Prescribing and Proscribing: The Treatment and Rehabilitation Report

  • Sarah G. Mars
Chapter
Part of the Science, Technology and Medicine in Modern History book series (STMMH)

Abstract

It might be surprising that a new system of specialist, state-funded Clinics could be set up with so little idea of how to approach their task, but seen through the eyes of senior psychiatrist Thomas Bewley, such was the situation in the early days of the Clinics. According to the minutes of a meeting of Clinic leaders and civil servants in 1969, when discussing the possibility of changing the law to allow compulsory treatment of patients, ‘the view was expressed that the philosophy and aims of treatment were at present too ill-defined for a decision to be reached on the subject’.2 It was in this state of uncertainty that the Clinics tried a number of approaches such as cocaine prescribing which was quickly abandoned.3 Heroin and methadone were prescribed in injectable form on a long-term maintenance basis and treatment could involve cocktails of stimulants and depressants, bargained over by doctors and patients.4 With the Clinics prescribing generously to addicts without the many restrictions that were later introduced, their approach was closer to that of the private prescribers. Patients had less to gain from ‘going private’ and from 1968 to the mid-1970s there was a degree of peaceful co-existence between the Clinics and private prescribers. Criticism of other doctors by the Clinics, if expressed, tended to focus on GPs instead.

Keywords

Drug User Civil Servant Interim Report Black Market General Medical Council 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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Notes

  1. 2.
    Department of Health and Social Security, ‘Heroin Dependence: Clinical Conference’ [Minutes of meeting] (18th September 1969), Private archive.Google Scholar
  2. 6.
    See also T. Bewley, ‘The Illicit Drug Scene’, British Medical Journal, 2 (1975), 318–320.CrossRefGoogle Scholar
  3. 7.
    H. B. Spear (and ed. J. Mott), Heroin Addiction Care and Control: The ‘British System’ 1916–1984 (London: DrugScope, 2002), p. 194.Google Scholar
  4. 8.
    P. H. Connell, ‘Drug dependence in Great Britain: a challenge to the practice of medicine’, in H. Steinberg (ed.), Scientific Basis of Drug Dependence, Coordinating Committee for Symposia on Drug Action (London: J&A Churchill, 1969), pp. 291–299, p. 293.Google Scholar
  5. 9.
    DHSS, Better Services for the Mentally Ill (London: HMSO, 1975), p. 67.Google Scholar
  6. 10.
    M. Mitcheson, ‘Drug Clinics in the 1970s’, in J. Strang and M. Gossop (eds.), Heroin Addiction And Drug Policy: The British System (Oxford, New York, Tokyo: Oxford University Press, 1994), pp. 179–191.Google Scholar
  7. 11.
    H. B. Spear (and ed. J. Mott), Heroin Addiction Care and Control: The ‘British System’ 1916–1984 (London: Drugscope, 2002), pp. 275–276.Google Scholar
  8. 13.
    T. H. Bewley, ‘Prescribing Psychoactive Drugs to Addicts’, British Medical Journal, 281 (1980), 497–498, p. 497.CrossRefGoogle Scholar
  9. 16.
    The Lancet, ‘Drug addiction: British System failing’, The Lancet, 1 (1982), 83–84, p. 83.Google Scholar
  10. 18.
    For example, A. Dally, ‘Personal View’, British Medical Journal, 283 (1981), 857.CrossRefGoogle Scholar
  11. 19.
    ACMD, Treatment and Rehabilitation, DHSS (London: HMSO, 1982).Google Scholar
  12. 23.
    DHSS, Better Services for the Mentally Ill (London: HMSO, 1975), pp. 69–70.Google Scholar
  13. 24.
    G. V. Stimson and R. Lart, ‘The Relationship Between the State and Local Practice in the Development of National Policy on Drugs between 1920 and 1990’, in J. Strang and M. Gossop (eds.), Heroin Addiction And Drug Policy: The British System (Oxford, New York, Tokyo: Oxford University Press, 1994), pp. 331–341, p. 336.Google Scholar
  14. 27.
    ACMD, Treatment and Rehabilitation Working Group, First Interim Report (London: DHSS, 1977).Google Scholar
  15. 28.
    For a full discussion of the first working group and its interim report, see S. G. Mars, Prescribing and Proscribing: The Public-Private Relationship in the Treatment of Drug Addiction in England, 1970–99 (University of London: PhD Thesis, 2005), pp. 63–69.Google Scholar
  16. 46.
    S. MacGregor, ‘Choices for policy and practice’, in S MacGregor (ed.), Drugs and British Society. Responses to a Social Problem in the 1980s (London and New York: Routledge, 1989), pp. 170–200.Google Scholar
  17. 47.
    Interdepartmental Committee on Drug Addiction, Drug Addiction. The Second Report of the Interdepartmental Committee [second Brain Report], Ministry of Health, Scottish Home and Health Department (London: HMSO, 1965), p. 9.Google Scholar
  18. 48.
    DHSS, Better Services for the Mentally Ill (London: HMSO, 1975).Google Scholar
  19. 49.
    ACMD, Treatment and Rehabilitation Working Group (1977), p. 9.Google Scholar
  20. 51.
    M. Plant, ‘The epidemiology of illicit drug-use’, in S. MacGregor (ed.), Drugs and British Society. Responses to a Social Problem in the 1980s (London and New York: Routledge, 1989), pp. 52–63.Google Scholar
  21. 54.
    J. Strang, ‘A model service: turning the generalist on to drugs’, in S. MacGregor (ed.) Drugs and British Society. Responses to a Social Problem in the 1980s (London and New York: Routledge, 1989), pp. 143–169.Google Scholar
  22. 55.
    B. Thom, Dealing With Drink. Alcohol and Social Policy from Treatment to Management (London and New York: Free Association Books, 1999), pp. 105–134.Google Scholar
  23. 59.
    J. Strang, ‘“The British System”: past, present and future’. International Review of Psychiatry, 1 (1989), 109–120.CrossRefGoogle Scholar
  24. 60.
    V. Berridge, ‘Historical issues’, in S. MacGregor (ed.), Drugs and British Society. Responses to a Social Problem in the 1980s (London and New York: Routledge, 1989), pp. 20–35.Google Scholar
  25. 68.
    A. Kerr, ‘In conversation with Thomas Bewley’, Psychiatric Bulletin, 31 (2007), 220–223.CrossRefGoogle Scholar
  26. 69.
    R. Cawley, Obituary: Dr P H Connell, The Independent (Monday 10th August 1998).Google Scholar
  27. 71.
    GMC, Minutes of the General Medical Council and Committees for the Year 1979 with Reports of the Committees, etc. CXVI (London: GMC, 1979).Google Scholar
  28. 72.
    GMC, Minutes of the General Medical Council and Committees for the Year 1991 with Reports of the Committees, etc. CXXVIII (London: GMC, 1991).Google Scholar
  29. 73.
    T. Bewley, ‘Prescribing psychoactive drugs to addicts’, British Medical Journal, 281 (1980), 497–498.CrossRefGoogle Scholar
  30. 75.
    A. Dally, A Doctor’s Story (London: Macmillan, 1990), pp. 141–144.Google Scholar
  31. 78.
    A. Thorley, TRWG (82) 15, Memorandum to David Hardwick (22nd March, 1982) File DAC 28, DH Archive, Nelson, Lancashire.Google Scholar
  32. 103.
    C. Webster, The National Health Service. A Political History (Oxford: Oxford University Press, 1998), pp. 140–219.Google Scholar
  33. 104.
    A. M. Blythe, Memo from to J. M. Rogers (19th February 1982), File 16/DAC 28 Vol 2, DH Archive, Nelson, Lancashire.Google Scholar
  34. 105.
    ACMD: Report on Treatment and Rehabilitation. Draft Submission (November 1983) From File DAC 14 Volume 4, DH Archive, Nelson, Lancashire.Google Scholar
  35. 106.
    K. Clarke, Memo to Secretary of State (31st October 1983), File DAC 14 Volume 4, DH Archive, Nelson, Lancashire.Google Scholar
  36. 107.
    ACMD. Treatment and Rehabilitation DHSS (London: HMSO, 1982).Google Scholar
  37. 108.
    A. Thorley, ‘Longitudinal Studies of Drug Dependence’, in G. Edwards and C. Busch (eds.), Drug Problems in Britain: A Review of Ten Years (London: Academic Press, 1981), pp. 117–169.Google Scholar
  38. 109.
    For example, ACMD, AIDS and Drug Misuse Part 2 (London: HMSO, 1989).Google Scholar
  39. 111.
    A. M. Blythe, Memo to M. Moodie. ‘Services for Drug Misusers. ACMD’ (5th February 1982), File DAC 7, DH Archive, Nelson, Lancashire.Google Scholar

Copyright information

© Sarah G. Mars 2012

Authors and Affiliations

  • Sarah G. Mars
    • 1
    • 2
  1. 1.Heroin Price and Purity Outcomes StudyUniversity of San FranciscoUSA
  2. 2.London School of Hygiene and Tropical MedicineUK

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