offences" are mainly the contravention of regulations governing the manufacture, distribution, and retail prescription of controlled drugs.
Understanding data in table 6 is difficult because of unclear trends. There was a decline in heroin-related convictions between 1968 and 1970, and an increase from 1970 to 1972. Convictions for cocaine and manufactured drugs remained relatively constant between 1969 and 1971 but showed sizable increases in 1972. For each narcotic, the increase in 1972 was due, in large part, to convictions for theft, although possession of cocaine and manufactured drugs increased also.
There seem to be three possible interpretations of these data. First, police may have been somewhat lax in enforcing narcotic laws from 1969 through 1971, but for some unknown reason began serious enforcement in 1972. Second, the clinics may be ineffective in containing heroin and other opiates; addicts are resorting to the illegal market to obtain their drugs with more arrests and convictions resulting. Third, the clinics are relatively effective in switching many addicts from heroin to methadone or in refusing to provide heroin or injectable methadone to new or recidivating addicts (Johnson, 1975). Since many addicts really want heroin, they sell methadone for heroin or money to buy heroin; thus they are more exposed to arrest Underlying the second and third interpretations is an assumption of a continuing, and perhaps increasing, demand for heroin and opiates
TABLE 6
Number of convictions for offences involving opiates and cocaine under Dangerous Drug Act, 1965 (1968-1972) and Misuse of Drugs Act, 1971 (1973) as well as penalties and amount seized in illicit trade
(U.N. Reports 1969-1974)
Number of Convictions for : |
||||||||||
---|---|---|---|---|---|---|---|---|---|---|
Year |
Unlawful pos- session |
Unlawful premises |
Unlawful supply |
Unlawful import |
Theft |
Procuring |
Others |
Total |
Amount seized in illicit trade (gm) |
|
Total: all opiates and
|
||||||||||
Cocaine
|
1968 | 705 | 4 | 65 | 3 | 241 | 61 | 93 | 1172 | 6952 |
1969 | 752 | 1 | 11 | 6 | 417 | 53 | 72 | 1412 | 14708 | |
1970 | 609 | 1 | 66 | 6 | 486 | 46 | 66 | 1280 | 10700 | |
1971 | 906 | 2 | 117 | 7 | 409 | 85 | 99 | 1625 | 9281 | |
1972 | 1250 | 2 | 80 | 2 | 682 | 55 | 95 | 2166 | 20940 | |
1973 |
1754
c
|
1 | 130 | 40 | 1017 | 34 | 276 | 3252 | 18257 | |
Heroin
|
1968 | 391 |
b
|
40 | 0 | 33 | 36 | 38 | 539 | 435 |
1969 | 200 |
b
|
36 | 1 | 77 | 26 | 1 | 341 | 561 | |
1970 | 157 |
b
|
20 | 1 | 93 | 9 | 1 | 281 | 1600 | |
1971 | 439 |
b
|
54 | 0 | 71 | 15 | 1 | 580 | 1140 | |
1972 | 471 |
b
|
33 | 1 | 134 | 20 | 6 | 665 | 13100 | |
1973 |
427
c
|
b
|
61 | 7 | 92 | 6 | 35 | 628 | 3265 | |
Cocaine
|
1968 | 56 |
b
|
3 | 0 | 40 | 1 | 11 | 111 | 417 |
1969 | 50 |
b
|
1 | 0 | 85 | 3 | 1 | 140 | 147 | |
1970 | 59 |
b
|
2 | 0 | 99 | 2 | 0 | 162 | 200 | |
1971 | 48 |
b
|
6 | 1 | 70 | 1 | 0 | 126 | 266 | |
1972 | 99 |
b
|
3 | 0 | 143 | 0 | 0 | 245 | 590 | |
1973 |
165
c
|
b
|
8 | 4 | 88 | 1 | 27 | 293 | 6438 | |
Other Manfactured
|
||||||||||
Drugs
|
1968 | 197 |
b
|
19 | 0 | 168 | 24 | 41 | 449 |
<100
|
(Morphine,
|
1969 | 455 |
b
|
73 | 3 | 255 | 24 | 68 | 878 |
2000+
|
Methadone,
|
1970 | 346 |
b
|
38 | 0 | 294 | 35 | 58 | 771 | 400 |
Pethedine, etc)
|
1971 | 379 |
b
|
55 | 1 | 268 | 69 | 92 | 864 | 15 |
1972 | 593 |
b
|
44 | 0 | 405 | 35 | 81 | 1158 | 1350 | |
1973 |
1028
c
|
b
|
55 | 11 | 765 | 27 | 201 | 2087 | 3098 | |
Opium (Raw or Prepared)
|
1968 | 61 | 4 | 2 | 3 |
a
|
a
|
3 | 73 | 6000 |
1969 | 47 | 1 | 1 | 2 |
a
|
a
|
2 | 53 | 12000 | |
1970 | 47 | 1 | 6 | 5 |
a
|
a
|
7 | 66 | 8500 | |
1971 | 40 | 2 | 2 | 5 |
a
|
a
|
6 | 55 | 7200 | |
1972 | 87 | 2 | 0 | 1 |
a
|
a
|
8 | 98 | 5900 | |
1973
d
|
134
c
|
1 | 6 | 18 | 72 |
a
|
13 | 244 | 5500 | |
Range of Fines (£s)
|
1968 |
1-100
|
200 |
10-100
|
5-50
|
10-100
|
5-100
|
5-100
|
1-200
|
|
1969 |
1-200
|
0 |
1-30
|
5-100
|
5-100
|
5-450
|
3-50
|
1-450
|
||
1970 |
5-250
|
0 |
5-150
|
100 |
5-175
|
5-50
|
2-50
|
2-250
|
||
1971 |
5-200
|
50 |
25-50
|
5-100
|
5-100
|
1-50
|
5-100
|
1-200
|
||
1972 |
1-200
|
10-50
|
1-75
|
0 |
3-120
|
1 30 |
3-50
|
1-200
|
||
1973 |
Not available in U.N. Report (1974)
|
|||||||||
Prison Sentences
|
1968 |
1m-6y
|
0 |
3m-30m
|
1y |
3m-2y
|
6m-15m
|
6m-30m
|
1m-6y
|
|
(Range) d = days,
|
1969 |
1d-7y
|
0 |
3m-3y
|
0 |
1m-4y
|
6m-18m
|
3m-7y
|
1d-7y
|
|
w = week,
|
1970 |
1m-4y
|
9m |
3m-3y
|
0 |
3m-5y
|
1m-3y
|
1m-py
|
1m-5y
|
|
m = month,
|
1971 |
1w-7y
|
0 |
3m-5y
|
1y |
1w-5y
|
3m-2y
|
2m-18m
|
1w-7y
|
|
y = year)
|
1972 |
2w-5y
|
0 |
6m-8y
|
4y |
2w-5y
|
3m-2y
|
3m-6y
|
2w-8y
|
|
1973 |
Not Available in UN Report (1974) - Maximum: 10 years for heroin supply
|
d Includes medicinal opium; source: Derbyshire (1974)
aNot an offence for opium under the Dangerous Drug Act, 1965 but is an offence under Misuse of Drugs Act 197l.
b Not an offence for manufactured drugs under the Dangerous Drug Act, 1965.
c Includes convictions for possession with intent to supply unlawfully (Misuse of Drugs Act, 1971).
The correct interpretation, if there is one, is undoubtedly much more complex. The rising number of narcotic thefts (table 6) indicates that those receiving legal prescriptions are being robbed by those without scripts. However, the sharp rise in heroin possession convictions between 1970 and 1971 may indicate increasing police attempts to control heroin from the Far East region (Wolman, 1972; Judson, 1973; Johnson, 1975). The increase in possession of manufactured drugs between 1971 and 1972 may indicate increasing diversion of methadone ampoules (DHSS, 1973; Johnson, 1975). Nevertheless, it seems reasonable to conclude that the DTCs are containing the supply of legal heroin. It is less clear, however, that illegal supplies are being contained, since the amount seized in 1972 (13.1 kg) is almost as much as was legally prescribed (DHSS, 1973; Josephson, 1973; Blumberg, 1974; Johnson, 1975). Thus, given that conviction statistics indicate a continuing or increasing demand for heroin, the general policy of DTCs of reducing the number of persons receiving heroin may have the negative effect of supporting a growing illegal market (Judson, 1973; Josephson, 1973).
Table 7 is much easier to analyse. Cannabis convictions are on the increase, and probably indicate an increasing demand for the substance. A contrary interpretation, that the convictions reflect increased police concern about cannabis, is somewhat dubious. Public concern, and hence political pressure, upon police to control cannabis users seems much less extensive than in the period 1968-70 (Schofield, 1971; Zinberg and Robertson, 1972).
The bottom of tables 6 and 7 indicate the minimum and maximum fines and prison sentences handed out for specific offences in different years. Probably the most striking feature is that the maximum fines imposed for cannabis offences are usually larger than those for the same offences regulating narcotics and that the legal maximum fine (£1000) is almost never imposed for narcotic offences. Furthermore, maximum prison sentences imposed are generally less than the legal maximum (10 years) and roughly equivalent for narcotics and cannabis for the same offence.
The statistical data issued by the Home Office and Department of Health and Social Security are quite detailed and generally valid measures of hard core addiction in Great Britain (Judson, 1973). Since 1968, the main basis of these high quality British statistics is the routine reports filed by Drug Treatment Centres. The well-trained, experienced staff of these clinics make knowledgeable decisions about a client's addiction, efficiently regulate dosage, and otherwise exert some degree of control over addicts (Judson, 1973; Johnson, 1974). The co-operation of police, courts, prison physicians, and general practitioners is also valuable in collecting data on drug addiction and convictions.
Information presented in the tables above indicates that a rising problem of heroin addiction between 1962 and 1967 was arrested by the introduction of the treatment clinics in 1968. Further, legally maintained heroin addiction has been reduced by almost one-third since 1968, since many heroin addicts have been transferred to injectable methadone. The decline in heroin prescribing and the relatively steady number of narcotics addicts has apparently occurred in the face of a continuing, and perhaps increasing, demand for heroin and other opiates.
With few exceptions of a minor nature analysis of various tables suggests that the official statistics are internally consistent. There are apparently few "hidden" addicts, since few unknown addicts die of overdoses or are arrested by police (Lewis, 1973), although Blumberg (1974) indicates that some unknown users may exist. In addition, many opiate users not officially notified are known by clinic doctors as friends of addicts receiving prescriptions (Judson, 1973; Home Office, 1974). In brief, official British drug statistics seem to be generally valid and demonstrate that heroin and perhaps methadone addiction has been well contained by the treatment clinics.
TABLE 7
Number of convictions for offences involving Cannabis (Marihuana and Hashish) under Dangerous Drugs Act, 1965 (1968-1972) and Misuse of Drugs Act, 1971 (1973) as well as penalties and amounts seized in illicit trade
U.N. Reports, 1968-1970)
Number of Convictions for |
|||||||||
---|---|---|---|---|---|---|---|---|---|
Year |
Possession |
Premises |
Supply |
Import |
Cultivation |
Others |
Total |
Amount seized in kilograms |
|
Cannabis
|
1968 | 2,663 | 193 | 87 | 77 | 6 | 45 | 3071 | 1125 |
1969 | 4,094 | 225 | 147 | 122 | 5 | 90 | 4683 | 544 | |
1970 | 6,545 | 340 | 319 | 171 | 43 | 102 | 7520 | 1178 | |
1971 | 7,837 | 474 | 394 | 224 | 99 | 191 | 9219 | 3068 | |
1972 | 10,986 | 570 | 453 | 243 | 246 | 113 | 12611 | 5921 | |
1973 |
11911
a
|
586 | 661 | 478 |
387
b
|
96
c
|
14119 | 9265 | |
Range of Cannabis
|
|||||||||
Fines: (£s)
|
1968 |
2-500
|
5-350
|
5-200
|
5-100
|
10-25
|
3-100
|
2-500
|
|
1969 |
1-250
|
2-150
|
2-200
|
1-350
|
10-75
|
3-100
|
1-350
|
||
1970 |
1-1000
|
5-150
|
3-250
|
4-200
|
3-200
|
5-100
|
1-1000
|
||
1971 |
1-3000
|
5-500
|
5-200
|
8-4000
|
5-100
|
2-250
|
1-4000
|
||
1972 |
1-500
|
1-200
|
3-200
|
3-1000
|
2-200
|
5-100
|
1-1000
|
||
1973 |
Not available in U.N. Report (1974): Maximum - £750 for Import.
|
||||||||
Prison Sentences,
|
|||||||||
Cannabis (Range)
|
1968 |
1m-5y
|
6m-7y
|
3m-5y
|
9m-7y
|
0 |
3m-3y
|
1 m-7y
|
|
(d = day,
|
1969 |
1d-5y
|
3m-6y
|
4m-3y
|
9m-7y
|
0 |
1m-10y
|
1d-10y
|
|
m = month
|
1970 |
1d-7y
|
3m-5y
|
lm-6y
|
6m-7y
|
0 |
1m-30m
|
1d-7y
|
|
w = week
|
1971 |
1w-7y
|
1m-5y
|
3m-5y
|
3m-7y
|
3m-ly
|
1d-7y
|
1 d-7y
|
|
y = year)
|
1972 |
1d-6y
|
1m-3y
|
1d-7y
|
3m-6y
|
1m-3y
|
1m-5y
|
1 d-7y
|
|
1973 |
Not Available in U.N. Report (1974)
|
a See footnote c of table 6.
b Source: Derbyshire (1974).
c Includes 53 convictions for procuring and 7 for theft or fraud under Misuse of Drugs Act 1971.
Advisory Committee on Drug Dependence "Rehabilitation of Drug Addicts." Report to the Home Office, London, Her Majesty's Stationery Office (6 September) 1968.
Baden, Michael M. "Narcotic Abuse." New York State Journal of Medicine, 843-840 (1 April), 1972.
Bewley, T. H., et al. "Maintenance Treatment of Narcotic Addicts (Not British nor a System, but Working Now)," International Journal of the Addictions, 7- 4, 597-612, 1972.
Bissell, LeClair. "British Program Seen Limited to Control of Drug Supply." New York Law Journal, 37 (6 December) 1974.
Blumberg, H. H., et al. "British Opiate Users: I. People approaching London drug treatment centres." International Journal of Addictions (forthcoming), 1974.
Bransby, E.R. "A Study of patients notified by hospitals as addicted to drugs: first report." Health Trends, November 1971.
Brecher, Edward M., and Editors of Consumers Reports Licit and Illicit Drugs, Consumers Union, Mount Vernon, N.Y., 1972.
Brill, Henry, and Granville W. Larimore. "Second on-site study of the British Narcotic System." N.Y. Narcotics Addiction Control Commission, 1-2, 1965.
British Information Services. "The Prevention and Treatment of Drug Dependence in Britain." Office of Information, London (April), 1973.
British Medical Journal (Editorial). "Transatlantic Debate on Addiction", 321-322 (7 August), 1791.
Bureau of Narcotics and Dangerous Drugs (BNDD). Reported Narcotics Abusers, Calendar Year 1972, Washington, D.C., U.S. Dept. of Justice, 1973.
"The Most Frequently Asked Questions About Drug Abuse". (Pamphlet) Washington, D.C., U.S. Dept. of Justice, 1971.
Cahal, D. A. "Drug Addiction and the Law." Journal of the Royal College of General Practioners, 20:32-38, 1970.
- - - - - - , "The British Approach", in Royal Society of Medicine, Anglo-American Conference on Drug Abuse, London, 16-18 April 1973.
Connell, P.H. "The Impact of the New Approach to the Problem of Drug Dependence in Great Britain." Industrial Medicine, 40- 1: 17-24, 1971.
Cuskey, Walter, Arnold Klein and William Krasner. Drug-Trip Abroad, American Drug Refugees in Amsterdam and London, Philadelphia, Univ. of Penn. Press, 1972.
Cuskey, Walter R. and William Krasner. "The Needle and the Boot: Heroin Maintenance", Society, 10, 45-52 (May/June) 1973. de Alarcon, R. and N. H. Rathod. "Prevalence and Early Detection of Heroin Abuse", British Medical Journal, 2, 549-553, 1968.
Department of Health and Social Security (DHSS). Numbers of Outpatients and amounts of Heroin and Methadone Prescribed. (Unpublished tables obtained upon request) London, 14 Russell Square, 1973.
Derbyshire, E.J. An official at the Home Office. Personal Communication, Oct. 1974.
Dole, Vincent P. "Detoxification of Sick Addicts in Prison." Journal of the American Medical Assn., 220, 366-369, 17 April 1972.
Edwards, Griffith. "The British Approach to the Treatment of Heroin Addiction." The Lancet, 768-772, 12 April 1969.
Glancy, J.E. "The Treatment of narcotic dependence in the United Kingdom, Bulletin on Narcotics, XXIV: 4, 1-10, 1972.
Glatt, Max. "Present-day Methadone Prescribing in England." International Journal of the Addictions, 7(1), 173-177, 1972.
Glazer F. B., and J. C. Ball. "The British Narcotic 'Register' in 1970; A Factual Review." Journal of the American Medical Assn., 216(7), 1177-1182, 17 May 1971.
Greenwood, Joseph A. "Estimating Number of Narcotic Addicts," Washington, D.C., Bureau of Narcotics and Dangerous Drugs, 1971.
Home Office. "United Kingdom Statistics of Drug Addiction and Criminal Offences Involving Drugs." London Home Office Drug Branch (Press Release.) 1974.
- - - - Personal communication with Home Office officials, June 1974.
Hughes, Patrick H., Gall A. Crawford and Noel W. Barker. "Developing an Epidemiologic Field Team for Drug Dependence." Archives of General Psychiatry, 24,389-393, May 1971.
Interdepartmental Committee on Drug Addiction (Rolleston Report) Morphine and Heroin Addiction, London, HMSO, 1926.
Johnson, Bruce D. "Similarities and Differences between N.Y. City Methadone Maintenance Programs and London Drug Treatment Centres." Proceedings of the Fifth International Institute on the Prevention of Drug Addiction, Copenhagen, Denmark, 8 July 1974 (forthcoming).
- - - - "How Much Heroin Maintenance in England?" International Journal of the Addictions 1975 (forthcoming).
Jones, Terrence. Drugs and the Police. Butterworth & Co., Ltd., London, 1968.
Josephson, Eric. "The British Response to Drug Abuse," in National Commission on Marihuana and Drug Abuse, Drug Use in America: Problem in Perspective, Appendix Volume IV, Washington, D.C.: Gov. Printing Office, March 1973.
Journal, The (Drug Newspaper), 1973.
Judson, Horace F. "Heroin in Great Britain," The New Yorker, 76-113, (24 Sept.) and 70-112, 1 Oct. 1973.
King, Rufus. The Drug Hang up. Norton, New York, 1972.
Larrimore, G. and H. Brill. "The British Narcotic System; Report of Study". New York State Journal of Medicine, 107-115, 1 Jan. 1960.
Lewis, Edward, Jr. "A Heroin Maintenance Program in the United States." Journal of American Medical Assn., 223(5), 539-546, 29 Jan. 1973.
May, Edgar. "Narcotics Addiction and Control in Great Britain," in Wald, Patricia, and Peter Hutt, eds., Dealing with Drug Abuse, Report to the Ford Foundation. Praeger, N.Y., 1972.
Oatham, E. Mrs Oatham is Statistician for the Home Office Drug Branch. Personal communication, 1974.
Reeves, C. Reeves is a Researcher of Youth Culture in Southampton. Personal communication, 1974.
Schofield, Michael. The Strange Case of Pot. Penguin Books, Middlesex, England, 1971.
Second Brain Report. "Drug Addiction in the United Kingdom." Ministry of Health, Scottish Home and Health Dept., Her Majesty's Stationery Office, Bulletin on Narcotics, XVIII, 2, 23-28, 1965.
Spear, H.B. "The Growth of Heroin Addiction in the United Kingdom." British Journal of the Addictions, 64( 2): 245-255, 1969.
Stimson, George V. Heroin and Behavior, Halstead Press, N.Y., 1973.
United Nations Reports. Reports to the United Nations by Her Majesty's Government in the United Kingdom of Great Britain and Northern Ireland on the Working of the International Treaties on Narcotic Drugs, London, Home Office (annual reports, issued in October of the following year), 1968-1974.
Winick, Charles. "Physician Narcotic Addicts," in Becket, Howard S., ed., The Other Side, Free Press, N.Y., 1962.
Wolman, Christian. "The West End Drug Scene." Drugs & Society, 8-19, November 1972.
Woodcock, Jasper. Personal communication from the director of Institute for the Study of Drug Dependence, 1973.
Zinberg, Norman, and John A. Robertson. Drugs and the Public, Simon and Schuster, N.Y., 1972.