OPIUM IN BRITAIN: CONFLICTING AND CONVERGING INTERESTS

Opium and the People - Opiate Use and Drug Control Policy in Nineteenth and
Early Twentieth Century England - Virginia Berridge. 2nd edition. London:
Free Association Books. 1999. Pp 419. 16.95 pounds sterling. ISBN
1-85343-414-0

In early 19th-century Britain, opium was the aspirin and benzodiazepine of
its day. It was available, without medical prescription, from any corner
shop in small quantities at a price that could be afforded by the poorest
of the poor. Without ready access to medical care, opium and its
derivatives (laudanum, paregoric) were sovereign remedies for fevers,
aches, and pains, colicky and fractious infants, the dying, and the mad.
Opium was used for its "stimulant properties" by beer drinkers in the fens
of Norfolk and literary figures like Coleridge and de Quincey. The British
government (involved in opium production in Bengal) fought two wars with
China during the century to assert its right to sell opium to the Chinese.

By the end of World War I, opium and its derivatives were available only by
medical prescription, and a medical addiction specialty had emerged. The
British government not only had disengaged from opium production, but also
had signed an international agreement as part of the peace process after
the war prohibiting the use and sale of opiates for all but medical purposes.

The history of how these changes occurred is well told by Virginia Berridge
in the second edition of a book that has become a classic in the history of
opiate use and societal responses to it in Britain. Whereas the first
edition ended at the turn of the 20th century, the new edition describes
the international movement that after World War I restricted the sale and
use of opiates and other "narcotics", such as cocaine and cannabis. The new
edition also explains why Britain remains one of the few countries to allow
doctors to use heroin for medical purposes, including prescribing it to
maintain dependent users. The last chapter briefly describes the history of
British opiate policy from 1926 to the present day.

The history of the control of opiate use in Britain is a complex tapestry
woven from skeins of conflicting and converging interests - working-class
consumers of opiates; public-health officials concerned about opiate
overdose deaths, especially in infants given opium-based syrups; the
professional interests of the emerging pharmacy and medical professions in
restricting competition from shopkeepers; the emerging disease concept of
addiction and the development of the specialty of addiction; disapproval of
the "stimulant" use of opiates, especially by the poor; and Evangelical
opposition to the Indian opium trade and later to opium use domestically.
What is surprising is how little of this history was influenced by the
pattern of opiate use that now causes most public concern - the injection
of black-market heroin for its euphoric effects by young, often
anti-social, males who engage in drug dealing and property crime to finance
their heroin use.

Media concern about recreational cocaine use by several hundred Canadian
troops in Britain during World War I prompted regulations under the Defence
of the Realm Act, so that the possession and use of cocaine became a
criminal offence. After the war, these regulations formed the basis of
legislation that restricted the use of all "narcotic drugs" in accordance
with international treaties.

In the penultimate chapter, Berridge describes the work of the Rolleston
Committee - an interesting story of how the medical profession, represented
by a President of the Royal College of Physicians, came to an arrangement
with the Home Office whereby any British doctor was permitted to prescribe
opiates for maintenance to patients who had repeatedly failed to withdraw
from opiates.

For most of the first 40 years of their operation, the Rolleston provisions
were used to treat patients with iatrogenic opiate dependence. Admirers of
British policy in the USA credited the "British System" with averting the
post-war US heroin epidemic that they attributed to the criminalisation of
opiate use and maintenance prescribing (Harrison Act 1914). Berridge
presents a persuasive case that the "British System" represented "a case of
masterly inactivity in the face of a non-existent problem" since a very few
iatrogenic addicts were maintained on opiates by a handful of doctors. The
emergence of illicit opiate use in London in the early 1960s led to
restrictions on opiate prescribing and to fewer doctors who prescribed
heroin to dependent users.

The process of increasing restriction and regulation, culminating in the
imposition of criminal penalties for the use and sale of opiates, has since
been applied to other therapeutic psychoactive substances, such as
amphetamines, barbiturates, and benzo-diazepines. The difficult task in
regulating psychoactive substances is striking a balance between minimising
harms to drug users and others affected by such use without depriving the
community of any therapeutic benefit. We are still arguing about whether we
have got the balance right for cannabis and the opiates.

This book is essential reading for those who wonder why Britain has the
opiate control policy it has today. Readers whose appetite for history is
whetted will find that Berridge's history of British opiate policy repays
comparison with the very different American experience described in David
Musto's The American Disease and David Courtwright's Dark Paradise.