Tag Archives: UNGASS

British System, American Century: A short case study

British System, American Century: A short case study

Chris Hallam

This blog shows the intimate ties between the international and domestic domains of drug control. This is a well-known phenomenon; however, it involves considerable complexity. The lengths to which governments will go to reduce potential tension at the international level are apparent. This is especially so when states – as in the following case – are wary of the US position. At the same time, powerful domestic forces can counteract the influence of international powers, even when the United States is concerned, as in the aftermath of the Second World War.
The blog selects the example of Britain during that period in which the negotiations leading to the Single Convention were taking place. The then-famous ‘British System’ of drug treatment was a key aspect of Britain’s drug policy relationships; stemming from Sir Humphrey Rolleston’s inquiry into addiction that reported in 1926, the ‘British System’ permitted any doctor to supplyheroin, morphine, cocaine and other drugs to those who were dependent upon them. Unlike the present mode of ‘Heroin Assisted Treatment (HAT), the British System imposed few requirements on patients, who could take their prescription to a pharmacy, collect their drugs and consume them more or less at will. This depended on the regulatory context, the liberal views and the largesse of the doctor, but these were generally forthcoming.
Both the international and the domestic domains played a part in the changes that overtook the British regulatory framework in the 1950s and 60s, leading to the demise of the ‘British system’ of prescribing and its replacement with a much more restrictive ‘clinic’ system in 1968. The international dimension was always important, but in the period preceding the agreement of the 1961 Single Convention, it was especially significant as countries sought to shape the draft treaty to suit their national interests, or (less rationalistically) to forge the global order of intoxication according to their mythological image.

Sir Humphrey Rolleston

Following the war and the continuing rise of the United States as an international military, political and economic superpower, there was friction between it and Britain over aspects of the latter’s drug policies. The 1955 American attempt to impose a global prohibition on heroin was eventually faced down by the British government after internal pressure from the medical profession in support of the drug’s retention in medical therapeutics, including in the treatment of drug dependence. The medical profession was a powerful force in British politics and culture, sufficient to bring the government to resist US pressure.
Britain’s representative at the Commission on Narcotic Drugs (CND), the policy-making body for the new UN international drug control system, was J.H. ‘Johnnie’ Walker. Bing Spear, the Home Office civil servant who had written extensively on UK drug policy, identified Walker as providing the initiative that led to the first Brain Committee, which, commencing its meetings in 1958, reviewed the British drug control system for the first time since Rolleston did so in the 1920s. Government documentation from the mid- to late-1950s supports this claim. The context for Walker’s views was largely international, with the British System undergoing criticism from a number of countries, particularly the United States, through the mechanism of the new United Nations drug control regime.
In 1955, Walker sent a lengthy and thoughtful memorandum to the Home Office suggesting that it was time to look again at the British drug control system. Despite the system’s smooth domestic running, said Walker: ‘It so happens that a number of problems have arisen, or are on the horizon, which indicate that this is a suitable moment to review the present system of control.’ These problems or potential problems included the proliferation of new synthetic drugs such as pethidine and methadone; the UK policy on addiction (by which was meant in particular the Rolleston-inspired regulations permitting the long term of maintenance of opiate habits and the belief in the ‘stabilised addict’); addict doctors; and improper prescribing and supplies to addicts (the issues surrounding ‘script doctors’). The memorandum paid the greatest attention to the second and the fourth of these categories, replicating the situation that obtained when the Rolleston Committee reported and showing that the issue of doctors prescribing dangerous drugs to addicts had remained at the heart of governmental anxieties. Walker claimed that the Rolleston Committee never intended the ‘lavish supply of dangerous drugs to addicts merely for the maintenance of addiction’. He then made reference to a ‘small but potentially dangerous group of drug addicts (mainly heroin addicts) in London at the present time’. This group was ‘disturbing’, as it represented ‘the first real sign of a significant increase in heroin addiction for very many years’. The group’s members had become addicted young and were mostly under thirty – often nearer twenty; many shared an involvement in one particular field of entertainment and therefore met socially at regular intervals – a reference to the jazz club scene. The social context of this drug use made it ripe for proselytism, contended Walker, ‘always one of the more dangerous features of drug addiction’.
He continued that many ‘appear to obtain supplies from a small number of doctors who make no attempt whatever at cure or even, so far as can be judged, at reduction of the dose. In other words, their addiction is deliberately fed, almost certainly in some instances for purposes of gain.’ Walker concluded that: ‘The “script doctor” who thus makes drugs freely available to addicts represents a special problem…’
Walker’s memorandum showed that the Home Office was by this time fully aware of the flourishing new London addict subculture, a full ten years before these facts were published in the Second Brain Report. As noted by Spear, the peculiar thing is that the first Brain Committee did not address it in their deliberations nor their report. At the Home Office, it was Tom Green (who succeeded Walker at the Drugs Branch) who led the drafting of the advice and information sent to the Ministry of Health, from which emerged the shape of the review. For ‘some inexplicable reason’, while drawing heavily on Walker, Green did not include evidence of the emergence of London’s expanding heroin subculture.
One possible reason for this startling omission lay in the international relations around the topic of drug control. Walker points out that US medical opinion was firmly against maintenance and the notion of the stable addict. The ‘strongly held’ view in the American medical profession was that it is ethically unacceptable to condemn a patient, especially a young patient, to perpetual addiction by offering this form of treatment. It was also remarked that the CND and World Health Organisation were highly critical of ambulatory treatment of the kind practiced in the UK. Indeed at its 10th session, the CND ‘expressed the view that ambulatory treatment (including the so-called “clinic” method) was not advisable and asked the World Health Organization to prepare a study on the appropriate methods of treatment.’ Furthermore, a clause had recently been inserted into the draft Single Convention which spoke of treatment being given on ‘a planned and compulsory basis, in properly conducted and duly authorised institutions’. However, by virtue of a qualifying clause that was initiated by the UK, such measures would be applicable only in those countries having a large addict population; it was this proviso that permitted the UK government to sign the 1961 treaty despite its differences with respect to drug treatment. Notwithstanding this, Walker expressed concern that the general trend at the CND was toward compulsion, and that there may in due course be concerted pressure for the removal of the UK clause. He added that, ‘it is unlikely that the United Kingdom could ever accept an obligation to require compulsory treatment of drug addicts in a closed institution’. In fact, Walker made it clear that such a measure could prevent the UK from signing the treaty, and would have been in conflict with the overall trend of mental health policies in Britain at this time, as expressed in Lord Percy’s 1957 Report of the Royal Commission on the Law relating to Mental Illness and Mental Deficiency. This optimistic document led the trend away from confinement, toward voluntary and community based mental health treatment, and fed into the 1959 Mental Health Act. In relation to addiction, Walker commented in closing that: ‘There is a limit to what the State should attempt, and the deprivation of personal liberty for medical reasons is far too serious a matter to contemplate unless there is overwhelming evidence of the need for it because of some widespread and particularly virulent social problem. This need does not exist in the United Kingdom’.
This last sentence is the key one. In order to fight its corner at the CND, the UK government needed powerful evidence that the domestic drug problem continued to be so small as to be negligible, a point which some other countries disputed. Consequently, ‘there would be much to be said from the point of view of strengthening our case in international circles for obtaining an authoritative opinion from a body of experts on the necessity for, and the feasibility of, providing special treatment for drug addicts in this country.’77 In other words, a Committee set up to review Britain’s arrangements could prove very useful in providing the government with ammunition which to fight its international drug policy corner, so long as this evidence indicated that the problem was tiny and relatively insignificant.
Although, as Spear claims, Walker’s superiors at the Home Office were initially unreceptive to his argument, the Brain Committee may well have been influenced by it at the meetings which produced the first report. Green led the way in producing the documentation for the Committee; mention of the expansion of the opiate subculture was entirely absent, and the growth in heroin addiction strongly downplayed. Accordingly, its Report was structured on precisely the lines that would support the government in its negotiations at the CND. It stated baldly: ‘After careful examination of all the data put before us we are of the opinion that in Great Britain the incidence of addiction to dangerous drugs… is still very small.’
This argument remains for the present a speculative one; nonetheless, the omission of the West End heroin subculture from the Home Office memorandum of evidence to the first Brain Committee, and the Report’s conclusion, which supports the UK’s requirements at CND in the run up to the 1961 Single Convention, are highly suggestive. Beyond this specific question, however, it is clear that the construction of international drug policy is a matter of both international and domestic (and transnational) domains, and that it is impossible to understand countries’ conduct in international fora without taking into account international politics and culture. And vice versa.

Dr John Petro

[1] Departmental Committee on Morphine and Heroin Addiction: Report (London: HMSO, 1926). (Rolleston Report)

[2] 59 D. R. Bewley Taylor, The United States and International Drug Control, 1909-1997 (London and New York: Continuum, 1999) p.141.

[3] Spear, H. B. & (ed) Mott, J. Heroin Addiction, Care and Control: The British System. London: Drugscope, 2002. Pp.65-89.

[4] Spear, H.B., Heroin Addiction, Care and Control p.90

[5] The National Archives HO 319/1 and MH 58/565.

[6] McAllister, W. B. Drug Diplomacy in the Twentieth Century: An international history. London and New York: Routledge, 2000. Pp.185- 211.

[7] TNA HO 319/1 ‘Dangerous Drugs Administration and Policy in the United Kingdom’ 25 October 1955.

[8] Ibid.

[9] Ibid.

[10] Ibid.

[11] Ibid.

[12] Ibid.

[13] Spear, H.B., Heroin Addiction, Care and Control, p.92.

[14] Ibid.

[15] The Tenth Session of the Commission on Narcotic Drugs, 1955. http://www.unodc.org/unodc/en/data-and-analysis/bulletin/bulletin_1955-01-01_2_page005.html Accessed 3rd September 2016

[16] TNA HO 319/1, ‘Dangerous Drugs Administration and Policy in the United Kingdom’ 25 October 1955. In this passage, Walker was quoting from a 1954 CND draft of the Single Convention.

[17] Ibid.

[18] E. Percy Baron of Newcastle Report of the Royal Commission on the Law relating to Mental Illness and Mental Deficiency (London: HMSO, 1957).

[19] TNA HO 319/1, ‘Dangerous Drugs Administration and Policy in the United Kingdom’ 25 October 1955.

[] Report of the Interdepartmental Committee on Drug Addiction 1961 London: HMSO. Paragraph 24.

ICSDP (re)Blog: Scientific Experts Launch Open Letter on Need for New Metrics to Evaluate Drug Policy

Reblog from:

http://www.icsdp.org/scientific_experts_launch_open_letter_on_need_for_new_metrics_to_evaluate_drug_policy

On January 21, 2016, more than eighty representatives from Member States, UN agencies, and civil society organizations gathered for the launch of a scientific open letter on the path forward for drug policy evaluation.

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Titled, “Identifying Common Ground for UNGASS 2016: Rethinking Metrics to Evaluate Drug Policy,” the event hosted by the International Centre for Science in Drug Policy (ICSDP) at the United Nations Headquarters in New York City provided valuable expertise and guidance to Member States and UN agencies in the lead up to the United Nations General Assembly Special Session on Drugs (UNGASS) in April 2016.

The ICSDP’s open letter calls for a reprioritization of the metrics used to evaluate illicit drug policy. Co-authored by ten global scientific leaders, the open letter uses decades of scientific research to demonstrate that the small number of indicators currently prioritized by the vast majority of UN agencies and Member States – such as levels of illicit drug use and availability – fail to capture the complex ways that drug policy can impact communities. The open letter therefore argues for the adoption of indicators in the areas of health, peace and security, development, and human rights in order to provide a broader and more granular understanding of drug policy impacts. This, in turn, would equip policymakers with the data required to optimize outcomes and substantively control the world drug problem.

Screen_Shot_2016-02-23_at_5.03.55_PM.pngDr. Dan Werb, Director of the ICSDP, focused his presentation on the development challenges that have undermined the successful implementation of Mexico’s drug policy reform. In 2009, Mexico decriminalized the possession and use of small amounts of drugs and legislated a system of diversion that would see drug dependent individuals triaged into drug treatment rather than prison. Despite one of the most progressive drug policies on the books, research measuring the effectiveness of the policy reform in Tijuana – conducted by Dr. Werb and colleagues at the University of California, San Diego – indicates that implementation has fallen short of expectations, as the number of arrests for drug possession in Tijuana have continued to rise despite the policy of decriminalization. According to Dr. Werb, this can be at least partially attributed to the lack of capacity of the Mexican state to provide members of law enforcement with adequate levels of pay, as well as training in the basic tenets of the drug policy reform. Problematically, although a cornerstone of the drug policy reform relies on increased coverage and accessibility of evidence-based addiction treatment, such as methadone maintenance therapy (MMT), resource constraints have resulted in a lack of adequate treatment scale up. Dr. Werb concluded his presentation by emphasizing that, as the Mexican case study demonstrates, a lack of resource commitment by Member States can seriously undermine drug policy goals and development indicators must therefore be captured in drug policy evaluations.

According to Dr. Kanna Hayashi, Research Scientist at the British Columbia Centre for Excellence in HIV/AIDS, evaluating levels of coverage for health services would be incomplete without also including indicators to assess quality, such as in the context of treatment for substance use disorders. Describing her research among people who inject drugs in Bangkok, Thailand, Dr. Kayashi noted that although Thailand added MMT to their universal health coverage in 2008, thereby increasing the accessibility of this health service, negative attitudes towards MMT by healthcare providers has led to suboptimal quality and rollout of this treatment modality. Research from 2011 found that the average dosage of methadone in Thailand was 30 milligrams, falling far below the 60-120 milligrams range recommended by the World Health Organization. As a result, 16% of those accessing MMT were also obtaining methadone illicitly and 19% reported syringe sharing. Dr. Hayashi stressed that if MMT were provided appropriately, these outcomes – which undermine efforts to reduce rates of drug dependence and to control the HIV epidemic – could have been avoided. The presence of compulsory drug detention centres is also an issue of suboptimal quality in treatments for substance use disorders. Research from 2011 indicates that, despite a lack of evidence that compulsory treatment for addiction is effective in treating drug dependence, 60% of people accessing drug treatment in Thailand were in compulsory treatment. Hence, as Dr. Hayashi’s presentation outlined, evaluations that do not include assessments of both treatment quality and availability will have limited utility in improving the health impacts of drugs and drug policy.

Dr. Daliah Heller, Clinical Professor at CUNY School of Public Health, provided concrete steps towards the adoption of health indicators by explaining how the majority of Member States could enhance existing data sets to evaluate the health impacts of their drug policies. For example, by collecting information on the presence of drug use as a contributor to death, existing death data in the United States could assess the impacts of dug use in a population. Dr. Heller also emphasized the importance of accompanying health indicators for drug policy with benchmarks for scaling up effective interventions. Monitoring and setting benchmarks for health interventions related to drug use, such as sterile syringe coverage, could help define government funding priorities and highlight disparities to ensure equity in the scale up of health services.

After explaining that the separation between the international drug control and human rights regimes has created an environment of systemic human rights risk in drug policy, Ms. Genevieve Sander, Human Rights Research Analyst at Harm Reduction International, described a series of steps that could be used to ensure the adoption of human rights indicators into drug policy evaluations. First, the specific human rights relevant to drug policy, such as the right to life, must be identified. Human rights standards should then be reviewed to determine the key characteristics of each right in the context of drug policy. A relevant key characteristic of the right to life, for example, would be the use of the death penalty for drug offences. Next, in order to design comprehensive human rights indicators for drug policy, structural, process, and outcome indicators must be included. Structural indicators can be used to shed light on the intent of a Member State. For the right to life , these may include the ratification of international human rights treaties relevant to protecting this human right. Process indicators indicate complicity in human rights violations, and in the example of the right to life, could include the number of convicted people facing the death penalty for drug offences. Finally, a relevant outcome indicator in the context of the right to life is the number of executions for drug offences in the last 12 months. Ms. Sander noted that incorporating all three types of indicators helps to reveal connections between actions and human rights outcomes, and thereby provides information on accountability. Ms. Sander concluded her presentation by emphasizing that all Member States are bound by their obligation in the UN Charter to respect, protect, and fulfill human rights. Adopting human rights indicators, targets, and benchmarks would allow Member States to better meet this obligation by reframing global priorities, focusing on more effective policies and interventions, and redirecting resources to where they are most needed.

Event attendees left with a greater understanding of the need to integrate scientific evidence into the development of a broader set of drug policy metrics, and were equipped with clear and demonstrable steps to better evaluate the multilayered impacts of drug policy on communities.

[WATCH A VIDEO RECORDING OF THE EVENT]

PRESENTATION SLIDES: [DR. WERB] [DR. HAYASHI] [DR. HELLER] [MS. SANDER]