Heroin Addiction, Care and Control: The British System

The decision in the 1960’s to stop GP’s prescribing heroin was an ‘unmitigated disaster’, according to Bing Spear, the former Chief Inspector of the Home Office Drugs Branch, in words he wrote prior to his death. The decision created massive problems which are only now being realised.

The damning insider account of the evolution of drugs policy over nearly 70 years was penned by Bing Spear shortly before his death in 1995 and has only now been published.

Bing Spear was employed in the Home Office Drugs Branch from 1952-1986 and was its Chief Inspector from 1977. He was an unusual civil servant whose open office was frequented by drug users who ‘invited themselves to tea’ and asked for his help. The small number of drug addicts at the time and Spears’ commitment to the cause meant he came to be on first name terms with most London drug addicts and their doctors.

Bing Spear was central to drug policy developments during that time but despite his protests, treatment rapidly changed from a GP-led system, that included heroin prescribing, to a system where prescribing to addicts was made illegal for all but a handful of doctors. In 1965 there were 1,000 registered addicts, today, according to government estimates, there are around a quarter of a million problem drug users.

The crucial shift, which began in 1968, and which Bing Spear calls ‘an unmitigated disaster’, is only now being reversed by the Home Secretary’s recent decision to extend prescribing. The dramatic reduction in heroin prescribing, Spear argues, led to addicts no longer being ‘treated as individuals’ and customised treatment being replaced by a ‘uniform and inflexible response’. An Audit Commission report published earlier this year found that treatment still, ‘fails to meet individual needs’ and can operate an ‘inflexible treatment regime’, applying ‘standard treatment conditions to all clients irrespective of their needs.’

Bing Spear, perhaps the key authority in drug policy over this period, believes that the failure of treatment was due to the fact that ‘the moral high ground was seized by a small group within the medical establishment’ who imposed ‘their own ethical and judgemental values on treatment policy’, rather than providing treatment on the basis of need or what works.

Spear identifies numerous failings within the treatment system, many of which have still not been resolved. For example, the Audit Commission report found that there are ‘limited treatment options, lengthy delays and poor care management’. The report concluded that, ‘the current pattern of service means that too many drug misusers still struggle to get the help they need, when they need it. As a result, many end up trapped in a cycle of dependency and drug-related crime.’

Writing about treatment for drug addicts, Spear highlights the, ‘widespread apathy and unwillingness of the medical profession to become involved with these unpopular and unrewarding patients’. Once again the Audit Commission reports the continuing nature of this problem with ‘many GP’s’ still ‘reluctant to provide specialist help’.

Bing Spear’s analysis of British drugs policy is published today by DrugScope and titled, ‘Heroin Addiction Care and Control: The British System 1916-1984’. Commenting on the publication of the book, David Musto, Professor of Child Psychiatry, Yale School of Medicine and a world expert on the history of drug use said, ‘This is a book of great importance. It brushes away fantasies about British drugs policy and brings us close to the difficult and persisting problems of an appropriate social and legal response.’

The Reverend Ken Leech, founder of Centrepoint said, ‘Bing Spear acquired a massive range of knowledge, expertise and wisdom, much of which is contained in these pages.’ Arnold Trebach, Professor Emeritus, American University, Washington DC, said, ‘For over a quarter of a century, Bing Spear was the compassionate heart and soul of British drug control policy. It is to be hoped that everyone who cares about the enduring goodness and effectiveness of the traditional British System will read his words very carefully and take them to heart.’