The Politics of Addiction: Medical Conflict and Drug Dependence in England since the 1960s by Sarah G. Mars
Originally published in 2012 by Palgrave Macmillan, ‘The Politics of Addiction: Medical Conflict and Drug Dependence in England since the 1960s’ is written by Sarah G. Mars. At the time of publication, Mars was Qualitative Project Director, Heroin Price and Purity Outcomes Study, at the University of San Francisco. She has also previously worked on the history of drugs, alcohol, and tobacco at the University of California, and London School of Hygiene and Tropical Medicine.
The Politics of Addiction is concerned with how various forces within the English medical establishment seek to exert control over the manner in which individuals deemed ‘drug addicts’, and therefore in some manner diseased, were treated by the medical system. Mars’s detailed analysis is a thorough exposition of documents pertaining to drugs policy, both medical and political, and a series of interviews she conducted herself. The overall effect is a drug history based around the State’s description, prescription, and treatment of the ‘drug addict’ in England since the 1960s.
If you are sick, who decides what treatment you should be receive? Who controls where treatment should be given and by whom? Do you as a patient have a choice, or is it all in the hands of doctors, civil servants, or even politicians? If you were seeking help for drug dependence, would the same rules apply? (Mars 1)
The historical entwinement between the medical profession and the identification and treatment of individuals who habitually use psychoactive drugs is a well-rehearsed one in the literature. In the 18th century, there was no regulation, and opium-based products could be bought from the local grocer. After Thomas de Quincey’s infamous Confessions of an English Opium Eater (1821) the medical interest in opium not only as a medicine, but also conversely as a pathological cause of addiction, began to take shape.
From the 19th century, doctors in England prescribed heroin and morphine to addicts who were believed to not be able to give up their addiction, and in 1926 a committee of doctors concluded that drug addiction was medical and not criminal. This helped form what became known as the British System where maintenance prescribing was an important part of their approach. In the United States the very opposite was happening and drugs have very often been dealt with in a criminal capacity. However, since the 1960s in England, approaches began to change:
The last five decades has shown a period of turbulent change in both drug use and the policy responses to it. An increasing number and widening range of people have become involved in taking illicit drugs, in commenting upon drug use and in providing services. The policy process has moved from being conducted mainly in private to an often public and more overtly political undertaking (Mars 24)
At the centre of this change are various doctors and policy-makers. GPs, private prescribers, NHS doctors, all representing different policy approaches that began to emerge as a more virulent medical-criminal drugs discourse than had existed before in England. Political conflicts, such as private practitioners accused of too freely giving out drugs – leaving much to go into the black market – appeared. Economically and medically – should the NHS foot the bill for a continuing addiction? Should they not be trying to wean addicts off slowly – for the patient’s health, for the NHS’s money. Even the question of criminal behaviour lurked in policy reports and discourse during this period – in contrast to England’s traditional medical approach.
This flux is where we find ourselves today.
What is especially typical of drug histories that detail State perspectives, of which The Politics of Addiction is a clear example, is the pre-eminence it gives to the drug heroin above all others. The effect, very often, is to create a blanket idea about drugs and the people who use them, defined by narrow, often stereotyped, presumptions—ones dominated by the concerns (or otherwise bias) of politicians and doctors. If one class A drug is addictive – heroin –, and another non-addictive class A drug – LSD – are jumbled together in this one heroin-based drugs debate, then the system is failing. It needs to be stripped back.
However, heroin as an axiom of debate is also inescapable as so much drug policy has been built around the ‘heroin menace’—and thus this means that drug approach/debate is systemic and narrow. Mars, although following this debate and thus the ideal drug of heroin (for the most part), does begin to demonstrate just how small the allowed corridors of debate are. For someone reading this book, who might think that a range of scientific models and approaches might exist, would likely be surprised at the limited range and ability of the debates therein.
There is in the popular mind a line between criminal and addict that ties itself around all drugs. Mars does a thorough and detailed exposition of this line in The Politics of Addiction, detailing the policies, organizations and lead players and how they have narrowly described the ‘addict’ in England today. It seems to me that an important question to ask of such a drugs narrative as this is, how far has the single heroin focus – with its own set of cultural narratives – infected the social vision of all drugs? I would guess to an extent that other class A substances such as LSD are just left forgotten – especially by doctors over-concerned about one area of drugs policy.