Epidemiology of Substance Use Historical and International Aspects

1
Adolescent Addiction Course Thursday 8th
February 2007
Epidemiology of Substance Use Historical
and International Aspects
Martin Frisher Department of Medicines
Management Keele University Harplands
Hospital
http//www.keele.ac.uk/schools/pharm/ drug-misuse/
DrugMisuseDownloads.htm
2
Learning Objectives

• To be familiar with
• History of Opium, Morphine and Heroin
• The Opium Wars
• History of Cannabis and Cocaine
• History of Drug Regulation
• Major Enquiries into Drug Use

3
Why History?

• What experience and history teach is this -- that
  people and governments never have learned
  anything from history, or acted on principles.
  George Wilhelm Hegel
• We learn from history that we learn nothing from
  history. George Bernard Shaw
• Those who cannot learn from history are doomed to
  repeat it. George Santayana

4
Why History?

• History is more or less bunk. It's tradition. We
  don't want tradition. We want to live in the
  present and the only history that is worth a
  tinker's damn is the history we make today. Henry
  Ford
• People always seemed to know half of history, and
  to get it confused with the other half. Jane
  Haddam
• History is merely a list of surprises. It can
  only prepare us to be surprised yet again. Kurt
  Vonnegut

5
Petroglyphs 12th - 10th Centuries BCE
6
Bible 10th - 5th Centuries BCE

• 920 And Noah began to be an husbandman, and he
  planted a vineyard
• 921 And he drank of the wine, and was drunken
  and he was uncovered within his tent.
• 929 And all the days of Noah were nine hundred
  and fifty years and he died.

7
Opium in History

• The source of opium is the opium poppy. Known as
  papaver somniferum (literally the poppy that
  brings sleep.)
• Opium is harvested by a small shallow incision in
  the capsules allowing a milky white juice to ooze
  out.

8
Opium in History

• Egyptians were knowledgeable about the medicinal
  value of opium. Evidence of this was found in the
  Ebers Papyrus writings.
• In the second century A.D., Claudius Galen, the
  famous Greek physician and surgeon to Roman
  gladiators recommended opium for many conditions.
• Spreading across the Asian land mass, opium was
  described as an effective drug in China's
  Herbalist Treasure of 973 AD.
• Western Europe was introduced to opium in the
  eleventh and twelfth centuries from returning
  crusaders who learned of it from the Arabs.

9
Prehistory to Middle Ages

• While traces of drug use have emerged in
  practically all human cultures since the
  beginning of recorded history, very little is
  known with regard to drug use before the early
  modern period.
• The opium poppy plant (papaver somniferum) is
  native to the Mediterranean, and was used in
  mystical and religious rites in Greece and Crete
  a thousand years before the birth of Christ.

10
15th-17th Centuries, European Drugs

• Prior to the voyages of exploration, Europe had
  comparatively little choice in drugs.
• There was no tea, coffee, tobacco little opium,
  cannabis, hallucinogens mainly alcohol.
• Alcohol was (and is) the dominant drug.

11
17th Century, Opium

• In 1680, the English physician Thomas Sydenham,
  considered the father of clinical medicine,
  introduced a highly popular version of an opium
  drink called Syndenhams Laudanum.
• For the next 200 years or so, the acceptable form
  of taking opium among Europeans and Americans
  would be in the form of a drink, either
  Sydenhams recipe or variations.

12
1606

• English trading ships chartered by Elizabeth the
  First commence the importation of Indian Opium
  into the UK .

English Ships outside Bombay Harbour.
13
1729, China

• Imperial edict bans the importation of opium into
  China. Dutch, Portuguese and English ships were
  trading opium to China, where the opium habit was
  catching on in a big way.
• When the Chinese Emperor banned it, however, all
  that happened was that the price went up,
  encouraging more trade, and the practice
  continued to spread.

Yongzheng Emperor (born December 13, 1678 -
October 8, 1735)
14
1750, India

• The British East India Company assumes control of
  Bengal and Bihar, the major opium poppy growing
  areas of India.
• The company, which is operating under royal
  charter and linked intimately to the British
  government, assumes the dominant position in the
  shipping of opium from India to China.

15
1799, China

• Chinese emperor Kla King introduces total
  prohibition of the importation, cultivation and
  use of opium.

Chinese Opium smokers
16
1797- Samuel Taylor Coleridge writes Kublai Khan

• The poet prefaces the published version of the
  (unfinished) poem by narrating the tale of his
  opium dream, his awakening and subsequent attempt
  to write down his recollections of the
  experience, which was interrupted by the arrival
  of a 'person on business from Porlock'.

17
18th - 19th Centuries, Opium

• Opium and tea were the mainstays of the British
  East India Company, who had a monopoly on the
  opium produced in Bengal.
• In 1772 Warren Hastings, then chief executive of
  the company, realized the potential for foreign
  revenue in exporting Indian opium to China.
• When East India Company tool over Bengal in 1773
  they took control over large opium growing area.
• In England, Thomas De Quincey publishes
  Confessions of an Opium Eater (1821)

18
1832

• Sir Robert Christison reports on opium and
  longevity in the Edinburgh Medical and Surgical
  Journal The study of a small number of users
  (including Thomas De Quincey) forms the basis of
  his report, which concludes that there is
  insufficient evidence to support the claim that
  regular use of the drug significantly reduces
  life expectancy.

19
19th Century, Opiates in Medicine

• Physicians in the nineteenth century as now
  prescribed opiates for pain. They were also
  widely prescribed, however, for cough, diarrhea,
  dysentery, and a host of other illnesses.
  Physicians often referred to opium or morphine as
  "G.O.M."--- "God's own medicine."
• Another nineteenth-century use of opiates was as
  a substitute for alcohol. As Dr. J. R. Black
  explained in a paper entitled "Advantages of
  Substituting the Morphia Habit for the Incurably
  Alcoholic," published in the Cincinnati
  Lancet-Clinic in 1889, morphine "is less inimical
  to healthy life than alcohol."

20
1803/1866, Morphine and the Hypodermic Syringe

• Morphine was isolated from Opium in 1803 but did
  not make an impact until 1866 with the invention
  of the hypodermic syringe.
• Its extensive use during the American Civil War
  resulted in over 400,000 sufferers from the
  "soldier's disease" (addiction), though this is
  disputed.

21
19th C Morphine and Opium

• In the US, Morphine was legally manufactured from
  imported opium.
• Opium poppies were also legally grown within the
  United States
• The nineteenth-century distribution system
  reached into towns, villages, and hamlets as well
  as the large cities
• A classic report on the English industrial
  system, The Factory System Illustrated (1842), by
  W. Dodd, noted that factory workers of the time
  used opiates--- notably laudanum--- to quiet
  crying babies.

Opium smokers in the East End of London, 1874.
From the Illustrated London News, 1 August 1874
22
1839-56, The Opium Wars

• Sometime in the eighteenth century, China
  discovered opium smoking
• In the eighteenth century tea had become popular
  in Britain. British merchants wanted to buy tea
  and send it home, but what could they sell to the
  Chinese in exchange?
• The problem was that there were few, if any,
  commodities that China really wanted from the
  outside.
• As Britain had a monopoly on raw opium in India,
  it was easy to introduce opium to China as a
  major item of trade.

23
1839-42, First Opium War

• Opium was successfully smuggled into China
  through local British and Portuguese merchants,
  allowing the British government and its official
  trade representative, the East India Company, to
  carry off the public image of not being directly
  involved in opium trade.
• Despite repeated efforts by the Chinese to reduce
  the use of opium within China or to cut the
  supply line from India, the trade flourished.

24
1839-42, First Opium War

• By 1839, the tension had reached a peak. In a
  act of defiance against the European powers,
  including Britain, an imperial commissioner
  appointed by the Chinese emperor to deal with the
  opium problem once and for all confiscated a huge
  quantity of opium and burned it publicly in
  Canton.
• Events escalated shortly after this until open
  fighting between Chinese and British soldiers
  broke out.

25
1839-42, First Opium War

• By 1842, British artillery and warships had
  overwhelmed a nation unprepared to deal with
  European firepower.
• China was forced to sign over to Britain the
  island of Hong Kong and its harbor (until 1997),
  granting to British merchants exclusive trading
  rights in major Chinese ports, and pay a large
  amount of money to the British losses during the
  war.

26
1858-60, Second Opium War

• Fighting broke out again between 1858 and 1860
  this time British soldiers were joined by the
  French and Americans.
• Finally in a treaty signed in 1860, China was
  required to legalize opium within its borders.
• A second set of treaties weakened the imperial
  government. Provisions in these treaties for the
  complete legalization of opium.

27
1860, Convention of Peking

• China's recognition of the validity of the Treaty
  of Tientsin
• Opening Tianjin as a trade port
• Cede No.1 District of Kowloon to Britain
• Freedom of religion established in China
• British ships were allowed to carry indentured
  Chinese to the Americas
• Indemnity to Britain and France increasing to 8
  million taels of silver respectively.
• Legalization of the Opium Trade

28
Opium in 19th Century Britain

• The acceptable form of opium use in Victorian
  England was opium drinking in the form of
  laudanum.
• The Oriental practice of opium smoking was
  identified by the British with vice and
  degradation and associated with the lowest
  fringes of society.
• Opium in the mid-1800s was the aspirin of its
  day. There was no negative public opinion and
  seldom any trouble with the police.

29
1874, Suppression of the Opium Trade

• The Society for Suppression of the Opium Trade
  (SSOT), founded in 1874, became the best-known
  anti-opium organisation.
• It was controlled by Quaker businessmen and
  funded by one family.

30
1892 Royal Commission

• The motion finally passed asked that Her Royal
  Majesty appoint a Commission to inquire into the
  following questions-all pointed toward the
  question of prohibition in India
• Whether poppy growing and sale of opium should be
  prohibited, except for medical purposes in
  British India and the Indian states?
• Whether existing agreements with the Indian
  States could be changed?What would be the cost
  to the finances of India of prohibition?
• Whether any measure short of total prohibition
  would be possible?
• What was the effect of opium use on "the moral
  and physical condition of the people"?
• what was the opinion of the people of India about
  possible prohibition and would they be willing to
  accept the costs involved?

31
Opium in 19th Century USA

• Opium was advertised as a treatment of alcohol
  addiction, white star secret liquor cure was
  designed to be added to a gentlemens
  after-dinner coffee.
• 1850s-1860s
• Thousands of Chinese men and boys were brought to
  the West to build the railroads.
• Most of the Chinese workers were recruited from
  the Canton area where opium traffic was
  particularly intense.
• The practice of opium smoking was well known to
  them.

32
19th Century Victorian England, Recreational Drug
Use

• A few artists and mystics searched for inner
  experience, rejecting vulgar materialism, but
  the majority of drug abusers, considered
  themselves to be taking medicines to help them
  work or relax.

"If opium-eating be a sensual pleasure, and if I
am bound to confess that I have indulged in it to
an excess, not yet recorded of any other man, it
is no less true, that I have struggled against
this fascinating enthralment with a religious
zeal, and have, at length, accomplished what I
never yet heard attributed to any other man -
have untwisted, almost to its final links the
accursed chain which fettered me.(from
Confessions of an English Opium Eater)
33
Opium in China in 19th Century

• What happened in China in 19th century when opium
  became available. How many became dependent?
• Previously it was eaten it for medicinal use but
  smoking was for pleasure. This was introduced
  from Formosa when the Dutch had introduced the
  habit of smoking tobacco mixed with opium in the
  17th C.
• By 1870 estimated 3 million users in China out of
  population of 300 million.
• In England in later 18th C, opium dens in east
  end of London-but these were never more than rare
  in the UK.

34
Licit Opium Production in 20th Century

• To many it seems that the pharmaceutical trade
  was a continuation of the Opium Wars. Pressure
  grew for action.
• In 1912 first international treaty. By 1946 there
  was almost no pharmaceutical production.
• Macfarlan Smith of Edinburgh are now (2002) the
  worlds leading licit manufacturers-strictly for
  medical use in the few countries where it is
  allowed

35
19th Century, Heroin

• Heroin introduced in 1898 with the hope that the
  acetylation of the morphine molecule would reduce
  its side effects (similar to acetylation of
  salicylic acid which is used to make aspirin).
• But heroin proved to be as addictive as morphine.

36
1925, Heroin

• Intravenous injection about 1925.
• Seems to have emerged in US and Egypt.
• Between the wars UK and European firms exported
  tons of heroin to addicts in the Far East

37
20th C, Heroin Injection

• During the first few years of this century, when
  heroin could be bought over the counter--just
  like aspirin. At that time, it was mostly
  administered orally. This usually took the form
  of heroin cough drops.
• People were not dissolving heroin, just as people
  don't inject alcohol or nicotine today.
• http//www.heroinhelper.com/user/admin/why_inject_
  part_1.shtml

38
1950s, Chasing the Dragon-Hong Kong

• This is a way of smoking heroin which usually
  involves placing powdered heroin on foil and
  heating it from below with a lighter. The heroin
  turns to a sticky liquid and wriggles around like
  a Chinese dragon. Fumes are given off and are
  inhaled sometimes thorough a rolled up newspaper,
  magazine or tube. Chasing caught on in Europe
  from early 1980s.

39
1970s, Heroin

• From 1975 new type of heroin from Iran-soft fine
  beige powder-brown sugar. Ideal for smoking.
• Same type predominates today but mostly from
  Afghanistan.

40
Spread of Heroin

• Pre-WW1 use was unregulated
• Between wars laws passed considerable success
• Post WW2 criminal organisation have sidestepped
  control with support from corrupt governments.
• War on drugs is out of control and is causing
  more harm than good.

41
History Of Opiates, 1903-1910

• 1903 Heroin addiction in the United States rises
  at an alarming rate.
• 1905 U.S. Congress bans opium.
• 1906 U.S. Congress passes the Pure Food and Drug
  Act which caused that availability and
  consumption of opiates to decline dramatically.
• 1909 The first federal drug prohibition passes in
  the U.S., outlawing the importation of opium and
  opiates.
• 1910 The Chinese convince Britain to dismantle
  the India-China opium trade.

42
History Of Opiates, 1914-1925

• 1914 The Harrison Narcotics Act is passed which
  required all doctors and pharmacists that
  prescribed opiates to register with the
  government and pay a tax.
• 1922 The Narcotic Import and Export Act is
  passed which restricted the importation of crude
  opium except for medicinal purposes.
• 1923 The first federal drug agency, U.S. Treasury
  Departments Narcotic Division, is formed and all
  narcotic sales are banned.
• 1924 The Heroin Act is passed and the
  manufacture, possession, and consumption of
  heroin is made illegal.
• 1925 In the wake of the federal ban on opiates, a
  thriving black market opens in New Yorks
  Chinatown.

43
History Of Opiates, 1930s to 1970s

• 1930s The majority of illegal opiates smuggled
  into the U.S. comes from China.
• 1945 Burma gains independence from Britain
  following WWII and opium cultivation flourishes
  in the surrounding areas.
• 1962 Burma outlaws the cultivation, possession
  and consumption of opiates.
• 1965-70 Opium and heroin smuggling into the U.S.
  is at an all time high. This is blamed in part
  on the U.S. involvement in the Vietnam War. An
  estimated 750,000 heroin addicts live in the
  United States.

44
History Of Opiates, 1970-1988

• 1970 Controlled Substance Act is passed which
  divided drugs into categories and set penalties
  for crimes involving narcotics.
• Mid 1970s Heroin and Opiate use in the U.S.
  begins to subside. Mexican heroin enters the
  market and would remain a large player for almost
  a decade.
• 1978 The U.S. and Mexican governments meet and
  decide on a way to eliminate the Opium farms in
  Mexico. The U.S. proceeded to spray the Poppy
  fields with Agent Orange.

45
History Of Opiates, 1988-1995

• 1988 Opiate production in Burma increases due to
  the State Law and Order Restoration Council, the
  Burmese junta regime. The single largest heroin
  seizure is made in China, 2,400 pounds.
• 1992 Colombias drug lords introduce a high grade
  form of heroin in the U.S.
• 1993 The Thai Army with support from the U.S. DEA
  destroyed thousands of acres of opium poppies.
• 1995 The Golden Triangle area of Southeast Asia
  is the worlds leading producer of opiates, over
  2,500 tons annually.

46
History of Opiates 1999-2001

• 1999 United Nations Drug Control Policy (UNDCP)
  estimates that 75 of the worlds opiates come
  from Afghanistan and that a bumper crop of over
  4,600 tons exists there.
• 2000 Taliban leader Mullah Omar bans opiate
  cultivation in Afghanistan, the UNDCP confirms
  the ban.
• 2001 War in Afghanistan, opiates, primarily
  heroin, flood the Pakistani and world market.

47
1800, Cannabis

• Napoleon's soldiers returning to Europe following
  the ill-fated campaign in Egypt bring with them
  an exotic cargo from North Africa Hashish

48
Pre 20th Century, Cannabis

• Cannabis unfamiliar until 20th century.
• Longstanding fear-considered esoteric and
  perilous-association with the middle east and
  bizarre effects described by literary figures.

49
1840, Opium and Cannabis

• In 1840 the pro-opium banker William Bingham
  Baring MP told the Commons that if the opium
  trade were suppressed then there would be a
  danger of users turning to drugs "infinitely more
  prejudicial to physical health and energy than
  opium (i.e. cannabis).

50
1889, Cannabis

• One reason why cannabis was not as widely used as
  opium products, was the difficulty found refining
  an "active ingredient."
• In 1889, Dr E.A.Birch described in the Lancet the
  successful use of cannabis in the treatment of
  opium withdrawal, drawing attention to the
  abolition of craving and the antiemetic (vomit
  suppressing) effects.

51
1915, Marijuana Prohibition

• The first state marijuana prohibition law came in
  Utah in 1915 and was enacted into law along with
  a number of other Mormon religious prohibitions.
• The early state marijuana laws in the Southwest
  and West were passed because "All Mexicans are
  crazy and marijuana is what makes them crazy."
  That is, they were the result of racial prejudice
  against newly arrived Mexican immigrants.
• The other early state marijuana laws were passed
  out of the fear that opiate addicts, who had been
  deprived of legal access to opiates by the
  Harrison Tax Act of 1914, would turn to
  marijuana. In other words, they were afraid that
  opiate use would lead to marijuana.

52
1880, Cocaine

• From 1880s pure cocaine became more easily
  available and was immediately praised in the
  states.
• Anaesthetic properties.
• Remedies for hay fever etc.
• Between 1895 and 1915 it became associated with
  southern blacks hostility to whites.
• Cocaine considered negro drug while opiates
  considered whites drug.

53
1884, Sigmund Freud and Cocaine

• 1884 Sigmund Freud treats his depression with
  cocaine, and reports feeling "exhilaration and
  lasting euphoria, which is in no way differs from
  the normal euphoria of the healthy person. . .
  You perceive an increase in self-control and
  possess more vitality and capacity for work. . .
  . In other words, you are simply more normal, and
  it is soon hard to believe that you are under the
  influence of a drug."

54
19th Century, Drug Dependency

• Although the dependency syndrome had been
  described two centuries earlier by Thomas
  Sydenham (1624-89), the risk was not taken
  seriously by most medical practitioners.
• Following increasing reports of dependency
  symptoms after 1860, culminating in a series of
  articles in The Practitioner in 1870, the debate
  on the wisdom of permitting free access to opium
  accelerated.

55
1894 India, Indian Hemp Drugs Commission Report

• This 3,281-page, seven-volume classic report on
  the marijuana problem in India by the British
  concluded
• "Viewing the subject generally, it may be added
  that moderate use of these drugs is the rule, and
  that the excessive use is comparatively
  exceptional. The moderate use produces
  practically no ill effects."

56
Drug Regulation, 20th Century

• Early 20th C-there was little precedent for
  federal regular of drugs.
• Newspapers main source of information didnt
  want to scare off advertisers.
• Not till 1906 pure food and drug act-labels
  required to state amount of opiates, cannabis,
  cocaine.
• But doctors and pharmacists could prescribe
  opiates/cocaine unrestricted.

57
1906, Pure Food and Drug Act

• Required manufacturers to include on labels the
  amounts of alcohol, morphine, opium, cocaine,
  heroin, or marijuana extract in each product
• Prohibited misrepresentation and marked the
  beginning of involvement by the government in
  drug manufacturing and promotion

58
1912, Sherley Amendment

• Manufacturers therapeutic claims were not
  controlled by the Pure Food and Drug Act.
• The Sherley Amendment in 1912 was passed to
  strengthen existing law and required that labels
  should not contain any statement...regarding the
  curative or therapeutic effect...which is false
  and fraudulent.

59
1910-1920, International Policy

• International opium conference in 1911 (also
  sought to control cocaine) and opium convention
  1912-quite vague.
• 1920s debate (as now) about number of drug
  users-drug use linked to crime, anarchism etc
• Belief in public health medical modelwhen this
  proved disappointing, punitive model gained sway.

60
1868, UK

• The Pharmacy act imposes some restrictions on the
  sale of drugs, with opium in the less stringent
  schedule 2 the Pharmaceutical Society is given
  responsibility for policing the act under the
  overall authority of the Privy Council Office.

61
1906, UK

• The UK pharmacy act is amended and opium and all
  its preparations containing at least 1 are newly
  included in schedule 1 of the act.

62
1918, UK

• After a night of partying at a Victory Ball
  organised to celebrate the armistice, the English
  actress Billie Carleton dies.Her death is
  attributed to the cocaine of which she was a
  regular consumer, although in fact she most
  likely dies as result of Veronal poisoning. A
  full-blown moral panic ensues in the press about
  the drug culture and the young bohemians who
  participate in it.

63
1920, UK

• The Ministry of Health, having been established
  the previous year, is drawn into conflict with
  the Home Office regarding which of the two should
  be given overall control of drugs policy.After
  a period of inter-departmental wrangling, the
  Home Office emerges victorious. At the symbolic
  level, this outcome represents the priority of a
  punitive over a medical approach to drugs and
  their users.

64
1923, UK

• The Dangerous Drugs Amendment Act stiffens up the
  provisions of the criminal law by increasing the
  severity of punishments it imposes stricter
  controls over the prescribing practices of
  physicians, augments the bureaucratic
  requirements for pharmacists, and expands the
  search powers of the police.

65
1926, UK

• The publication in the UK of the report of the
  Rolleston committee. The report issues an
  endorsement of the medical approach to addiction,
  which it pronounces to be a disease as opposed to
  'a mere form of vicious indulgence'.
• A logical consequence of the acceptance of a
  disease theorisation is the implied validity of a
  range of therapeutic responses, including the
  prescription of maintenance doses of opiates
  and/or cocaine.

66
1928, UK

• An amendment to the Dangerous Drugs Act
  introduces a new offence- the possession of
  cannabis.

67
1944, US, The LaGuardia Committee Report
Mayor's Committee on Marihuana

• This study is viewed by many experts as the best
  study of any drug viewed in its social, medical,
  and legal context. The committee covered
  thousands of years of the history of marijuana
  and also made a detailed examination of
  conditions In New York City. Among its
  conclusions "The practice of smoking marihuana
  does not lead to addiction in the medical sense
  of the word."
• "The use of marihuana does not lead to morphine
  or heroin or cocaine addiction.
• "The publicity concerning the catastrophic
  effects of marihuana smoking in New York City is
  unfounded."

68
1950s, UK Drug Use

• In 1956 54 registered heroin addicts due to
  British Systembut influence of new bohemians
  especially Alexander Trocchi
• Trocchi had one major handicap he couldn't
  write. Any perusal undertaken latterly of any of
  his works only confirms this impression. It's not
  a spectacular failing. There's just a general
  line-to-line ineptitude that seems to say this
  man would have been happy doing almost anything
  else except writing. Which in a way explains a
  life of wheeling and dealing, minor organising,
  socialising, messing up various women's
  existences, drug and alcohol addiction.

69
1951-1966, UK Drug Addicts
70
1961, England, Interdepartmental Committee,
Drug Addiction, (The First Brain Report)

• When the Brain Committee first met at the
  invitation of the minister of health, its mission
  was to review the advice given by the Rolleston
  Committee in 1926.
• That advice had been to continue to allow doctors
  to treat addicts with maintenance doses of
  powerful drugs when the doctors deemed it
  medically helpful for the patient.
• Brain I reiterated that advice and in this first
  report recommended no changes of any significance
  on the prescribing powers of doctors. This report
  expanded on one important point alluded to in
  Rolleston-the authenticity of the existence of
  "stabilized addicts."

71
1962,Treatment

• Dole and Nyswnder 1962-Problem with
  heroin/morphine-constant need for drugs, patients
  had no other goals.
• 1964 the ice cream experience-showed huge
  decrease in criminal activity.

72
1965, England, Interdepartmental Committee,
Drug Addiction, Second Report, (The Second Brain
Report)

• Brain II has been consistently misinterpreted by
  leading american scholars and officials. It did
  not recommend the dismantling of the british
  prescription system nor the compulsory
  registration of addicts, as has been claimed.
  Instead, brain II urged that
• Doctors who wished to prescribe "restricted
  drugs" to addicts for the purpose of maintenance
  be required to obtain a special license from the
  home office
• Treatment centers be established for treating
  addicts who were to be regarded as sick and not
  criminal

73
1968, England, Advisory Committee on Drug
Dependence, Cannabis, (The Wootton Report)

• This study report on marijuana and hashish was
  prepared by a group that included some of the
  leading drug abuse experts of the United Kingdom.
  There is no evidence that in Western society
  serious physical dangers are directly associated
  with the smoking of cannabis.
• It can clearly be argued that cannabis use does
  not lead to heroin addiction.
• The evidence of a link with violent crime is far
  stronger with alcohol than with the smoking of
  cannabis.
• There is no evidence that this activity ... is
  producing in otherwise normal people conditions
  of dependence or psychosis, requiring medical
  treatment.

74
1971, The Misuse of Drugs Act

• The Misuse of Drugs Act 1971 is an Act of
  Parliament, by which the United Kingdom aims to
  control the possession and supply of numerous
  drugs and drug-like substances, as listed under
  the Act, and to enable international co-operation
  against illegal drug trafficking. As passed in
  1971 the Act updated UK legislation to bring it
  in to line with the requirements of the Single
  Convention on Narcotic Drugs.

75
1971, The Misuse of Drugs Act

• Is intended to prevent the non-medical use of
  certain drugs. For this reason it controls not
  just medicinal drugs (which will also be in the
  medicines act) but also drugs with no current
  medical uses.
• Drugs subject to this act are known as
  'controlled' drugs.

76
1971, USA

• US president Richard Nixon initiates the
  full-blown policy of War On Drugs, declaring drug
  use to be 'Public Enemy Number One'.

77
Drug Users in an English Town 1972

• Overwhelmingly, curiosity and because media had
  created a mystique
• Influenced by the writings of Huxley, Leary,
  Burroughs
• Initial experience, entry into a group of
  initiates
• Most said they had become more tolerant or
  perceptive
• Some retreated from the mainstream
• No single pattern of events was evident in
  becoming a drug user or in ceasing to be a drug
  user
• Ref Drugtakers in an English Town (Martin Plant,
  1975)

78
Road Traffic Act 1972

• It is an offence to be in charge of a motor
  vehicle while unfit to drive through drink or
  drugs. The drugs can include illegal drugs,
  prescribed medicines or solvents.

79
1985, UK

• The Controlled Drugs (Penalties) Act introduces
  life imprisonment as a maximum penalty for
  trafficking.

80
1989 UK AIDS and Drug Misuse, Part 1, Advisory
Council on the Misuse of Drugs

• "The spread of HIV is a greater danger to
  individual and public health than drug misuse,"
• In contrast to the Bush administration's war
  plans - a comprehensive health plan that seeks to
  prevent the use of drugs
• Advisory Council accepted the lessons of the
  "harm reduction" programs of Liverpool area
  recommended that they be spread to the entire
  United Kingdom (e.g. needle exchanges and
  prescribed drugs for addicts).
• "We believe that there is a place for an
  expansion of residential facilities where drug
  misusers may gain better health, skills, and
  self-confidence whilst in receipt of prescribed
  drugs."

81
1998

• United Nations sets out its plan to eradicate
  drugs entirely by 2008. At the U.N. General
  Assembly Special Session on Drugs (UNGASS 1988),
  the international community (as represented by
  the UN delegates) reaffirmed their support for
  prohibitive drug policy and committed themselves
  to achieving a 'drug free world' by 2008- i.e.,
  setting a 10 year timetable for realising the
  project.

82
1998, Crime and Disorder Act

• This new Act introduces, for the first time,
  enforceable drug treatment and testing orders,
  for people convicted of crimes committed in order
  to maintain their drug use.

83
2000, MDA

• Of the 104,400 people who committed drug offences
  under the MDA in 2000
•   41 per cent were given a police caution and
  not taken to court.
•  26 per cent were fined.
•  24 per cent were dealt with by other means such
  as suspended prison sentences, probation or
  supervision orders, community service orders or
  discharged.
•  9 per cent were imprisoned.

84
2000, Percentage of offenders dealt with in
various ways was as follows.

• Method dealt with Possession  Supply
• Immediate custody 5 per cent 53 per cent
• Fine 27 per cent 4 per cent
• Other means 23 per cent 34 per cent
• Cautioned 44 per cent 8 per cent

85
2003, UK

• The Anti-Social Behaviour Act is intended to
  respond to public alarm about the existence of
  crackhouses, etc. The Act permits extensive
  powers of discretion to the police in issuing
  closure notices, and relies heavily on hearsay
  evidence. The likely result is that highly
  vulnerable, socially marginalized persons will be
  made homeless at short notice by closure orders
  made under the Act.

86
2005, UK

• Drugs Act is entered into the statute books on
  the day the general election is announced. The
  Act confirms and extends the trend toward a law
  enforcement and criminal justice focus, with
  clauses introducing
• A reversal of the burden of proof in instances
  where suspects are found in possession of a
  quantity which exceeds what might be considered a
  reasonable amount for personal use. i.e., it
  will be up to the defendant to prove that there
  was no intent to supply in cases involving
  amounts above a (yet to be specified) quantity.

87
2005, UK

• Magic mushrooms On July 18 2005 these became
  Class A drugs under the Drugs Act 2005. The law
  is expected to be tested in court by a number of
  magic mushroom suppliers.

88
2001, Section 8 Amendment

• In 2001, the Government passed an amendment to
  Section 8 of the Misuse of Drugs Act to cover the
  use or administering of a controlled drug. The
  new amendment makes it a criminal offence for
  people to knowingly allow premises they own,
  manage, or have responsibility for, to be used by
  any other person for
• adminstration or use of any controlled drugs
  which is unlawfully in that person's possession
  (this is not yet fully enacted. The Home Office
  will issue detailed guidance when the amendment
  is enacted)
• supply of any controlled drug
• the production or cultivation of controlled
  drugs, such as growing cannabis

89
2005 - Drugs Act

• A reversal of the burden of proof in cases where
  suspects are found in possession of a quantity of
  drugs greater than that which would be required
  for personal use. In other words - it will be up
  to the defendant to prove there was no intent to
  supply. The actual amount has yet to be defined.

90
Current (2006) Maximum penalties under the Misuse
of Drugs Act are as follows

• Drug class  Possession Supply
• Class A 7 years fine Life fine
• Class B 5 years fine 14 years fine
• Class C 2 years fine 14 years fine

91
The Future

• Tea had to fight for public acceptance.
• Tea drinking is a troublesome and pernicious
  habit. I view tea drinking as a destroyer of
  health, an enfeebler of the frame, an engenderer
  of effeminacy and laziness, a debaucher of youth,
  and a maker of misery in old age (William
  Cobbett)
• Like heroin, tea arrived in Europe as a
  medicine.. It was the need to pay for Chinese tea
  that inspired British merchants to export opium
  to china. Tea contains strong stimulants-appears
  harmless because we drink it as a weak infusion.

Camellia sinensis
92
The Future

• 20th C has imposed a temporary interruption on
  one of mankind's most ancient habits ?
• (Tom Carnwarth Ian Smith, Heroin Century)