Illustration by David Humphries

    Illustration by David Humphries

    Junk policy

    9 May 2015

    In 1982 a doctor called John Marks walked into a grey little GP surgery in the Wirral, in the drizzly north of England where they used to build ships but now they built nothing. It was his first day as a psychiatrist there, and he was about to discover that this surgery was doing something he regarded as mad. It was handing out heroin to addicts — free, on the NHS.

    Dr Marks was a big, bearded Welshman from the valleys, and his real interest was the mystery of schizophrenia and what causes it. But because he was the new boy, he was given a chore. His colleagues said to him, ‘You can have all the addicts, John — all the alcoholics and drug addicts.’

    He was about to stumble across one of the last remaining loopholes in the global war on drugs. A century ago, in 1914, the United States banned heroin and cocaine, and it then gradually used its diplomatic might to impose this ban across the world. Doctors tried to resist here in Britain and across the world, because they believed that if addicts were forced to buy contaminated drugs from armed criminal gangs, their health would only get worse. Doctors wanted to prescribe drugs to chronic addicts. This resistance only succeeded in one country — Britain. This little window of legal drug use continued quietly for decades.

    So Dr Marks watched as, every Thursday, a slew of addicts came into the clinic and received their heroin prescriptions. They were, he recalls, ‘maybe a few dozen lads, the occasional girl, who came and got their tot of junk… Railwaymen, bargemen, all walks of life really.’ He told them to stop using, and they argued back, telling him they needed it. ‘I found this a bit of a headache,’ he says, ‘and I had bigger fish to fry.’ He decided to shut the programme down.

    But as he prepared to do this, there was a directive from Margaret Thatcher’s government. Every part of Britain had to show it had an anti-drugs strategy, it said, and conduct a cost-benefit analysis to show what worked. So Marks commissioned the academic Dr Russell Newcombe to look into it. He assumed Newcombe would come back and say these patients were like heroin addicts everywhere, at least in the cliché — unemployed and unemployable, criminal, with high levels of HIV and a high death rate.

    Except the research found something very different. Newcombe found that none of the addicts had the HIV virus, even though Liverpool was a port city where you would expect it to be rife. Indeed, none of them had the usual problems found among addicts: overdoses, abscesses, disease. They mostly had regular jobs and led normal lives.

    After receiving this report, Marks looked again at his patients. Sydney was ‘an old Liverpool docker, happily married, lovely couple of kids’, Marks recalls. ‘He’d been chugging along on his heroin for a couple of decades.’ He seemed to be having a decent, healthy life. So, in fact, now Marks thought of it, did all the people prescribed heroin in his clinic.

    He asked himself: but how could this be? Doesn’t heroin inherently damage the body? Doesn’t it naturally cause abscesses, diseases and death? He discovered that all doctors agree that medically pure heroin, injected using clean needles, does not produce these problems. That’s why when people are routinely given heroin in hospitals — to treat the pain of a hip operation, for example — none of these problems occur. But under drug prohibition, the criminals who control our drug trade cut their drugs with whatever similar-looking powders they can find, so they can sell the heroin in more batches and make more cash. Allan Parry, who worked for the local health authority, saw that patients who didn’t have prescriptions were injecting smack with ‘brick dust in it, coffee, crushed bleach crystals, anything’. He explained to journalists at the time: ‘Now you inject cement into your veins, and you don’t have to be a medical expert to work out that’s going to cause harm.’


    Dr Marks could see the difference between the street addicts stumbling into the clinic for help for the first time, and the patients who had been on legal prescriptions for a while. The street addicts would often stagger in with abscesses that looked like hard-boiled eggs rotting under their skin, and with open wounds on their hands and legs that looked, as Parry told me, ‘like a pizza of infection. It’s mushy, and the cheese you get on it is pus. And it just gets bigger and bigger.’

    The addicts on prescriptions, by contrast, looked like the nurses or receptionists or Dr Marks himself. As a group, you couldn’t tell.

    Faced with this evidence, Marks was beginning to believe that many ‘of the harms of drugs are to do with the laws around them, not the drugs themselves’. In the clinic, as Russell Newcombe tells me, they started to call the infections and abscesses and amputations ‘drug war wounds’. So Dr Marks began to wonder: if prescription is so effective, why don’t we do it more? He expanded his heroin prescription programme from a dozen people to more than 400.

    The first people to notice an effect were the local police. Inspector Michael Lofts studied 142 heroin and cocaine addicts in the area, and he found there was a 93 per cent drop in theft and burglary. ‘You could see them transform in front of your own eyes,’ Lofts told a newspaper, amazed. ‘They came in in outrageous condition, stealing daily to pay for illegal drugs; and became, most of them, very amiable, reasonable law-abiding people.’ He said elsewhere: ‘Since the clinics opened, the street heroin dealer has slowly but surely abandoned the streets of Warrington and Widnes.’

    One day a young mother called Julia Scott came into Dr Marks’s surgery and explained she had been working as a prostitute to support her habit. He wrote her a prescription, and she stopped sex work that day.

    And something nobody predicted took place. The number of heroin addicts in the area actually fell. Research published by Dr Marks in the Proceedings of the Royal College of Physicians of Edinburgh compared Widnes, which had a heroin clinic, to the very similar Liverpool borough of Bootle, which didn’t — and found Widnes had 12 times fewer addicts.

    Heroes and heroin: famous users
    Heroes and heroin: famous users. Clockwise from top left: Coco Chanel, Billie Holiday, Miles Davis, Eric Clapton, Janis Joplin, Keith Richards, Robert Downey Jr, Philip Seymour Hoffman

    But why would prescribing heroin to addicts mean that fewer people became addicts? Dr Russell Newcombe, working out of John Marks’s clinic, told me what he believes is the explanation. Imagine you are a street heroin addict. You have to raise a large sum of money every day for your habit: £100 a day for heroin at that time in the Wirral. How are you going to get it? You can rob. You can prostitute. But there is another way, and it’s a lot less unpleasant. You can buy your drugs, take what you need, and then cut the rest with talcum powder and sell it on to other people. But to do that, you need to persuade somebody else to take the drugs too. You need to become a salesman, promoting the experience.

    So heroin under prohibition becomes, in effect, a pyramid-selling scheme. ‘Insurance companies would love to have salesmen like drug addicts’ — i.e. with that level of motivation — Dr Marks explains. Prescription kills the scheme. You don’t have to sell smack to get smack.

    When Dr Marks’s experiment began to attract tabloid attention — and bring diplomatic pressure from the US government — the British government panicked and shut it down. The results came quickly. In all the time Dr Marks was prescribing, from 1982 to 1995, he never had a drug-related death among his patients. After the closure, of the 450 patients Marks prescribed to, 20 were dead within six months, and 41 were dead within two years. More lost limbs and caught potentially lethal diseases. Both Sydney, the Liverpool docker, and Julia, the young mother who had given up prostitution, died.

    Dr Marks found he was blacklisted within his own country. He ended up literally at the other side of the earth, in Gisborne, the farthest corner of New Zealand, the place from which he told me his side of the story by telephone. One day, the Royal Astronomical Society asked him to play Galileo at an open day, and he had to play-act being burnt at the stake. When I expressed frustration at his fate, he said to me, ‘Whatever gave you the idea folk in authority operate according to reason? Your trouble is you’re being rational.’

    Today, Britain has more than 250,000 people using illegal opiates — and Dr Marks’s experiment, in the drizzle and hope of the Wirral, has been written out of history.