In less than 60 days, the British Health Service plans to terminate the contract with the Liverpool drug clinic that has recently become the focus of the international drug policy debate. The clinic is one of the last in England operating under the rules of the so-called "British System" where addicts are given free prescriptions for their drug of choice. Until the 1960s, this practice was the norm in Great Britain, and was credited by many experts with keeping the English addict population limited to a few hundred in total. But over the last twenty-five years, out-side forces -- largely from the United States -- have pressured the British to bring their policies in line with U.S. drug prohibition. The concept of heroin and cocaine maintenance for addicts has been slowly replaced with a stringent methadone reduction policy intended to lead to total abstinence.
The Chapel Street Clinic in Widnes (a suburb of Liverpool) run by Dr. John Marks is the most famous holdout for the old system of free drug mainte- nance. The incredible success of this small institution has been a stark contrast with the documented failure of other alternatives. Unfortunately, the U.S. government has maintained constant pressure to shut down this glaring example of an approach that flies in the face of American drug war orthodoxy.
The situation became critical following a CBS "60 Minutes" broadcast on the clinic in 1990. The facts in this story completely debased fundamental U.S. policy assumptions. The most startling statistic was the crime rate. Beginning in 1988, the local police began tracking the criminal records of 112 addicts who entered the drug maintenance program at Chapel Street. According to the Cheshire Drug Squad, there was a 93 percent drop in theft, burglary, and property crimes among this group over the next two years -- thus illuminating the age-old argument about whether it is the drugs themselves or the pursuit of drugs that drives addicts to criminal behavior.
In addition, the HIV infection rate among these injecting drug users was zero. Zero. And the incidence of death among addicts -- normally 15 percent per year -- was also zero.
Even more significant was the fact that the incidence of new drug users in the Widnes-Holton area dropped dramatically -- contrary to popular assumptions. Drug dealers simply stay away because they know the local addicts don't need them anymore. And the addicts themselves have no reason to sell drugs since they can get whatever they need for nothing.
The "60 Minutes" broadcast and subsequent world-wide media attention -- MTV broadcast a segment from the clinic last fall -- has been a terrible embarrassment to the conservative governments of Margaret Thatcher, John Major, and their American allies.
The British government could not attack Dr. Marks directly because the British medical establishment -- unlike their American counterpart -- will not permit the state to get between a doctor and his patient. So they attacked the clinic on the basis of economics, saying that heroin mainte- nance is too expensive and that Methadone is much cheaper. A one-year supply of heroin costs the clinic 10,000 pounds, where Methadone costs 500 pounds. And why does a synthetic drug cost less than the natural product? Because a single British pharmaceutical company has been granted a heroin monopoly and they are allowed to charge whatever they want.
Last year the local health authority informed Dr. Marks that his services were too expensive and that the future health needs of the addicts in the district would be managed by the Warrington Health Clinic. There they will be switched to a regime of Methadone maintenance and withdrawal. Oddly, the Warrington Health Clinic has no trained personnel, their management was recently investigated for fraud, the chairman had just resigned -- and in fact, the clinic had not even bid for the contract. Their solitary asset seems to be their Christian fundamentalist philosophy.
So on April 1st of this year, Dr. Marks' Chapel Street Clinic will lose its funding and 450 addicts now receiving maintenance doses will be out on the street.
For many years, researchers in England and elsewhere have been asking for a study of the British drug clinics to determine which approach is most successful. This study has finally been commissioned. It will start on April 1 -- the day Dr. Marks loses his funding. Then the Methadone treat- ment centers in England will be able to avoid any embarrassing comparisons with a system that works better.
In March of last year I visited the Chapel Street Clinic and met with seve- ral of the patients. I sat in on a group session where eight heroin users discussed their lives and problems with a counselor before picking up their weekly prescriptions for pharmaceutical heroin. Unlike the junkies we are used to seeing, this group was virtually indistinguishable from any other bunch of young adults on the streets of Liverpool. They were well dressed, talkative, energetic -- they had jobs -- and they used heroin daily.
One of the most attractive was a young woman named Juliette who had been an addict for 13 years. She came from a middle-class background, married a rich kid who got her into heroin, then left her with two kids and no money. She tried desperately to kick but couldn't make it. Somehow for ten years she managed to stay afloat through petty theft and prostitution, with the authorities breathing down her neck. Finally, terrified that they were about to take her kids away, she happened to find the right doctor and he sent her to John Marks. Marks gave her a check-up, satisfied himself that she was indeed a heroin addict, and wrote her a prescription for a week's supply.
"For the first time in ten years," she said, "I had spare time. I didn't have to worry that my dealer wouldn't show -- I didn't have to worry about the price or where to steal the money. So for the first time in ten years, I had a minute to look in the mirror. I looked and I said, `Oh, my God.' Then I looked at the kids, and I said, `What have I done?' All these middle-class values came flooding back in on me.
" Today Juliette has a job, a house, and a mortgage. The kids are
in school and doing well. Everybody's in excellent health. And once a week
she comes to Chapel Street for her prescription. I asked John Marks what
will happen to Juliette on April 1. He said, "Well, she'll go down
Since the US government is largely responsible for the impending disaster
at Dr. Marks' clinic, the very least we can do here in the US is write
the British government officials who may be able to influence this decision.
[Don't forget to use air-mail postage.]
|Rt. Hon. Virginia Bottomley
Secretary of State for Health
Department of Health
London SW 1A2NS
Fax: 011 44 71 210 5433
|MP Hon. John Bowis
Under-Secretary of State for Health
Department of Health
London SW 1A 2NS
Fax: 011 44 71 210 5433
|R.D. Wilson, Chairman
Northwest Reg. Health Authority
930 Birchwood Blvd
Warrington WA3 7QN
|G. Greenwood, Chief Executive
North Cheshire Health Authority
DRCNet advisory board member Cliff Schaffer recommends also writing Sixty Minutes, asking them to do a follow-up investigation on the closing of the Liverpool Clinic:
Story Editor: Betty Scorda
555 W. 57th Street
New York NY 10019
(212) 757-6975 (fax)
[Mike Gray is an author and screenwriter from Los Angeles. He is currently working on Lawyers, Guns and Money, a book about drug prohibition, and is a member of the newly forming DRCNet advisory board.]