The rail line from London curves in a great arc northward across the River Mersey, then touches the opposite shore at the working-class suburb of Widnes before sweeping west again for Liverpool. The two-story brick building on Chapel Street in Widnes seems an unlikely testing ground for the great issues of our time, but it was here, according to local officials, that the power and majesty of the United States was brought to bear on a small public health clinic that ran afoul of American drug war orthodoxy.
Dr. John Marks is an imposing Welchman with fire in his eye and unkind things to say about the Yanks. He traces his problem with the U.S. to a 60 Minutes broadcast that aired in 1992 a few days after Christmas. The segment opened with CBS Reporter Ed Bradley holding up a vial of pure heroin and asking, “Can Britain teach us anything about dealing with drugs? One thing seems certain, there is little or nothing we can teach them. They tried our hard line methods back in the 70’s
and 80’s and all they got for their trouble was more drugs, more crime, and more addicts. So they went back to their old way of letting doctors prescribe whatever drug a particular addict was hooked on. Does it work?”
John Marks, interviewed on camera as the psychiatrist in charge of the Chapel Street Clinic, was blunt. “If a drug taker is determined to continue their drug use, treating them is an expensive waste of time.”
But what about curing addiction?
“Cure people? Nobody can. Regardless of whether you stick them in prison, give them shock treatment, put them in a nice rehab center away in the country and pat them on the head, give them drugs, give them no drugs—no matter what you do, five percent per annum—one in twenty per year—get off spontaneously. They seem to mature out of addiction regardless of any intervention in the interim. But you can keep them alive and healthy and legal during that ten years if you wish to.”
The explosive images that followed—young Liverpudlians getting prescriptions filled for their drug of choice—flew in the face of everything U.S. drug policy stood for, and it didn’t take long for the shockwave to rebound. Friends in the Home Office warned Marks that the Embassy in Washington was getting heat over the broadcast. They said a high level meeting had been called and the Americans asked the English to ‘harmonize’ their drug policy with the U.S. But in spite of all the arm-flapping on the other side of the Atlantic, there was not much anyone could do about Marks. The British Government simply had no authority to stop a licensed clinical psychiatrist from prescribing heroin—or anything else—to whomever he chose, in whatever dose, for a day, a week, or a lifetime. Doctor Marks’ remarkable invulnerability in this regard was rooted in the bedrock of the British medical establishment. Back in the 1920s, while the American Medical Association was allowing its members to be hounded and jailed by Harry Anslinger, the Royal College of Physicians proved to be of sterner stuff. When the
lawmen attempted to get between the British doctor and his patient, they were brushed aside like gnats. A committee of eminent physicians led by Baron Humphrey Rolleston concluded in 1926 that drug addiction was a medical problem and the cops should stay out of it. So the “British System,” which the Americans came to abhor, was really no system at all. They simply left it up to the individual doctor to deal with each addict as he saw fit.
This single distinction set the two countries down separate paths with starkly different results. While the American addict was being run to earth in a nationwide game of fox and hounds, the Englishman with a habit could go to his family physician, get a prescription for heroin—or morphine, or cocaine, or whatever—and pick it up at the corner pharmacy. In this low-key environment, drugs failed to acquire the kind of underground cachet they enjoyed in the States, and coincidentally the addict population in England remained pretty much as it was—little old ladies, self-medicating doctors, chronic pain sufferers, ne’er-do-wells, “all middle-aged people”—most of them leading otherwise normal lives.
For the next forty years, American medical experts and academics would visit England, note the dramatic difference in crime and addiction rates, then go home and write books calling for a switch to the British system. Commissioner Anslinger would invariably smack down these suggestions, condemning the British numbers as unreliable and questioning the motives of the messengers. Besides, he would point out, Britain was an island. But in 1965, Anslinger could claim he had been vindicated. The numbers, which he now chose to believe, showed that the addiction rate in the U.K. had doubled over the previous five years—clear proof that the British system was a failure. Anslinger skipped over the fact that the doubling had been from 700 addicts to a total of 1400 in the whole of England. In the U.S. at that same moment there were an estimated 20,000^ addicts in Manhattan alone.
Nonetheless, this sudden jump was alarming to the British and they were equally unnerved by the look of these new addicts. As the upheaval of the ‘60s washed over England, it brought with it a whole new category of drug user—long-haired rebels with “unsatisfactory work records” who got high for the hell of it. All of a sudden there was a drug subculture in London to rival Greenwich Village. Concentrated in Picadilly, the scene was so outrageous it became a tourist attraction and the Home Office decided something had to be done. Yet another panel of eminent medics, this time under the guidance of Lord Russell Brain, were commissioned to look into it. They discovered that most of these new users were getting their stash from just six London doctors. One apparently tireless physician wrote scrips for 600,000 tabs of heroin in a single year. Clearly this was not sound medical practice.
When the Brain Committee reported back in the summer of 1965, they concluded that the business of maintaining addicts should be taken out of the hands of the general practitioner and turned over to specialists. For the first time in history, the unlimited power of the individual English physician to prescribe drugs was to be circumscribed—but only for addiction. If an ordinary patient needed pain relief, his doctor could still prescribe anything in the book. If, however, the patient was an addict, he would generally have to go to a treatment center and see a doctor who was specifically licensed to prescribe heroin and cocaine on a continuing basis.
Since there were so few addicts in England and so many in America, the people charged with setting up the new treatment centers naturally looked to the U.S. to see what the experts were doing. In the States, of course, the idea of heroin maintenance was considered the height of madness. Detoxification was the objective. The typical regimen in New York at that time was a decreasing dose of methadone designed to wean the addict off the drug as rapidly as possible. Methadone is a man-made replica of morphine that came out of World War II. It was a synthetic painkiller developed by I.G. Farben when the
Nazi supply of opiates from the Middle-east was cut off by the Allies. It came into use as a treatment for addiction in the U.S. in the late 1940s, apparently proving the theory that Americans will go for anything as long as they can call it something else. Although methadone was originally thought of as a cure for addiction, it didn’t actually cure anything. It just substituted one addiction for another, and methadone turned out to be harder to kick. But the new synthetic opiate had certain advantages—mostly for the administrators— because it was long-lasting, it could be given once a day, it could be taken orally, and it was easier to gage the dose needed to stabilize an addict. Unfortunately, Congress became directly involved in micro-managing methadone treatment and its potential as a maintenance drug was thwarted. It came to be used primarily as an agent for detoxing addicts, with or without their compliance, “in a period not to exceed 21 days.”
Since the U.S. specialists had dealt with tens of thousands of addicts and their British counterparts had never seen more than a few hundred, they naturally deferred to the American expertise, and the methadone withdrawal approach came to be generally accepted throughout the new English clinic system.
“It was a sledgehammer to crack a very tiny nut,” said Bing Spear, former head of the Home Office Drugs Branch. As Chief Inspector of Britain’s principal drug enforcement agency, Spear had a lofty vantage point for viewing the turmoil of the ‘60s and ‘70s, and he believes the Brain Committee overreacted. “If only a handful of doctors were involved, why deal with the whole medical profession?” Spear thought the new policy was a ticking bomb and events would bear him out. “Hardly anybody in the medical profession knew anything about the problem. And the only people who had any experience—the general practitioners—were derided and criticized.” The addicts were taken away from the doctors who knew them and handed over to a new bureaucracy that was determined to whip them into shape. Once again, the best intentions were flattened by the law of unintended consequences. The serious drug users left the system
and hit the streets, where they found the price of heroin had undergone a 600 percent jump. The black market exploded, and violence exploded along with it. “In the late ’70s you began to see the sort of thing, the traffic in heroin, that you had in America.” said Spear. “Up until the Brain Committee report, illicit heroin was not something that was ever known in this country.”
But away up in the north country, far from the hurley-burly of Picadilly, there were occasional heretics who chose to ignore the American advice, and here and there you could still find a clinic that continued the old practice of heroin maintenance. One such backwater was the Chapel Street Clinic in the Liverpool suburb of Widnes, and in the spring of 1982, Dr. John Marks, M.B.Ch.B (Edinburgh) M.R.C. Psych. (London), arrived with his newly framed certificates to take over as consultant psychiatrist. “When I took up my post, I found this old British System clinic that was handing out a ration of drugs, and I was a bit surprised. I thought, ‘This is a silly policy.’ I was interested in real madmen. Drug takers to me are not mentally ill, and I missed real psychiatry. I thought, ‘We’ll evaluate it to make sure it doesn’t work, close it down, and use the money for a new schizophrenic hospice.’”
But as he began digging through the records, Marks made a series of surprising discoveries. Among the cohort of serious needle-users now in his charge, he expected to find 15 to 20 percent infected with the AIDS virus—Liverpool is a port city after all—but there was not a single case in the whole roster. When he checked for drug-related deaths he found the same thing. Then he interviewed the patients and was dismayed to find them in good health, most with jobs, and all clean and properly dressed. His next surprise came from the local police. Heroin maintenance, they said, cut crime. In one test, the Cheshire Drug Squad tracked a hundred users before and after they entered the clinic and found a 94 percent drop in theft, burglary, and property crimes. But the most interesting finding was the decline in
the number of new users. After the clinic opened, convictions for illegal possession in the area dropped immediately.
“We could explain why the crime rate dropped,” said Marks. “We could explain why there were fewer deaths—they were getting clean heroin instead of rubbish. But what we couldn’t understand was the reduction in the incidence of new cases. It seemed to prevent the spread of addiction. And we just thought we’d done the experiment wrong. But when we consulted official statistics—both American and English and other foreign statistics—we found identical results: that if you loosened up a little bit on drug issues, you actually got a fall in the incidence of addiction. But if you loosened up too much, and made it freely available like we now have with alcohol, it started to rise again.”
What Marks realized was that the demand curve for forbidden fruit is not linear—it’s U-shaped. If drugs and alcohol are too freely available—or if they’re prohibited—you increase consumption. “Free markets promote use; prohibitions pedal use. And I discovered quite by accident the validity of this at the Widnes clinic.”
One a typical Tuesday morning in March, seven drug addicts wind their way up the narrow stairs to the second floor clinic on Chapel Street. They’re here to pick up their weekly prescriptions, but first they’ll have to sit in on a group session—not therapy exactly—just a little chat so the staff can eyeball them and see how they’re doing. As they pull their chairs into a circle in the cluttered conference room, they are indistinguishable from any other seven citizens on the streets of Liverpool. Nothing in their appearance or behavior would suggest that they are serious addicts. Among them is a round-faced Irish brunette with a wry smile named Julie. Well-dressed, in her mid-thirties, she could easily be taken for a businesswoman or a teacher, but something about her eyes suggests broader experience. Julie shoots heroin once a day.
“I’ve tried most drugs, and heroin is the most physically and mentally addictive drug ever. And I wouldn’t advise anybody to get into it. I just think that, anybody who does find themselves in that mess, there should be somewhere, an option to go somewhere to get help.”
For the first twenty years of her life Julie had no idea what trouble was. Growing up in a big house in suburbia, she dreamed of becoming a movie star. But in the early ‘80s she fell in love with a young guy from a rich family who gave her three kids and a heroin habit. “My husband and I were both taking drugs and he lost his job and I started getting on at him and he’s getting on at me, and the marriage just crumbled. So there I was, I was left on my own with three children. And because we spent all the money on drugs, the rent didn’t get paid, so I became homeless.”
For the next several years, she moved the kids from one bed-and-breakfast to another, supporting herself with prostitution and shoplifting, all the time frantically chasing the dragon. “Everything revolved around heroin. I couldn’t plan a weekend away. I had to worry about the next fix. And going out and being frightened that the guy’s been busted and it’s not gonna be there. You’re so channeled into that, you can’t think of anything else. It’s just heroin, heroin, heroin. The minute you’ve got spare money for a birthday or Christmas or something, it’s gone on the heroin—‘I’ll put it back in later’—you never do. You’re just completely kidding yourself the whole time.”
Somehow, she managed to keep all these balls in the air, simultaneously feeding three children and a major habit. Like most addicts, she tried to kick repeatedly without success.
“When you’re on the drug, you can say, well, I’ll do this and I’ll do that. But when the drug’s wearing off, it’s a different story. You’ll do anything. And if it means dragging three children around for hours… I knew those children were going to be very bored sitting in the back of the car waiting for a dealer to come with drugs, so I’d pacify them with ice cream or make them promises that I knew I wasn’t going to keep.”
By 1991 the health officials were breathing down her neck and she was in serious danger of losing the kids. Frantically searching for high ground, she heard about John Marks in Chapel Street and went there to see if it was true. Marks and his staff examined her, investigated her background, confirmed that she was indeed a heroin addict, and on her next visit he wrote her a prescription for a week’s supply. Almost unbelieving, she took the slip of paper to the chemist up the street and he filled it without batting an eye.
As she stood at the counter staring at the small round container of pure heroin and the packet of new needles, an odd sensation washed over her. The auger of panic that had been twisting her gut every waking moment for a decade was spinning down. For the first time in memory, she had a tiny bit of brain space that wasn’t focused on the next fix. It began to dawn on her that it no longer made any difference whether or not her dealer would show up. She didn’t have to figure out who to con, how to get the cash, what to do if she got busted, or if the shit was any good…
She slipped the packages into her purse and as she turned away, she caught a glimpse of her reflection in the glass and for the first time in ten years she stopped to take a serious look. She was stunned.
Then she glanced down at her children, and she said, “Oh, my God.”
The morality that had been instilled in her as a child suddenly came flooding back. “I felt so disgusted…” Over the next weeks and months her dose was stabilized at a point that allowed her to function without suffering withdrawal, and within a year her life had been completely turned around. “I’ve been able to rebuild a home. And I can take the kids out for treats. I can do anything that anybody else does. The only difference is that I’m on a heroin prescription. I can have one injection and I can function normally for the rest of the day.” The piece of paper John Marks handed her almost nonchalantly turned out to be a passport out of hell. By 1994, she was again talking about one of
the dreams she lost in the haze of the previous decade. “Three years ago, I wouldn’t have even considered going to college. Now I’ve got a much wider scope. I want to do everything.” And, as Marks expected, there was even a chance that Julie might be among the lucky five percent who escape addiction every year. Secure in the knowledge that the clinic would be there for her if she relapsed, she was beginning to talk about permanent withdrawal. “Now I’m at the point where I’m thinking… I don’t get stoned at all, I live a normal life… why bother taking it? It’s as if it’s run its course with me.”
Unfortunately, Julie would never get the chance to find out. Dr. Marks may have been personally invulnerable to his critics, but the Widnes clinic was not, and in 1995 the local health authority simply pulled the plug on Chapel Street and gave the contract for psychiatric services to somebody else. On April 1, some 450 of Dr. Marks’ former patients were handed over to the Warrington Community Health Care Trust. The new organization, not surprisingly, was in perfect sync with the American concept of total abstinence, and the addicts were informed that they were to be taken off heroin and cocaine completely. “The idea is to negotiate with clients,” said one official, “offering a gradual change to methadone.” Unfortunately, a survey of the clients themselves revealed that 60 percent would probably refuse methadone treatment, and when the dust finally settled, most of them were back in the streets. “Two years later,” said Marks, “twenty-five of the addicts were dead.”
And what of Julie, the heroin user with three children who planned to go to college? “I saw Julie the other day,” said Marks. “She was desperate, back to criminality, a lot of her friends are back in prison. She’s on the streets. She saw me in passing and asked if I could take her back on. Her doctor tried to refer her to me but the Warrington Health Authority refused to defray the costs.” And so the state, in its righteous determination to set everything straight, has managed to teach Julie and her children a lesson. It’s a lesson they won’t soon forget.
One of the most frequent broadsides leveled at the Widnes Clinic was that John Marks’ startling claims were never verified by independent investigators. In fact, a serious study was undertaken 1990 to measure the Widnes approach against the results of methadone treatment, and for a minute it looked like there might be a face-to-face scientific shoot-out between the British and the American systems. The one-year survey was already underway when word suddenly came from the regional health authority demanding immediate return “within 24 hours” of the entire research grant. No explanation was given. And though Marks repeatedly invited outsiders to confirm or refute his numbers, there were no takers until 1995. Then the government finally set in motion a major review of all drug treatment regimes in the U.K. It was set to start on April 1, 1995—the day the Widnes Clinic closed down—once again, neatly avoiding any unfortunate comparisons.
But not everybody in Europe was so dazzled by the American experience. Swiss health authorities had been watching the developments in England for some time, and they decided the concept of prescribing drugs to serious addicts was too intriguing to be tossed in the dustbin. So with famous Swiss precision, they engineered a tightly controlled experiment with the intention of putting a measuring stick up against this issue once and for all.
Most Americans are under the mistaken impression that Switzerland tried drug legalization back in the 1980s and that it ended in disaster. The “Needle Park” scene at the Platzspitz in Zurich was often cited by U.S. officials as proof of “the failure of legalization programs tried in other parts of the world such as Zurich.” In fact, there was never a legalization experiment in Zurich. The debacle in Platzspitz was nothing more than an unsuccessful attempt at street cleaning. The burghers tried to tidy up the city center by designating a free trade zone for serious
drug users in hopes they would stay out of sight. For a time, they were given free rein over a riverside park called the Platzspitz, but it was soon overrun with addicts from all over Europe. Eighty percent were from out of town. The scene finally spun out of control and had to be shut down, but in no way was this an experiment in anything other than crowd control. Back in the days of alcohol prohibition, an equally disgusting sight could have been created by designating Lafayette Park as a sanctuary for alcoholics.
The first actual large-scale controlled experiment in heroin maintenance—an experiment that had been successfully avoided since the 1920s—got underway in January of 1994 when the Swiss government authorized a three-year research program involving 1000 addicts under the watchful eye of the Swiss Academy of Medical Sciences and the World Health Organization. Eight hundred volunteers were to be given heroin, 100 would get morphine, and 100 would be put on methadone in 17 different locations throughout the country. The volunteers had to be daily users with a long history, and they had to have proof of at least two serious attempts to kick. The study included independent evaluation, double-blind trials, and rigorous controls.
When the Swiss Federal Office of Public Health issued the final report in July of 1997, the conclusions were exactly as John Marks would have predicted. Crime among the addict population dropped by 60%, half the unemployed found jobs, a third of those on welfare became self-supporting, nobody was homeless, and the general health of the group improved dramatically. By the end of the experiment, 83 patients had decided on their own to give up heroin in favor of abstinence.
A severely marginalised group of long-standing heroin-dependents was able to be reached through the study, and to a high degree (80 percent) be kept in treatment.
No significant side-effects of heroin prescription were noted.
The controlled prescription of heroin is clinically and practically feasible.
For Marks and his colleagues up in Liverpool, the Swiss report must have been vindication of a sort, but he was more concerned with the short range. “What will happen in Widnes? The gangsters will move in and we’ll have a situation like the no-go areas in Manchester or the Bronx.”
As they say in the lowlands, “God made Heaven and Earth, but the Dutch made Holland.” In the lobby of the City Hall in Amsterdam, there is a subtle reminder of that tiny nation’s ongoing battle with the Atlantic. Rising two stories into the atrium is a slender glass column filled with water. The level rises and falls during the day because the tube is connected to the coast at IJmuiden, and it shows how far above your head the surface would be if the dike broke.
This water column speaks volumes about the Dutch. When your enemy is the North Sea, it breeds respect for reality, and that has evolved into a national reverence for pragmatism. The Dutch are interested in what works, and that always takes precedence over what would be nice. Among their more interesting departures from less flexible cultures is a legalistic loophole—the “expediency principle”—that might be called the rule of common sense. If a law turns out to be more trouble than it’s worth, they don’t enforce it. It may remain on the books. It’s just ignored.
To the ongoing horror of U.S. officials, one of the laws the Dutch have chosen to ignore is the law against marijuana. And though the Americans have unleashed a twenty-year barrage of invective at The Hague for their deviant behavior, the Dutch have yet to blink. They did not come to this position lightly. It was based on evidence, and given their history, it’s not likely that a moral argument will overwhelm their scientific measurements.
The origins of the Dutch heresy go back to the early ‘70s
when governments on both sides of the Atlantic were suddenly confronted with a generation of dope-smoking hippies and anti-war protestors. The global alarm over the clouds of marijuana smoke inspired high level investigations throughout the Free World. In the U.S., Richard Nixon created the Shafer Commission, the Dutch assembled a group of experts called the Baan Working Party, the U.K. formed a prestigious committee under Baroness Wootten, and in Toronto, law school dean Gerald Le Dain headed the Canadian Government’s Commission of Inquiry. While the U.S. group was front-loaded with conservative politicians who were expected to come down heavily against the Devil Weed, their conclusions surprisingly mirrored those of the more scientifically rounded commissions. All four groups found marijuana roughly as intoxicating and dangerous as alcohol, and the English report went a step further: “The evidence of a link with violent crime is far stronger with alcohol than with the smoking of cannabis.”
Without exception, these four disparate committees, which included some of the leading legal, medical and scientific specialists of the Western World, recommended that laws against marijuana be relaxed. President Nixon dealt with this unwelcome news by sweeping it under the rug, and the Canadian government followed suit. But in Holland, where scientists and engineers are taken seriously, they simply followed the recommendations. The Baan group, like the other commissions, noted the significant difference between marijuana and the other drugs on the dealer’s shelf. And since they recognized the ritual duty of young people to flirt with danger, the Dutch thought it would be better for the ones who chose to experiment with drugs to experiment with reefer rather than smack. The plan was to erect a wall between the so-called soft drugs—marijuana and hashish—and hard drugs like heroin and cocaine. This meant they would have to set up a quasi-legal distribution system, because if students had to buy their grass from criminals, they would be exposed to every other conceivable option as well.
So the government came up with a utilitarian scheme for “hashish coffee shops” which were allowed to sell small amounts of marijuana to anyone over 16. They were tightly controlled—absolutely no hard drugs, no underage customers, no advertising—and the rules turned out to be easily enforceable since the proprietor, like the tavern owner, had an incentive to keep the lid on or lose the farm.
Today in Amsterdam it’s still against the law to smoke marijuana, but if you stop a police officer on the street and ask him where to buy it, he’ll probably give you a choice of half-a-dozen modern-day speakeasies within walking distance. Along the Warmoesstraat near the Centraal Station, you’ll see an occasional storefront with a potted plant in the window, and at the bar inside might be a college professor or a journalist, a couple of dismayed tourists from Vermont, and seated around tables covered with newspapers, comics, and chessboards you can find college kids, bricklayers, office workers and visiting Germans. Ask to see the menu and the waiter will pull a three-ring binder from under the bar that looks like a wine list, but the plastic pockets contain samples of everything from Jamaican ganja to Moroccan hashish at bargain prices. At the bar a Dutch insurance salesman splits a cigarette with his thumbs and dumps the tobacco onto an EZ-Wider rolling paper. He crumbles some hashish, sprinkles it on the tobacco, rolls it, lights it, and offers a hit to the total stranger sitting next to him. At a glance, the place looks like any other small-town college hangout, but the laid-back atmosphere contrasts sharply with the noise from the saloon across the street where they’re serving alcohol.
There are some 1200 of these clubs scattered through Holland, over 150^ in Amsterdam alone. And despite continuous international pressure to shut them down, the Dutch have held fast. Their original objective was to keep youngsters away from hard drugs and by that measure the program has been a smashing success. Today the average age of a heroin addict in Holland is 36. It was 25
when the experiment began. This aging cohort means that young recruits are no longer joining the ranks, and the Dutch may have saved themselves from a whole new generation of heroin shooters.
They have also paid a price for this victory with an increase in the use of marijuana, and to American critics, that price is unacceptable. When the latest Dutch drug statistics were released in 1995, U.S. Representative Gerald Solomon of New York rose in the House to lash out in shock and anger: “Mr. Speaker, the test has been conducted and the results are in from the Netherlands… From 1988 to 1992, cannabis use among pupils increased 100 percent…” But the Congressman was avoiding the larger picture. Yes, marijuana use among Dutch teenagers had doubled, but in the U.S. at that moment, despite the most repressive prohibition in history, teenage drug use had also doubled and was still climbing. As the Dutch gently observed, “Soft drug use among young people is on the increase in a large number of Western countries, and in some, more strongly than in the Netherlands.”
But perhaps even more galling for strict prohibitionists like Solomon, was the fact that Dutch tolerance for soft drug users extended to hard drug users as well. In Holland, people holding small amounts of heroin or cocaine for personal use are ignored, and the police themselves are the strongest supporters of this arrangement. “Nobody in my country is happy with the drug problem,” says Bernard Scholten, “but we accept that there are drug users, and then find ways to be realistic.” Scholten’s office is on the top floor of Police Headquarters in Amsterdam. He’s the department’s official spokesman and he spends much of his time trying to straighten out misinformation being spread by foreign officials. “This is for us a good system. If you compare this soft drug addiction to the alcohol addiction… alcohol addiction is a much bigger problem. We have the figures.”
What about hard drugs?
“We have 8000 registered hard drug users in Amsterdam. About 400 of this group are the hard core”—
people frequenly busted for making a nuisance of themselves. “In case one of this group is arrested for the fourth time in 12 months, that person has to make a decision: treatment or punishment. And there always is capacity in the clinic and there always is capacity in the jail.” This tolerance for drug users, however, does not extend to dealers. The Government of the Netherlands, like other signatories of the United Nations Single Convention, is obligated to go after traffickers, and they have to take the obligation seriously. Rotterdam is the largest port in the world and the European gateway for South American and Asian shippers. So the Dutch pursue drug kingpins with a vengeance and overlook the street dealer with a wink and a nod. It’s a policy that Bernard Scholten acknowledges as “enlightened schizophrenia.”
In spite of all evidence to the contrary, U.S. officials never seem to tire of reporting the collapse and fall of the Dutch system, but from time to time this conceit blows up in somebody’s face. Lee Brown, first drug czar of the Clinton Administration, was speaking to a Los Angeles Town Hall meeting about the disaster in Holland when a gentleman in the audience stood up and introduced himself as the Consul General of the Netherlands and politely refuted everything Brown had just said. But while the Americans are the most vocal, they are not the only critics of Dutch liberalism. The French are also hopping mad. When President Jacques Chirac took office in June of 1995, he reportedly told the Dutch Prime Minister, “Either you fight drug trafficking or I close the borders.” Chirac was particularly annoyed with the parade of French narco-tourists crossing into Rotterdam on weekends to get high on heroin. The Elysee Palace berated the Dutch for their corrupting influence. And the Dutch, ever courteous, skipped the opportunity to remind Chirac that his addiction rate was nearly double theirs.
In 1994 an American journalist was interviewing Bing Spear, former Chief Inspector of the Home Office Drugs Branch, and
after recounting some three decades of drug war history in the U.K., Spear was lamenting how it had all gone wrong. The reporter asked if he felt the Americans were the dark force in this scenario, and Spear said, “I’ll put it this way. You Yanks have a lot to answer for.”
 CBS 60 Minutes Sunday, December 27, 1992, segment on Chapel Street Clinic with Ed Bradley.
 John Marks, Consultant Psychiatrist, Chapel Street Clinic, Widnes; interview Mar 15 1994; Anthony Henman, Harm-reduction on Merseyside 1985-1995: The Rise and Fall of a Radical Paradigm of Health Care for Illicit Drug Users; paper presented at conference, “Drug Policy in the ‘90s: the Changing Climate,” John Moores University, Liverpool, June 95 — “Diplomatic sources also describe the storm produced in Washington when the major in-depth US TV news report Sixty Minutes broadcast a favourable report on the Widnes clinic just as President George Bush was whipping up support for a global military offensive against drugs.”
 Arnold S.Trebach, The Heroin Solution, Yale Univ. Press, New Haven, 1982, 90-95
 Bing Spear, Chief Inspector, Home Office Drugs Branch (ret.), interview, Windsor Great Park, Mar 16, 1994
 Arnold S.Trebach, The Heroin Solution, 85; Edwin M. Schur, Narcotic Addition in Britain and America, Indiana University Press, Bloomington, 1962; Lindesmith, Alfred Ray, Addiction and Opiates, Aldine Pub. Co., Chicago,1968
 Edward M. Brecher, Licit & Illicit Drugs, Consumers Union Report, Little, Brown & Co., Boston, 1972, p121-125. The British statistics were far more reliable than the American numbers because the British gave heroin to those addicts willing to be counted where the Americans sent them to jail.
 Trebach, The Heroin Solution, 109
 Ministry of Health and Scottish Home and Health Department, Drug Addiction: The Second Report of the Interdepartmental Committee, London: HM Stationary Office, 1971, quoted in Trebach, The Heroin Solution, 108
 Federal regulations regarding the use of methadone, 37 FR 26795, December 15, 1972
 Bing Spear, Chief Inspector, Home Office Drugs Branch (ret.), interview, Windsor Great Park, Mar 16, 1994.
 Dr J. A. Marks, interview, Feb 2, 1995 — “Stimson & Openheimer found a 15 percent mortality among drug users over a 10 year period if you simply leave the addicts to their own devices. We followed cohort of 89 addicts from 1982-89 and found a zero death rate and zero HIV rates. There were no locally acquired cases of HIV infection and no drug related deaths from 1982 to ‘89. This information is available from the National Recording Center or the Mersey Regional Health Authority.”
 New Perspectives: “Heroin Treatment – New Alternatives.”
Proceedings of a seminar held in Canberra in 1991 by the Australian Institute of Criminology.
Edited by Bammer and Gerrard. Pages 97-108 are by M. Lofts of the Cheshire Drug Squad
“Policing the Merseyside Drug Treatment Program.” p 105: “Between July of 1988 and January of 1990…we evaluated the criminal records of the participants.
July 1988 – 142 clients – averaged 6.88 convictions for property crimes
Jan 1990 – 112 remaining – averaged 0.44 convictions.
This represents a 15-fold reduction among participating drug users.
 J.Best et al, Abstracts of the Proceedings of the Royal College of Psychiatrists, 1986 p 43; James Willis, Drug Dependence, Faber & Faber, London, 1969
 Ms. Shain Clarke, Corporate Affairs Directorate, NHS Executive Headquarters, Leeds; letter dated 15 March 1995.
 Warrington Community Health Council, Survey to Obtain the Views of Users of the Drug Dependency Clinic, 1994, quoted in Drogues Legales, L’experience de Liverpool, Editions du Lezard, Paris, 1996; Anthony Henman, Harm-reduction on Merseyside 1985-1995.
 Dr. J.A. Marks, interview, Mar 24, 97
 Dr. J.A. Marks, interview, Mar 24, 97
17. Dr. J.A. Marks, interview, Feb 2, 95; Anthony Henman, Harm-reduction on Merseyside 1985-1995: The Rise and Fall of a Radical Paradigm of Health Care for Illicit Drug Users, paper presented at conference, “Drug Policy in the ‘90s: the Changing Climate,” John Moores University, Liverpool, June 95.
 Los Angeles Times, Apr 19, 92, B-9, “Judge’s Plea for Legal Drugs”
 The New York Times, Mar 12, 1995, “Zurich’s Open Drug Policy Goes Into Withdrawal”
 “Methadone could not be prescribed to the planned number of patients because of the side effects and the problems with acceptability and recruitment. It became evident that the original research plan (250 treatment places for heroin, 250 places for morphine, and 200 for i.v. methadone) had to be adapted.” Diversified Narcotics-on-Prescription Programme, Swiss Federal Office of Public Health, Berne, 1996
 A. Uchtenhagen et al, Programme for a Medical Prscription of Narcotics: Final Report of the Research Representatives, Swiss Federal Office of Public Health, July 10, 97, Berne.
 A. Uchtenhagen et al, Diversified Narcotics-on-Prescription Programme, Swiss Federal Office of Public Health, Berne, Sept 1996
 Advisory Committee on Drug Dependence, The Wootten Report (U.K. 1968); The Baan Committee Report (Netherlands 1972); Canadian Government’s Commission of Inquiry, The Le Dain Report (Canada 1970); National Commission on Marihuana and Drug Abuse, The Shafer Commission (U.S. 1973) abstracted in Theodore R. Vallance, Prohibition’s Second Failure, Praeger, Westport CT, 1993, Appendix C.
 Advisory Committee on Drug Dependence, Cannabis, (The Wootten Report) 1968, quoted in Theodore R. Vallance, Prohibition’s Second Failure, Praeger, Westport CT, 1993, p146
 Drug Policy in the Netherlands, Ministry of Health, Welfare and Sport, The Netherlands, Jan 97
 Chicago Tribune, Nov 2, 95, “Europe Finds U.S. Drug War Lacking in Results,” A,1
 Netherlands Alcohol and Drugs Report, Fact Sheet 7, Trimbos Institute, Utrecht.
 Interview, Bernard Scholten, Chief Spokesman, Amsterdam Police Department, Police Headquarters, Mar 21, 1994
 L.A. Town Hall Business Forum, Feb 22, 95, Matthiew A. Peters, Consul General of the Kingdom of the Netherlands, correcting drug czar Lee Brown.
 Reuters, Aug 10, 95, 08:37; Reuters, Feb 18, 97, 11:49 EST, According to Dutch Statistics, the Netherlands has 1.6 drug addicts per 1,000 head of population, well below about 2.5 per 1000 in France.
 Bing Spear, Chief Inspector, Home Office Drugs Branch (ret.), Windsor Great Park, Mar 16, 1994, interview.