Chasing the Scream: The First and Last Days of the War on Drugs (41 page)

John knew that there would be plenty of addicts waiting for him, because Merseyside in the 1980s was the site of one of the most charged class wars in British history. Margaret Thatcher’s Conservative government had pledged to kick the north of England off what they saw as subsidy-sucking nationalized industries, and her ministers were privately proposing to abandon Liverpool, saying that reviving its economy would be like “trying to make water flow uphill.”
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The people of Merseyside saw their workplaces shuttered, their houses become dilapidated, and their streets set on fire as riots began to rip through the inner cities. Now heroin was spreading in the wake of the flames. John could see that the hopelessness sinking over the region would breed even more addiction, and he sighed.

Every Thursday, a slew of addicts came into the clinic, and it was John’s job to write them prescriptions—for heroin. They sat down. They answered a few questions. Then they were given enough heroin to last them until the following Thursday. And that was it. At first, John was bemused, thinking this a bizarre idea. Free heroin for addicts? He had unwittingly inherited the last crease in the legal global drug supply system that Harry Anslinger had never been able to iron out.

Before my journey home, I believed Britain’s war on drugs had been like most of our foreign policy: a cry of “Me too!” in a bad American accent. We jail huge numbers of people, but a little less than the United States.
⁴
We back the drug wars abroad, but not quite so intensely. It turns out I was a little right and a little wrong. There is one significant area in which we are worse: black men are ten times more
⁵
likely to be imprisoned for drug offences than white men in Britain, a figure beating both the United States and apartheid South Africa.

This is partly because—just as in the United States—our drug war began in a race panic. As the book
Dope Girls
by Marek Kohn explains, on the twenty-seventh of November 1918,
⁶
a young white showgirl called Billie Carleton stayed up until five in the morning with her friends in her flat behind the Savoy Hotel, with a large amount of cocaine in front of her. She was found dead later that day. There was a press furor about how two sinister forces were bringing these chemicals into the British Isles—the “sickening crowd
⁷
of under-sized aliens” who made up the wave of Chinese immigrants, and the “nigger ‘musicians’ ”
⁸
playing jazz. (They put quotation marks around the word “musician,” not the word “nigger.”) Drugs were banned to save the country from these racial poisons. After the ban, the
News of the World
reported with relief:
EVIL
NEGRO CAUGHT
,
⁹
and added “the sacrifice of the souls of white women” would finally stop—and it was all cheered on by the U.S. government, delighted to see that other nations shared its concerns.

But for a long time, there was one loophole. Back when the United States was ordering its doctors to block up all legal supplies of heroin and breaking Henry Smith Williams’s brother, doctors in Britain flatly refused to fall into line. They said addicts were ill and that it was immoral to leave them to suffer or die. The British government, unsure of how to proceed, appointed a man called Sir Humphrey Rolleston,
¹⁰
a baronet and president of the Royal College of Physicians, to decide what our policy should be. After taking a great deal of evidence, he became convinced that the doctors were right: “Relapse,”
¹¹
he found, “sooner or later, appears to be the rule, and permanent cure the exception.” So he insisted
¹²
that doctors be left the leeway to prescribe heroin or not, as they saw fit.

And so for two generations, Henry Smith Williams’s policies prevailed in Britain, and nowhere else on earth. The result was that while heroin addiction was swelling into the hundreds of thousands in the United States, the picture in Britain was different. The number of addicts never exceeded a thousand, and, as Mike Gray explains,
¹³
“the addict population in England remained pretty much as it was—little old ladies, self-medicating doctors, chronic pain sufferers, ne’er-do-wells, ‘all middle-aged people’—most of them leading otherwise normal lives.” British doctors insisted there was such a thing as a “stabilized addict,”
¹⁴
and they said that when you prescribe, this was the norm rather than the exception.

When Billie Holiday came
¹⁵
to London in the 1950s, she was amazed. They “are civilized about it and they have no narcotics problem at all,” she explained. “One day America is going to smarten up and do the same thing.”

Whenever Anslinger was challenged about this evidence in public, he simply denied the British system existed. His evidence was that they didn’t have it in Hong Kong,
¹⁶
which he said “is a British city.” In private, however, he worked hard to shut down the British system. In 1956, the British health secretary told the House of Commons that, under pressure from the United States, he was going to have to cut off the manufacture of heroin. British doctors were outraged, explaining that “the National Health Service exists for the benefit of the sick and suffering citizen.” They would not back down, and Anslinger couldn’t crush them
¹⁷
the way he did his own country’s doctors, and so the policy stayed.

But then, in the 1960s, this system was suddenly ruptured. The British government announced that there had been a catastrophic increase in the number of heroin addicts, because it had gone up
¹⁸
from 927 to 2,782. This appeared to be happening for two reasons. The swinging sixties were changing attitudes across the world, prompting more drug experimentation—and it turned out that in London specifically, a handful of doctors in the West End had been effectively selling heroin prescriptions to recreational users. So the British government moved closer to the American model—but not all the way. The power to prescribe heroin was kept, but it was restricted to a smaller cadre of psychiatrists.

That’s hardly unreasonable, John thought, as he surveyed the addicts who came into his clinic. They were “maybe a few dozen lads, the occasional girl, who came and got their pot of junk. Workers, bargemen, all walks of life really.” He told them to stop
¹⁹
using, and they argued back, telling him they needed it. He decided after a few years to shut the program down so he could move on to exploring schizophrenia and manic depression and genuinely interesting conditions. “I found this a bit of a headache,” he said to me, “and I had bigger fish to fry.”

But as he prepared to do this, there was a directive from Margaret Thatcher’s government, inspired by her friend Ronald Reagan’s intensified drug war across the Atlantic. Every part of Britain had to show it had an antidrug strategy, it said, and conduct a cost-benefit analysis to show what worked. So John commissioned the academic Dr. Russell Newcombe to look into it. He assumed Newcombe would
²⁰
come back and say these patients were like heroin addicts in the United States, and like heroin addicts everywhere, at least in the cliché—unemployed and unemployable, criminal, with high levels of HIV, and a high death rate.

Except the research found something very different. Newcombe found that none of these addicts had the HIV virus, even though Liverpool was a port city where you would expect it to be rife. Indeed, none of them had the usual problems found among addicts: overdoses, abscesses, disease. They mostly had regular jobs and normal lives.

After receiving this report, John looked again at these patients. There was a man named Sydney, who was “an old Liverpool docker, happily married, lovely couple of kids,” John recalled. “He’d been chugging along on his heroin for a couple of decades.” He seemed to be living a decent, healthy life. So, in fact, now that John thought of it, did all the people prescribed heroin in his clinic.

But how could this be? Doesn’t heroin inherently damage the body? Doesn’t it naturally cause abscesses, diseases, and death? All doctors agree
²¹
that medically pure heroin, injected using clean needles, does not produce these problems. Under prohibition, criminals cut their drugs with whatever similar-looking powders they can find, so they can sell more batches and make more cash. Allan Parry, who worked for the local health authority, saw that patients who didn’t have a prescription were injecting smack with “brick dust in it, coffee, crushed bleach crystals, anything.” He explained to journalists
²²
at the time: “Now you inject cement into your veins, and you don’t have to be a medical expert to work out that’s going to cause harm.”

You could immediately see the difference between the street addicts stumbling into the clinic for help for the first time, and the patients who had been on legal prescriptions for a while. The street addicts would often stagger in with abscesses that looked like hard-boiled eggs rotting under their skin, and with open wounds on their hands and legs that looked, as Parry recalls, “like a pizza of infection. It’s mushy, and the cheese you get on it is pus. And it just gets bigger and bigger.” A combination of contaminated drugs and dirty needles had given a home to these infections in the addicts’ flesh and they “can go right through the bone and out the other side, so you’ve got a hole going right through you. You have that on both legs and your body’s not strong enough—it’ll cut right through. You had situations where people were walking and their legs snapped.” They often looked like survivors of a war, with amputated limbs and flesh that looked charred and scarred.

The addicts on prescriptions, by contrast, looked like the nurses, or the receptionists, or John himself. You couldn’t tell them apart.

Harry Anslinger thought this contamination of drugs was a good thing, because it would discourage people from using. By 1942, he was boasting:
²³
“The addict is now using heroin which is over 99 percent adulterated.” But Allan Parry saw the effects in this clinic. “These shitty drugs—when you try to inject them they block up [your veins] and they really make a mess of you,” he tells me. “The trouble is, with dirty heroin, one vein more or less goes with one hit.” Then, “if you damage that vein, you’ll try another one, and eventually you work your way around your body looking at what veins you’ve got and sticking stuff in them,” destroying your body as you go.

Faced with this evidence, John Marks was beginning to believe that many “of the harms of drugs are to do with the laws around them, not the drugs themselves.” In the clinic, they started to call the infections and abscesses and amputations “drug war wounds.” So he “slowly got,” he told me, “that this clinic was working wonders” by bypassing criminality and providing safer forms of the drug. John began to wonder: If prescription is so effective, why don’t we do it more? If it is preventing people from getting HIV, and injecting poisons into their veins, and dying in the gutters, why not expand it?

He decided to embark on an experiment. He expanded his heroin prescription program from a dozen people to more than four hundred, and with a local pharmacist, he pioneered the prescription of “heroin reefers”—cigarettes soaked in heroin.
²⁴
He also prescribed cocaine,
²⁵
including smokable cocaine, for a small number of people who had become addicted to street crack. He knew that, like alcohol, cocaine is harmful to your health over time, but he explained: “If you were an alcoholic
²⁶
in the Chicago of the 1930s, and had just stolen your grandmother’s purse to buy a tot of adulterated methylated spirits at an exorbitant price from Mr. Capone, I would have a clean conscience in prescribing for you a dram of the best Scotch whisky.”