Has The British System Been Effective

Clearly, the question of effectiveness is difficult to answer in the context of a national problem subject to many external and internal influences, within a system that has evolved over many years. Further, it is difficult to compare the effects of policies toward drug problems in various countries: Drug problems are often culturally specific, and attempted solutions that may be acceptable in one setting may be unwelcome or unhelpful in another. On one level, it is clear that the U.K. has not been spared the epidemic rise in heroin taking experienced by other Western industrialized countries; nor has it avoided the spread of HIV in intravenous drug takers—however, the epidemic of HIV has been far less severe than in several other European countries and in the United States. Regional variation in the pattern of the HIV epidemic in the U.K. suggests that the areas where prescribing and specialist clinics were limited, such as in Edinburgh, Scotland, experienced a much more rapid spread— although closer examination reveals this to be insufficient as the sole explanation.

At times, there have been disadvantages to the British System. In particular, a situation where addictive drugs were overenthusiastically prescribed contributed to a worsening of the problem.

Further, the U.K. experience with barbiturate and amphetamine prescribing was wholly negative and resulted in its complete discontinuation.

At an individual level, remarkably little controlled research has been carried out to evaluate different prescribing or other treatment approaches, given the opportunity available to do so in the British System. One controlled trial with ninety-six heroin takers involved the random assignment to either injectable heroin or oral metha-done maintenance. The results suggested advantages and disadvantages in both treatments. At one year follow-up, more in the methadone group were abstinent than in the heroin group, but more had also returned to illicit drug use in the methadone group.

With the increasing emphasis on treatment in the primary care setting in the 1980s, specialist Community Drug Teams were established with the brief of encouraging the increased involvement of general practitioners. The main advantage of such an approach is, in theory at least, that this should allow greater availability of services than could be provided by specialist clinics alone. During the 1990s, there has been an important but modest increase in the extent of general practitioner involvement, but this still falls short of the goal of universal availability of treatment for drug takers.

Overall, it can be said that the principal benefits of the British System have been (1) to ensure the humanitarian handling of drug takers, through treatment services, and (2) to allow the evolution of a system of care responsive to changing needs— which also has been relatively free from unnecessary governmental constraints.

(SEE ALSO: Britain, Drug Use in; Injecting Drug Users and HIV; Needle and Syringe Exchanges and HIV/AIDS)

BIBLIOGRAPHY

Connell, P. H. (1968). Drug dependence in Great Britain: A challenge to the practice of medicine. In H. Steinberg (Ed.), Scientific basis of drug dependence. London: Churchill. Dorn, N., & South, N. (Eds.). (1987). A land fit for heroin?: Drug policies, prevention and practice. Basingstoke: Macmillan. Judson, H. F. (1974). Heroin addiction in Britain. New York: Harcourt Brace Jovanovic.

MacGregor, S. (Ed.). (1989). Drugs and British society: Responses to a social problem in the 1980s. London: Routledge.

Ministry of Health (1926). Report of the Departmental Committee on Morphine and Heroin Addiction (Rolleston Report). London: HMSO.

Stimson, G. V., & Oppenheimer, E. (1982). Heroin addiction: Treatment and control in Britain. London: Tavistock.

STRANG, J. (1989). 'The British System': Past, present, and future. International Review of Psychiatry, 1, 109-120.

STRANG, J., & GOSSOP, M. (1993). Responding to drug abuse: The 'British System'''. Oxford: Oxford University Press.

Strang, J., & Stimson, G. V. (Eds.). (1990). AIDS and drug misuse: Understanding and responding to the drug taker in the wake of HIV. London: Routledge.

Trebach, A. S. (1982). The heroin solution. New Haven: Yale University Press.

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