Founded 1980
Chair:        
Secretary: 
Treasurer: 

Graham Smith
Jan Thompson
Graham Mumby-Croft


John Berry
Drugs Society and Prisons

Opium eating and laudanum (an alcoholic solution of opiates) consumption were widespread in mid-19th century Britain. Opium, and its’ derivative morphine, were available as patent medicines, in tinctures and other commercial products that were readily accessible through chemists and herbalists. The use of these products declined after the 1868 Pharmacy Act restricted opium sales to the pharmacist’s shop, with the Act requiring pharmacists to keep records of the purchasers. The later 1908 Pharmacy Act moved morphine, cocaine, opium and derivatives containing more than 1 per cent morphine into part one of the poisons schedule. At this point, control was on availability and sale and was largely based on self-regulation by pharmacists, with little Government intervention. There was a small population of morphine-using addicts and some opium and cannabis smoking among artistic, mystic and bohemian circles, but the population of drug users at the beginning of the 20th century was relatively small and virtually unknown in prisons.

The 1920 Dangerous Drugs Act established that medical practitioners were allowed to prescribe morphine, cocaine and heroin, but it was not clear from either the Hague Convention or the Act whether prescribing these drugs to addicts constituted legitimate medical work. The population of opiate users at this time was small, largely middle class, addicted to morphine and in the medical and allied professions, or had become dependent in the course of medical treatment. At the suggestion of the Home Office, the Ministry of Health convened an expert committee (Departmental Committee on Morphine and Heroin Addiction) chaired by Sir Humphrey Rolleston, then President of the Royal College of Physicians, to consider and advise on the circumstances in which it was medically advisable to prescribe heroin or morphine to addicts. The report produced by the committee (usually known as the Rolleston Report), reaffirmed the doctor’s freedom to prescribe regular supplies of opioid drugs to certain addicted patients in defined circumstances that the committee regarded as ‘treatment’ rather than the ‘gratification of addiction’. While the possession of dangerous drugs without a prescription was still the subject of the criminal law, addiction to opioid drugs was recognised as the legitimate domain of medical practice
(and hence prescribing). This balance of a medical approach within a penal framework became a hallmark of British drug control and has been called the ‘British System’ by commentators.

Until the 1960s, prescribed heroin was the main medication used for treatment of those addicted to morphine and heroin; this population was predominantly aged over 30 years and middle class. This was a settled approach, as a major addiction problem was not apparent in the British drug scene. In the early 1960s, the first reports about the activities of young heroin users began to appear in British newspapers – a phenomenon that was new to Britain. The Home Office convened an interdepartmental committee under the chairmanship of Sir Russell Brain, largely prompted by concern about whether long-term prescribing was still appropriate more than 30 years after the Rolleston Report. 

The Brain Committee published its first report early in 1961, and concluded that the drug problem remained small and no changes in approach were needed. Increasing media and professional evidence of a heroin epidemic in Britain involving younger heroin users led to a Second Interdepartmental Committee on Drug Addiction, again chaired by Brain. Drug
addiction was formulated as a ‘socially infectious condition’, for which it was appropriate to provide treatment. The committee concluded that the increase in heroin use had been fuelled by a small number of doctors who were over-prescribing heroin and that individual doctors were unable to meet the demands of the new situation. As a result, the committee recommended that restrictions should apply to the prescribing of heroin and cocaine and that new drug treatment centres should be set up within the NHS hospital system.

These recommendations were enacted in the Dangerous Drugs Act 1967, which restricted the prescribing of heroin for treatment of addiction to doctors licensed by the Home
Office. The doctors who obtained licences were mostly consultant psychiatrists in charge of drug treatment centres. This limitation of doctors’ clinical autonomy received some criticism from the medical profession. As this restriction of clinical freedom did not extend to prescribing heroin for medical treatment other than addiction, and GPs were generally reluctant to treat addicts, the change was accepted by the medical profession. The committee’s recommendations also led to the introduction of a notification system for addiction (as with infectious diseases). The drug clinics took over the prescribing of heroin to patients who were previously prescribed by private doctors and NHS GPs. Prescription of heroin to addicts declined in the early 1970s, as doctors at the drug clinics were uncomfortable prescribing it. Methadone had recently been developed in the USA as a new treatment specifically for dependence on opioid drugs, and the clinic doctors considered oral methadone was a more suitable medication.


The 1960s and the rise of pop culture also saw widespread use of other illicit drugs by young people, notably cannabis, but also LSD and amphetamines. Concern over the use of amphetamines, or ‘purple hearts’ or ‘pep pills’ as they were commonly called, led to their control under the Drugs (Prevention of Misuse) Act 1964. While amphetamine use among young people was the first to draw political reaction, cannabis-related convictions increased steeply as use of this drug became more popular in the mid-1960s. The 1970s saw the growth of drugs in prisons and in Borstals, and glue sniffers were of significant concern along with the odd find of cannabis.


The 1980s brought new pressures on the treatment system and Britain’s drug control policy, with a new epidemic of heroin use. The numbers of addicts notified to the Home Office and the amount of heroin seized rose dramatically. There was widespread media coverage of this new wave of heroin use, and drug use became an important and sustained policy issue for the first time since the 1960s. The then Conservative Government sought to encourage a coordinated response from across the range of Government departments, by seƫng up an interdepartmental working group of ministers and officials, which resulted in the first Government strategy document ‘Tackling Drug Misuse’, issued in 1985. 

During the same period, new ways of tackling drug treatment were developed following the recommendations of the Treatment and Rehabilitation report from the ACMD in 1982. The focus became the broader population of ‘problem drug users’, seen as a heterogeneous group with a range of problems beyond the use of a drug itself, encompassing social and economic as well as medical problems. The generalist doctor was seen as key to dealing with drug-related problems, and drug use was no longer seen as the sole province of the specialist clinic psychiatrist.

The late 1980s saw HIV and AIDS become the dominant public health concern. People who injected drugs were seen as a potential route for the HIV virus to rapidly diffuse into the wider community, through the sharing of contaminated injecting equipment. In response to the widespread concern about AIDS, HIV and those who inject drugs, the ACMD set up an AIDS and Drug Misuse Working Group. The resulting report, ‘AIDS and Drug Misuse Part I’, provided the template and rationale for a reorientation of drug treatment practice to meet the new challenge of drug use and HIV. The report stated that ‘The spread of HIV is a greater threat to individual and public health than drug misuse’. The ACMD saw that the key aims of drug treatment were to attract seropositive injecting drug users into treatment, where they could be encouraged to stop using injecting equipment and move away from injecting toward oral use.

Harm minimisation was the core principle of this policy and received support from the Government. Harm minimisation was characterised by adopting measures that sought to reduce the harm caused by continued drug use, through modification of using behaviours.

‘AIDS and Drug Misuse Part I’ and the complementary report ‘AIDS and Drug Misuse Part 2’, continued the policy aim of involving GPs and general psychiatrists more actively in the direct provision of services to address the more general healthcare needs of drug users, while the specialist clinics maintained responsibility for the more complicated needs of the more difficult drug users. Needle exchange services rapidly became main stream. Their early introduction, together with a range of other harm-reduction interventions, has been seen as critical in preventing the major spread of HIV among individuals who inject drugs that has been seen in other countries where such approaches were not adopted. Around this time, maintenance prescribing re-emerged in the form of oral medication.

Those of us who were around in prisons at this time will remember the arguments about needle exchange, provision of contraceptives to reduce HIV transmission and the genuine concern that there was going to be an AIDS epidemic in prisons. We also had the first death of a member of staff from AIDS, the Chaplain at Chelmsford prison.

In 1996, the Department of Health (DH) set up a review of drug treatment services and their effectiveness, which concluded that ‘treatment works’. This conclusion underlaid the
10-year New Labour strategy, ‘Tackling Drugs to Build a Better Britain’, which stressed the use of diversion into drug treatment from the criminal justice system. An example of this new approach was the introduction of community sentences for offenders, involving drug testing and treatment components called Drug Treatment and Testing Orders (DTTOs). Treatment services within prisons expanded.

The main focus of the strategy was problematic drug users, which included those who injected drugs and those using opioid drugs and crack cocaine. Spending on drug treatment rose substantially. In 1994, around 67,000 people were counted as being in treatment, rising by 26.9 per cent to 85,000 in 1998-1999 and a further 129.9 per cent to 195,400 by 2006-2007, giving an overall rise from 1994 to 2006-2007 of 191.6 per cent. The treatment and rehabilitation budget for 1994 was £61 million, while the total spend on treatment in 2005-2006 was estimated to be £508 million. In criminality surveys conducted in England and Wales in 2000 and 2002, over one-third of male prisoners and over a quarter of men serving community sentences reported experiencing problematic drug use. Men were more likely than women to say that they had problems staying off drugs in the last 12 months (43% versus 39%). 

The budget for drug treatment interventions in the criminal justice system in England and Wales was over £330 million in 2006-2007 and spending on drug treatment in prisons increased from £7 million in 1997-1998 to £80 million in 2007-2008. The 2002 Updated Drug Strategy concentrated on the ‘most dangerous drugs’, defined as Class A drugs, and again emphasised the objective of getting more of the estimated 250,000 problem drug users into treatment. The Home Office was given overall responsibility for implementation of the drug strategy, although the DH and Department for Education and Skills (DfES) had key roles.

The unprecedented growth in "legal (now illegal) highs" has led to 348 new types of synthetic drugs appearing in more than 90 countries in every region of the world. Nigel Newcomen said that between June 2013 and January 2016 there were 58 fatalities where the prisoner was known, or strongly suspected, to have been using legal highs before their death. The toll of 58 deaths in 30 months was three times higher than the previous figure of 19 legal high-related deaths, recorded over a similar length of time between April 2012 and September 2014.

In prisons in 2017 drugs are endemic. In 2016 225kg of drugs along with 13,000 mobile phones were found in prisons. This is but the tip if the iceberg given that regular searching has virtually disappeared from the detail. Reduced staffing levels have contributed to the growth in drug use in prisons as has new technology, with drones being used to bring in a variety of illegal substances alongside the usual routes for bringing in illicit items.

Some countries and individual States in the USA have decided that legalising some drugs, e.g. cannabis for personal use, is both lucrative from a taxation point of view and reduces the deployment of intervention services to deter and convict users. The latest information is that where tobacco has been banned in prisons, the price is now around £100 for 100 grams. The day of the tobacco baron may have returned to be added to the other illegal substances they now provide.



John Berry OBE JP

 Issue No. 77 Autumn 2017