Choice and conflict about heroin -prescribing in the ...Choice and conflict about heroin...

Choice and conflict about heroin-prescribing in the clinics of the 1970’s

Martin Mitcheson

‘Heroin on trial’ conference, May 2018

BACKGROUND TO CLINICS

Sir Humphry Davy Rolleston,(President of Royal College of Physicians, 1922-1936)

Home Office Governmental Committee Report 1926

• The legitimacy and authority of the medical versus law enforcement perspective

• “maintenance” (not termed thus) with injectable morphine (or sometimes diamorphine(heroin) legitimate medical practice

• Sets UK apart from post-1920s US policy

Sir Russell (subsequently Lord Brain) 1961

• Essentially no change to the small problem

But• Risk of illegal import if

demand not satisfied from legitimate sources

• First addict under age of 20 recorded in 1960

Sir Russell (subsequently Lord Brain) 1964

• For the first time, seen as a growing problem amongst the young

• A ‘socially transmissable condition’

• Entirely based on prescribed or diverted pharmaceutical injectables(from small number of independent doctors)

• Recommends creation of a network of drug treatment centres (esp around London)

• Implemented 1967 – the new clinics take over all prescribing of heroin to addicts

Quantity of heroin prescribed annually (London)

Quantities of heroin and injectablemethadone prescribed annually (London)

Quantities of heroin, injectable and oral methadone prescribed annually (London)

notified addictsamount prescribedprice on the streetprice from dealer

Addicts, amount of prescribed heroin, street and dealer prices

ADDITIONAL SLIDES