This episode explores the issue of prescribing heroin to people with heroin problems, a practice with a long history and usually today termed Heroin Assisted Treatment or HAT. The episode draws on a recent research project exploring the controversial work of Dr John Marks in the late 1980s and early 1990s. A paper describing the project is available here, as well as a shorter discussion of some of the issues here.
In April 2016, I was in New York for an ISSDP meeting on cannabis policy in the Americas. At the end of the first day, I was due to meet up for dinner with Niamh Eastwood and Alex Stevens. I was a little early, so decided to have a drink in the bar of my hotel before setting off for the restaurant. I sat at a stool at the bar and after five minutes became aware of a man taking the stool next to me. He ordered a beer and asked me if I had been at the cannabis conference. I said yes and he inquired what my interest was. I explained I was an academic researcher and then asked him the same question, expecting that he was either an academic or a policy wonk. His reply took me completely by surprise: he was a businessman, attending the meeting to help him decide whether cannabis was an industry worth investing in or not.
This was a revelatory moment for me. I realised two things. First, that the pace and scale of change in the US was far greater than I had appreciated: cannabis was rapidly becoming big business. Second, that cannabis law reform was now as much about commerce and capitalism, as it was about the familiar ‘progressive’ tropes of civil rights and personal freedom. On the flight back to Manchester, I began to hatch an idea for a project, although it would take a couple of years to get off the ground.
One strand of the project was for an archival study of cannabis law reform within the counter-culture in the 1960s, which I worked on for most of 2019 and which eventually led to this paper published earlier this year. Historicising reform was an important foundation for the project. The other strand aimed to produce a global state-of-the-art review of the latest legal and policy developments in the field. This has resulted in a book, Regulating Cannabis, co-authored with Will Floodgate, which finally came out a few days ago. Will led on the preliminary work for the book in the summer of 2018. After a pause, we picked it up together in spring 2019, as we prepared to present our framework and approach at the annual ISSDP conference in Paris in May. The bulk of the book was then written in a fairly intense period between October 2019 and March 2020.
The central thesis of the book is that if we view the ‘cannabis challenge’ through the lens of business regulation, we can see that we have as much to learn from how we have regulated a range of agricultural products as we do from the usual go-to comparisons with alcohol or tobacco. This analytical approach not only provides new insights on familiar issues but also opens up less well explored areas for attention, including the vital question of how to ensure that a legal cannabis industry is based on a model of environmentally sustainable consumption.
Perhaps the book’s most controversial point concerns the politics of cannabis policy. It is usually argued that policy should be based more on science and evidence, rather than politics and ideology. But if we dig down far enough, many of the regulatory decisions about cannabis that policy-makers take have their roots in matters that are inescapably about values. They rest on choices about the type of society we wish to live in and the things that we want to prioritise. Pretending we can de-politicise cannabis law and policy is misguided. We must embrace the challenge of engaging more seriously and transparently with the politics of cannabis control. We hope that the book points to some ways forward for doing exactly that.
In early 2016, when I was drafting my chapter on drugs for the ‘Oxford Handbook of Criminology’, I made a passing reference to Dr John Marks’ heroin prescribing practice in the 1980s. I had assumed that somewhere there would be a definitive summary or account of Marks’ work which I could cite. It soon became apparent that this was not the case. For an episode that has always been so frequently referred to, this struck me as both odd and unsatisfactory. With my Handbook chapter completed soon after, however, I moved on to other things.
At the tail end of 2018, at the start of a period of research leave, I began to think about new projects I might develop. My vague thought was to do something that involved historical research that might lead to a rethinking or reassessment of an important contemporary issue. This led to two ideas: one on cannabis law reform that I will write about another day, and one revisiting John Marks. Arguably the most pressing drug policy issue of the last couple of years has been the crisis of drug-related deaths and Heroin Assisted Treatment has been much discussed as a potential tool for managing it. It seemed to me that filling this peculiar gap I had found in material about Marks could be a perfect vehicle for a project to think historically about a key contemporary policy problem and hopefully generate some new insights.
In the spring of 2019, I wrote to John Marks to share my idea and ask for his support. Had he not responded at all, or responded negatively, I would probably have abandoned the project. In fact, he replied quickly and positively, and offered to help in any way he could. His generosity and openness throughout the project was invaluable. In particular, his donation to me of many of his personal papers took the research up a level from what would have been possible otherwise.
The first stage of the project is now complete and a paper has been published in the International Journal of Drug Policy. I have created a page to house materials on the project and in due course this will include uploads of some of John’s donated personal papers, so that other researchers can also explore this fascinating and important body of work.
Listening to the Today programme this morning, I was interested to hear the Chief Medical Officer, Dame Sally Davies, defending the new guidelines on weekly limits for safe drinking. She was particularly keen to stress their basis in science and evidence. It reminded me of a passage in Betsy Thom’s book Dealing with Drink where she describes the somewhat arbitrary way in which the original guidelines were created, particularly the figures for weekly unit limits. It made me wonder whether the new figures were really as ‘scientifically’ based as she was suggesting.
She also didn’t answer the question put to her about why there are government warnings about safe alcohol consumption but not similar warnings about other common risky practices. The suggestion that this was a bit ‘unscientific’ didn’t go down well! Of course, the actual reason is political and socio-cultural but this is difficult for a Chief Medical Office to say when there is this attachment to the idea that health policy can and should be strictly and solely based on ‘scientific evidence’. As I have argued before, this is particularly short-sighted and unrealistic when it comes to drug and alcohol policy.
As part of the general sprucing up of this website, I have added a page for ‘Papers’ which includes free-to-access articles and reports. I’ll continue to add to this. In the meantime, feel free to share and if there are other articles you require, please email me: firstname.lastname@example.org.