Misuse of Drugs

British Medical Association

• Publisher: Routledge
• Year: 2022
• ISBN:
  9781000446616
• Edition: 1
• Topic: Sciences sociales
• Subtopic: Sociologie

Provides practical information for professionals who help drug misusers. The book surveys the facts which influence drug use and problems arising from it, whether weekend experimentation or heroin dependence. The emphasis is on improving current practice and integrating the treatment that can be offered by medical and non-medical professionals.

1
Setting the scene

DOI: 10.4324/9781003211136-2

In the context of this report the term ‘drug’ is used to refer to a substance illicitly used for its psychoactive or performance enhancing effects. This definition includes the ‘traditional’ illegal psychoactive substances such as cannabis and heroin. It also covers legal psychoactive substances such as tranquillisers which are used for purposes other than those for which they were licensed, and the misuse of substances such as volatile compounds from domestic products such as butane from cigarette lighter refills which may include ingredients that have psychoactive properties. For ease of reference in this report, anabolic steroids are also termed ‘drugs’. Although not misused for their psychoactive effects, they are now included within the Misuse of Drugs Act.

The legal framework

The Acts

There are two main statutes regulating the availability of drugs in the UK. The Medicines Act 1968 governs the manufacture and supply of pharmaceutical products of all kinds, most of which are legal drugs. Its enforcement rarely affects the general public, and it divides pharmaceuticals into three categories ‘Prescription Only’, sold with prescriptions by pharmacists; ‘Pharmacy Medicines’, sold without prescriptions by pharmacists; and ‘General Sales List’, sold without prescriptions from any shop.

The second of the two statutes, The Misuse of Drugs Act 1971, is intended to prevent the non-medical use of certain drugs, some of which, because they have legitimate medical uses, are also covered by The Medicines Act (eg, temazepam and heroin). Offences under the Misuse of Drugs Act 1971 overwhelmingly involve the general public, and drugs subject to it are known as ‘controlled’ drugs.

Offences and penalties

The law defines a series of offences, including unlawful supply, intent to supply, import or export, unlawful production and, perhaps the most frequently committed offence, unlawful possession. In 1995 93,600 people were found guilty, cautioned or dealt with by ‘compounding’ for drug offences, of which nearly 90% were for unlawful possession. (‘Compounding’ is a penalty introduced in 1982 where a penalty is paid in lieu of prosecution for cases involving the importation of small quantities of cannabis for personal use).¹

Under the Act, offences involving different classes of drugs attract varying penalties. Both for possession and supply of any drug, there is a possibility of an unlimited fine, but prison sentences are graded. Class A includes cocaine, heroin, morphine, LSD and ecstasy among others, and Class B drugs prepared for injection; their possession may result in up to a seven year sentence. Possession of Class B drugs which include amphetamines, barbiturates, cannabis and codeine may result in a five year sentence, and Class C drugs (pemoline, chlorphentermine, buprenorphine and benzodiazepines) a two year sentence. Supply or trafficking attract stiffer maximum penalties — sentences ranging from up to life for a Class A drug, to 14 years for a Class B, to 5 years for a Class C. However, most offenders are neither fined nor imprisoned, but cautioned — in total, 48,688 were cautioned in 1995 compared to 7,490 sentenced to immediate custody and 20,599 fined.²

Solvents are not classified under the Act, the only offence being to sell solvents to someone under 18 if there is reasonable cause to believe they intend to misuse them. In Scotland, if someone under 16 is found misusing volatile substances, they can be reported to the ‘Reporter of the Children’s Panel’ and may subsequently be taken into care. Full details of this legislation are provided in Chapter 4.

Development of UK policy relating to drug misuse

Opium and later morphine and heroin were freely available in Britain and in other countries during the 19th century. The first moves to control opium (and its preparations), morphine, and cannabis came in 1868, until which time they were available over the counter without any form of restriction. Opiates were widely used both on medical prescription and as self-medication by those without access to medical treatment, for pain relief and to promote sleep.³ Heroin was first controlled by the 1920 Dangerous Drugs Act and Britain’s first defined policy on drug misuse was set out by the Rolleston Committee in 1926. This allowed the medical profession considerable scope and flexibility with regard to the treatment of drug dependence and in particular gave general practitioners control of the prescription of drugs. Those who needed treatment for their addiction at this time were mainly described as anxious middle aged professional people who had become addicted to opiate drugs, usually injectable morphine which had been prescribed to them for pain relief. The numbers were small and they were enabled to live useful and productive lives by the maintenance of their prescription. This became known as the ‘British System’.

The Rolleston Committee was highly influential in defining addiction as a medical problem (as opposed to a moral one) as it advised that the prescription of heroin to an addict was within the remit of medical practice if in doing so the addict was allowed to live a normal, useful life.

Until the 1950s there were so few heroin addicts in Britain that nearly all of them were known personally to the Home Office Drugs Branch Inspectorate, which checked the pharmacy records from time to time.⁴ As the name suggests, the prescribing permitted under the British System was distinctive from most other western industrialised countries. With the exception of Switzerland and the Netherlands, treatments involving the prescription of heroin and injectables were almost unknown and until recently Britain’s doctors were given considerable clinical discretion.

In the early 1960s the picture changed. Newspaper reports were emerging of large numbers of young people taking drugs hedonistically. The Ministry of Health brought together an interdepartmental committee under Sir Russell Brain (the first Brain Committee) to examine the problem, but it reported in 1961 that the dnig situation in Britain gave little cause for concern. However reports continued to appear in the press and the number of known heroin addicts rose from 62 in 1958 to 342 in 1964. The Brain Committee was therefore reconvened and reporting in 1965 accepted that a new young, unstable, non-therapeutic group of drug takers had emerged and that a handful of London doctors were prescribing dangerous drugs in excessive amounts to this group. The main reason for the escalation of the problem was thought to be overprescribing by unscrupulous, uninformed, or vulnerable doctors open to blackmail.

The second Brain Committee recommended that a number of treatment centres should be set up, run by psychiatrists with a special interest in the problem. GPs were allowed to treat drug users if they so wished, but only doctors with a special licence from the Home Office should be allowed to prescribe heroin and cocaine. This formalised the relationship between government and the medical profession, and ushered in the controls of the Addicts Index, under which doctors were obliged to notify the Home Office of any patients they consider to be addicted to one of 14 drugs.

The Drug Dependence Units or Clinics (DDUs or DDCs) were set up from 1968-70, mostly in the London area, and the treatment of drug misuse became a specialty, with GPs being discouraged from taking an active role. There were not enough specialist services to cover the whole country and GPs were still allowed by law to treat drug dependence with any drug apart from heroin and cocaine (dipipanone, an opioid analgesic in a preparation with the antihistamine cyclizine, was added to this list in 1984). Nevertheless, most drug-taking in the late 1960s and 1970s was concentrated in inner city areas where there was usually access to a DDU. The shift in emphasis towards specialisation and the movement away from treatment by the primary care services, meant that skills were not developed in this field by GPs and other generic professionals. Furthermore the training of this group in the problems and treatment of drug misuse received little attention. These developments culminated in the 1971 Misuse of Drugs Act, which also established the Advisory Council on the Misuse of Drugs.

In the late 1970s statistics from a number of sources showed that drug misuse in the UK was increasing rapidly, and this trend has continued since that time, desp...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Table of Contents
• Introduction
• 1 Setting the scene
• 2 Defining the problem
• 3 The role of the medical profession
• 4 Constraints on current practice
• 5 Conclusion and recommendations
• Appendix I: The legalisation debate
• Appendix II: Fitness to drive
• Appendix III: The Task Force to Review Services for Drug Misusers
• References
• Index