Understanding British addiction statistics

Sections

Collection of statistical data
A mini-heroin epidemic
Declining heroin addiction
Clinic attendance patterns
New addicts
Youthful addicts
Specific offences
Summary

Details

Author: Bruce D. JOHNSON
Pages: 49 to 66
Creation Date: 1975/01/01

Understanding British addiction statistics

Ph.D. Bruce D. JOHNSON Assistant Professor of Sociology, Manhattanville College, New York

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.

Collection of statistical data

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.

I. Prior to 1968

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).

2. Notification of Addicts

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.

A mini-heroin epidemic

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).

Declining heroin addiction

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.

Clinic attendance patterns

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).

New addicts

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.

Youthful addicts

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
 
Full size image: 1 kB

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.

Specific offences

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.

Summary

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.

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