“You want a friend in Washington – get a dog”
— Harry S Truman
In the 1950s, Britain faced a fundamental choice: whether or not to retain its independence by continuing the import of opiates and the right of its doctors to make and supply heroin to their patients. It goes without saying that Dent wanted to retain this flexibility and remain consistent with his overall approach, an individual treatment model.
This was a heroin maintenance programme otherwise known as the “British system” and yet it was proposed by the World Health Organisation (WHO) in the 1950s that Britain step into line with the Americans, adopt their model of outlawing all imports of narcotics and stop the autonomy enjoyed by British doctors who could, without referring to any outside agency, still manufacture and prescribe heroin. The British Government wanted change which was bitterly opposed by many doctors but Dent, probably feeling bruised from the resentment meted out to him over Apo’, was slow to react. Then, in January 1955, a letter arrived from Canada which drew him into a new battle that had a bearing on his preferred treatments for opiate dependency.
The letter written and signed by William C. Gibson M.D. (Director of Research at the University of British Columbia, Vancouver and dated 6/1/1955) indicates that a
“Mr Anslinger, the Commissioner of Narcotics in the United States……is unaware of some of the cardinal facts of the British situation.”
Anslinger was a major figure behind US drugs policy in the 1920s which used the most ludicrous examples of racial stereotyping to ban marijuana. This nonsense was subsequently understood to have really been about shoring up the commercial interests of the American wood pulp and paper industry, threatened by hemp production.
In the 1950s, with Anslinger still in charge, the USA was strangely keen that Britain should adopt its own policy on the import ban of opium that prevented manufacture and prescription of heroin by its own doctors. This was odd because Britain did not have a problem that was in any way comparable. It was estimated that since 1924 the banning of the import of opiates into America and racketeering by drug cartels had managed to turn at least 200,000 Americans into addicts. Why, then, did the U.S. want the British to suffer in the same way? And why was Britain even contemplating such a disastrous change in policy? Interestingly America’s own doctors had got wind of how successful Britain had been in containing the heroin problem and suggested that, instead of Britain following America, a reverse strategy would be preferable!
Looking back at this period in Anglo-American relations we can only really guess at what was really going on behind the scenes. Certainly, it would have been unforeseen by American policy makers that a domestic issue had to be resolved before they could get Britain to agree to the WHO directive. Today, Anslinger appears as a crude operator of bureaucratic power, prepared to brush aside all ethical considerations that countermanded vested interests. He may have hoped that the following response (that appeared in the Journal for the American Medical Association -JAMA) to the opposition by American doctors to overseas plans by the U.S. Treasury Department would never surface in the U.K. because, even with Anslinger’s catalogue of absurd pieces of yellow journalism, this brazen piece of dissembling takes some beating:
BRITISH NARCOTIC SYSTEM
“To the Editor:- Several years ago a professor of sociology at an American university who is a self-appointed expert on drug addiction, after interviewing a few drug addicts, wrote an article in
which he advocated that the United States adopt the British system of handling drug addicts by having physicians write prescription for addicts. He reported that this system had abolished the “black market” in narcotics and that consequently there were only 326 drug addicts in the United Kingdom. The professor followed the method used by dictators to “make it simple say it often”; true or false, the public will believe it. “Adopt the British System” is now urged by all self appointed narcotic experts who conceal their ignorance of the problem by ostentation of seeming wisdom. The statement was recently used by a Columbia University professor on a television program and in a national press release in advocating this system. A Citizens Advisory Committee report to the attorney general of California urged the British system. It has appeared in articles by university professors in several states. The Yale University Law Review published a supporting article. It is now adopted as a fact.
Nothing could be further from the truth. The British system is the same as the United States system. Following is an excerpt from a letter dated July 18, 1953, from the British Home Office, concerning the prescribing of narcotics by the medical profession:
“A doctor may not have or use the drugs for any other purpose other than that of strictly administering to the medical needs of his patients. The continued supply of drugs to a patient either direct or through prescription, solely for the gratification of addiction, is not regarded as a medical need.”
There is a black market for opium in the United Kingdom. Following is a typical seizure report:
Seizure at Hull, England, on November 16, 1952. Report No. 247, communicated by the Government of the United Kingdom on January 12, 1953, to the secretariat of the United Nations:
Raw opium seized: 4 kg. 535.9 gr.
……….The British Government annual reports show only those addicts “known to the authorities.” Twenty-five per cent are in professional classes. Opium and hashish addicts are not reported. The British Government is a party to to all the international narcotic conventions to which the United States is a party. They enforce treaties in the same manner as the United States. The British and United systems for enforcing narcotic laws are exactly the same……………
Commissioner of Narcotics, Bureau of Narcotics
Treasury Department Washington 25, D. C.
Dent was not miserable and he wasn’t even a sinner but he knew one when he saw one. His response printed in JAMA appeared on March 12th 1955:
To the editor:- I have recently seen a letter to the Editor from the Journal of Oct. 23, 1954, page 787, written by Dr. (sic) Anslinger, who complained that he was being pestered by various individuals and groups with complaints that the American law as regards dangerous drugs should be altered to approach that of the United Kingdom. He asserted in no uncertain terms that the law on this subject was exactly the same in the two countries. This is very surprising, as addiction to drugs is very much greater in New York than in London. I wish to point out one difference, and I think it is a vital difference. The import and manufacture of heroin is prohibited in the U.S. This is not so in Britain; here it and hemp (marihuana) have been removed from the Pharmacopoeia to fall in line with the International Narcotic Convention but any doctor can still obtain and prescribe them.
Heroin has recently become the most vicious drug in New York because it can only be obtained on the black market, so a black market is produced to supply it and is accused of refusing it to victims unless they introduce others. Here a doctor is free to supply any substance, even Cannabis Indica, if he considers it helpful in curing his patient, as long as he keeps a record of the dangerous drugs and for whom he supplies them. Of course there is a small smuggling of drugs into Britain, but the smugglers are generally known and caught. There is a small black market because victims are ashamed and frequently do not know that they could get help and get their necessary supplies from their doctor on the NHS. It has been suggested that notices to this effect be posted in public lavatories would kill even the small black market that exists…….The Home Office can trace almost all the dangerous drugs to their consumers. Here it is not an offence to take them, but illicitly to provide others with them carries severe penalties.
John Y. Dent, Editor
British Journal of Addiction
And to Dr Gibson;
Dear Dr Gibson,
………..Mr Anslinger is, as you suspected, not correct. He is not correct on the very point of issue. The import of Heroin is prohibited in the States. This is not so in Britain; here it and hemp have been removed from the pharmacopoeia to fall in line with international narcotic convention but any doctor can still prescribe and obtain them.
Dent also wrote a letter to “Medical World” containing the following passage:
“In the October 23 1954 number of the American Medical Association H.J. Anslinger Commissioner of Narcotics Treasury Department Washington 25 D.C. complained that he was frequently urged by “self appointed narcotic experts” to adopt the British System of handling drug addicts and he pointed out that the system in the states was exactly the same as that in Britain. This of course is not true……”
The letter continues:
“If instead of the U.S. following our very efficient methods of controlling heroin addiction and traffic we are cowardly enough to copy their admittedly inefficient methods I fear we may turn London into a second New York. In London we also will have an epidemic of teenage addicts to heroin. And if the legally controlled manufacture and prescription of heroin is prevented there will at once be enormously greater profits to be made in the black market and a greater temptation to blackmail and bribe victims into bringing others into the same slavery.
If the argument is that heroin legally produced in this country finds its way to the black market in other countries British heroin could be made with a tagged carbon atom which would make it very easy to trace to its source.
If doctors are forbidden to prescribe heroin and prevented from obtaining it very soon they will not be able to treat their patients except with medicines prescribed by Whitehall, America or Mr Anslinger.”
The narcotic problem in 1950s Britain was tiny compared to today. On the 14th of June 1955 the Times’ Leader Article indicated that there were just 317 addicts to manufactured drugs with less than fifty dependent on heroin. Estimates put the 2012 levels of heroin and crack cocaine use for England as 306,000 (National Treatment Agency for Substance Abuse, 2012) which indicates just how ill-served we have been by U.K. drugs policy in the intervening years. However, back in 1955, and at the eleventh hour, the Second Chamber rejected the Government’s proposal to introduce the ban on opium enabling British doctors to continue to obtain and prescribe heroin. Unfortunately this victory for common sense was merely a prelude to the “War on Drugs” ushered in by President Nixon’s Administration in 1971. Ultimately it has been the insidious will of Anslinger and his ilk that has prevailed as the battle to preserve U.K. medical autonomy has been ceded. The rest:
- the inexorable rise in drug use,
- the insidious influence of the drug cartels,
- punitive measures that maintain and perpetuate recidivism,
- the addicts “parked on methadone” and other forms of maintenance therapies
- the steady erosion of communities destroyed by drug culture and crime,
- and the enormous wastage of man hours, the diversion of resources and the burden to the UK taxpayer policing, prosecuting, incarcerating and treating the British victims of a ruinous policy
can all be traced back to our “willingness” to try and fix what was not broken. Of course, you might say “Well its easy to say that now …” the trouble is that Dent (and indeed many other doctors, both American and British) said it at the time! There has really never been any excuse for the mindless way British legislators have repeatedly and inexorably brought us to this juncture with absolutely no indication that any of them have learnt from previous mistakes. (see later – 2005 Gaming Legislation by the Blair government represented by the deplorable Tessa Jowell and Harriet Harman) The writing was on the wall, America with its own abject record since 1924, had told us exactly what to expect.
Dent himself (in his capacity as Editor of SSA) had received warnings from those at the sharp end of the problem as this letter from an American doctor typically testifies:
“My dear Dr. Dent:
I have been much interested in recent clippings from the London Times describing the proposed ban in the United Kingdom on the manufacture of Heroin.
As far as addiction is concerned the information gained from a similar ban in this country in 1925 (sic) should be of value. As you know, since that time it has been impossible for doctors to prescribe Heroin, but we have the largest black market in the world.
As you have stated, the best method of keeping a black market from functioning is for the physicians to dispense this drug.
Sincerely yours, Herbert S Howe” (signed)
and Dent’s own Editorial for the SSA later in the same year:
“The Government proposal to stop the legal production of heroin in this country and prevent doctors from prescribing it is a retrograde step. Britain has a right to be very proud of its very small numbers of addicts to morphine, pethidene, heroin and other dangerous drugs. In contrast to us, America, which has forbidden the import and manufacture of heroin for many years is at present suffering from an enormous increase of heroin addiction, especially among teenagers. A black market can only flourish once the legal production is stopped. Heroin can be made easily and black marketeers are enriched. Their success depends on the production of ever more addicts. They blackmail their victims refusing them the necessary supplies unless they bring others into the same slavery. There has recently been a spate of complaints to Mr Anslinger, Commissioner of Narcotics of the Treasury Department, Washington, urging him to bring the law in the States into line with what it is here and pointing out the essential differences between the attitude of the American and British Governments towards heroin. It now looks as if the British Government is bowing to the dictates of the W.H.O. and allowing us to lapse into a position, which is comparable with that in America.
Our doctors ought to be trusted ……..Doctors have always had the right here to prescribe what they honestly think is best for their patients…..If victims can get their supplies legally they do not have to sell their souls to obtain it illegally and the profits of the black market are cut to a vanishing point and there is no inducement to produce more addicts.”
The inescapable simplicity – another Quaker testimony – of Dent’s logic is dependent on exercising utilitarian values. Unfortunately, markets, and particularly black markets, require the subjugation of the many by the few and any ethical consideration by British doctors would soon be brushed aside by the brutality of Anslinger under the expediency of “international co-operation.” The contrast between these men, Dent and Anslinger, could not have been greater. The American writer, William Burroughs described Dent: “Dr. John Yerbury Dent was the least paranoid of men, and he had the full warmth and goodwill, the best the English can offer.” “Last Words” (2000).
Burroughs was treated by Dent in the spring of 1956 for opiate dependency and became a lifelong advocate of Dent’s method of treatment with Apo’. But what is less well understood is the extraordinary serendipitous nature of their meeting and the profound influence that Dent had on Burroughs’ writing. Bizarrely, in a homophobic culture, a city he hated and at the lowest ebb in his life, Burroughs had not only found a doctor who would free him from the grip of “Opium Jones” but also, a man who became both mentor and kindred spirit. Burroughs had known many doctors, “croakers”, but this one didn’t forge “scripts”, moreover, Dent’s knowledge of globalisation and the narcotics industry had, out of the blue, provided Burroughs with a moral framework for his extraordinary ‘word hoard’; “Naked Lunch” (1959). When this fantastically prescient work appeared Burroughs sent Dent a copy. “I congratulate you on it.” Dent replied, and he meant it. As one of Dent’s patients, Burroughs had received, a front row seat of Apo’s efficacy, but also, as a confidant, what it represented and how, in a world increasingly dominated by vicious bureaus of control, a unique appreciation that “do no harm” doctors like Dent were a dying breed. Here was the satirical springboard for the malignant “Doctor Benway”, the antithesis of Dent, and one of Burroughs’ greatest and most enduring creations. Superficially, the patrician Dent and Burroughs, the unashamed transgressor, seem an unlikely pair, but their shared knowledge of medicine, addiction, geo-politics and literature led to a deep mutual respect and admiration. In later life Burroughs is always the “older man”, the reluctant guru, but with Dent he was the apprentice and, despite his enthusiasm for Apo’, demonstrated little, real understanding of Dent’s holistic approach. Furthermore, it was Dent, with literary pretensions of his own, soon recognised Burroughs’ talent and immediately tried to find a publisher for the nascent “Naked Lunch“. His introduction to Alistair MacLean, from the staid house of Macmillan, merely prompted Burroughs’ disdainful amusement at the thought of having to temper his message. As a virtually unknown writer Burroughs had integrity, a point not lost on Dent.
After Burroughs’ quick and successful treatment he left London for Venice and Tangiers to resume his writing but corresponded with Dent. The famous “Letter from a Master Addict” (this was the first time Burroughs’ writings appeared under his own name) appeared in the SSA Journal, January 1957. Burroughs was on the threshold of becoming one of the greatest writers of the Twentieth century simultaneously inviting conjecture how withdrawal from opiate dependency relieved by Apo’ may have been a boon to his creativity. As far as Dent was concerned, in his combined capacities as doctor and editor of the Journal, he was able to offer Burroughs the immediate incentive of a printed article that his continued sobriety and future as a writer may have hinged upon. Medicine has rarely, if ever, provided such a fruitful piece of operant conditioning. Additionally, for the iconoclastic Dent, there was the extra bonus of raised eyebrows at the Society caused by the inclusion of Burroughs’ unapologetic account of drugs and addiction amid the otherwise sober pages of its Journal.
For the next few years Dent continued to monitor the pressure that Britain was being put under to conform to the global ban on heroin and kept Burroughs informed. Initially, the will of the traditional British doctor, supported by the House of Lords, successfully resisted the Bill to ban heroin. A reluctant Whitehall had for the time being been forced to heed the advice of the medical profession and British medical sovereignty was clung to. However, this was short-lived. Since the 1960s it has been Britain’s willingness to cement a legislative conformity with its American “friends” that has dominated all policy and resulted in a tragic legacy for its own citizens that continues to this day.
A current assessment of where Britain goes with its drugs policies leads inevitably to the conclusion that we need more independent research, an understanding of ethics, better science, and less “Anslinger” or the inadequate David Cameron for that matter. Dent was an early campaigner for sensible drugs policies and whatever would contribute to the common good. Evidently, (as illustrated on this site) Dent also had a unique perspective on how public provision would be undermined by global corporations that manipulated governments. The extent that the scientific and medical communities have been drawn into co-operating with this toxic tendency resulting in widening health, wealth and social disparities must give pause for thought. Medicine is increasingly at the beck and call of a “science” controlled by Pharma and until the boot is on the other foot things are unlikely to improve. Dent was incapable of compromise on these issues, but it is only now, over half a century later, how abundantly justified his position was and how Apo’ not only typified Dent but also exemplified an approach to drug dependency which placed the needs of the patient above
all else but primarily pharmaceuticals, bureaucrats and gangsters. Moreover, when Apo’ is referred to as “aversion” “addictive” “charismatic” (even by some in the scientific community) it turns the clock of understanding back eighty years demonstrating the abject failure of “research and development” and consequential “trainspotting” generation when abstinence as an ideal was lost amid the insanity of maintenance therapies and prescription.
Methadone, a synthetic opioid (also known as Dolophine, Amidone, Heptadon, Methadose and Physeptone), is an interesting drug in light of the above. It was a German creation in the late 1930s but at the end of WW2 it was the Americans who controlled its patent. By 1947 Eli Lilly and Company were producing this as a pain killer and by the 1960’s it was developed as a heroin substitute. This treatment has become known as Methadone Maintenance Therapy (MMT) and accepted as one of the best ways of dealing with opiate addiction as it avoids withdrawal from heroin, has a less drastic effect on the body and reduces the risk substantially of using dirty needles, which can lead to other serious diseases and complications (“harm reduction”). Methadone is therefore a “good” thing but only because heroin had become such a scourge. Back in the 1950’s with approx fifty known heroin dependents MMT wouldn’t have had a problem to replace.
But the tragic implications of Uk’s ruinous Dangerous Drugs Policy do not stop there. Bizarrely methadone now has a higher mortality rate than the drug it is substituted for! As recently as last year over four hundred deaths were attributable to methadone (Office for National Statistics) because there is now a black market in methadone, a drug, which is even more addictive than heroin and includes, among its victims “sucking babies” born to addicts (Neonatal Abstinence Syndrome) as evidenced by Russell Brand’s recent expose of the problem. (December, 2014 – BBC 3)
It beggars belief that our U.K. drugs policies can be so bereft of common sense. Instead of resisting one black market we legislate so it flourishes (as was predicted) and when this leads to endemic heroin use (which many warned was inevitable) treatment involves replacing it with another stronger addiction that in turn becomes another black market and a greater killer. Where is the understanding that flooding our medical environment with drugs that are addictive is reckless and unethical? Justifiably Dent despised doctors who merely shifted the burden of addiction by prescribing alternatives with even more addictive properties. You cannot OD on oral Apo’, no case of physiological dependence to it has ever been recorded and therefore it couldn’t, even it were advocated, contribute to the 1,500 UK babies a year that are born suffering from withdrawal symptoms and yet, according to ‘science’ Apo’ has been ‘superseded’. Even at the progressive end of the research and development spectrum Neuroscience is not as enlightened as it would like us to believe, not by a long way.
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