by Johann Hari
Philip Owen smiled at me in his expensive suit and said he was proud to have sacrificed his political career in this cause.
In 2012, the Canadian Supreme Court ruled that drug addicts have a right to life, and that safe injecting rooms are an inherent part of that right and can never be legally shut down. There is no need to fill Oppenheimer Park with crosses today. The killing fields have emptied. And the addicts did it for themselves.
Throughout 2013, Bud kept getting sick. He had a lot of pain in his back—the legacy of his time on the streets, he believed—and finally, in May 2014, he was taken to the hospital, where he was diagnosed with pneumonia. They released him early. The next day, he was found dead in his apartment.32 He was sixty-six years old.
For his memorial service,33 the streets of the Downtown Eastside were shut down and sealed off—just as they had been on the day they laid a thousand crosses in Oppenheimer Park. Everyone from homeless street addicts to a member of Parliament read his poems aloud, and VANDU marched through the streets in a parade. There were many people in that crowd who knew they were alive because of the uprising Bud had begun all those years before.
Bud lived long enough to see something he feared he would never witness. Back when he was at the lowest ebb of his addiction, it was the poetry of Rimbaud that kept him alive. He vowed then, he told me, to “write one poem like that for another human being . . . to really connect deeply in their pain and their suffering, in the same way these poets did with me.”
A few years before he died, Bud went on a reading tour of high schools in British Columbia, and way up north in a town called Smithers, he read out a poem titled “When I Was Fifteen” about the time he had tried to kill himself. He didn’t impose any retrospective wisdom. He tried only to describe truthfully what it had been like for him on that day. He didn’t know it yet, but there was a girl in the audience who, a few days before, had taken an overdose, and her parents had responded by telling her she couldn’t be unhappy because they gave her everything. Her teacher suggested she come to the poetry reading to take her mind off things.
At the end of the reading, the girl approached Bud. She insisted that the teacher unlock the office and run off a photocopy of the poem; she wasn’t leaving without it, she said.
She clutched it as she left, glowing now.
And Bud thought to himself—I stayed alive long enough to keep my promise. I wrote my poem.
Chapter 15
Snowfall and Strengthening
After a year and a half of meeting victims of this war and feeling more and more angry and depressed, Vancouver had given me an itchy sense of hope. I had learned from Bud that things could get dramatically better if people organized and demanded it—and I wanted to see more experiments and innovations like his, to discover whether this was a freak result, or a harbinger of how things could be. But as I asked around, it slowly became clear to me that there were almost no positive experiments taking place in the Americas. A few prisons in the United States have slightly more generous addiction treatment programs. A few state governments have tiny programs giving out weaker substitute drugs to the most extreme addicts. That, it seemed, was it.
But I knew that the two European countries I am a citizen of—Britain and Switzerland—had experimented with much more substantial alternatives. It was time, I realized,1 to come home.
I had a vague memory—learned, I think, from reading Mike Gray’s book Drug Crazy years ago—that in the early 1990s, in the north of England, there had been an experiment in prescribing heroin, but I knew very little about it. I tracked down the man who had led this experiment, and it turned out he was in exile in New Zealand. I interviewed him by phone and then traveled to Liverpool to find everyone I could2 who had witnessed what happened there. The story they told me had—I quickly realized—startling echoes of where the story of the drug war had begun, long ago.
Forty-four years and five thousand miles from the shuttering of the last heroin clinics in California, a man named John Marks walked into a gray little doctor’s office in a stretch of the Wirral, in the drizzly north of England, where they used to build ships, and now they built nothing. It was his first day as a psychiatrist there. John was a big, bearded Welshman from the valleys, swathed in smoke from the pipe he puffed on, and with the murk of the River Mersey washing past, he was not optimistic. Like Henry Smith Williams, he was the intellectual son of a doctor, and like him, he thought he frankly had better things to do than waste his energies on addicts in a place like this.
John had come here to crack the mystery of schizophrenia and how it really works, 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.”
John knew that there would be plenty of addicts waiting for him, because Merseyside in the 1980s was the site of one of the most charged class wars in British history. Margaret Thatcher’s Conservative government had pledged to kick the north of England off what they saw as subsidy-sucking nationalized industries, and her ministers were privately proposing to abandon Liverpool, saying that reviving its economy would be like “trying to make water flow uphill.”3 The people of Merseyside saw their workplaces shuttered, their houses become dilapidated, and their streets set on fire as riots began to rip through the inner cities. Now heroin was spreading in the wake of the flames. John could see that the hopelessness sinking over the region would breed even more addiction, and he sighed.
Every Thursday, a slew of addicts came into the clinic, and it was John’s job to write them prescriptions—for heroin. They sat down. They answered a few questions. Then they were given enough heroin to last them until the following Thursday. And that was it. At first, John was bemused, thinking this a bizarre idea. Free heroin for addicts? He had unwittingly inherited the last crease in the legal global drug supply system that Harry Anslinger had never been able to iron out.
Before my journey home, I believed Britain’s war on drugs had been like most of our foreign policy: a cry of “Me too!” in a bad American accent. We jail huge numbers of people, but a little less than the United States.4 We back the drug wars abroad, but not quite so intensely. It turns out I was a little right and a little wrong. There is one significant area in which we are worse: black men are ten times more5 likely to be imprisoned for drug offences than white men in Britain, a figure beating both the United States and apartheid South Africa.
This is partly because—just as in the United States—our drug war began in a race panic. As the book Dope Girls by Marek Kohn explains, on the twenty-seventh of November 1918,6 a young white showgirl called Billie Carleton stayed up until five in the morning with her friends in her flat behind the Savoy Hotel, with a large amount of cocaine in front of her. She was found dead later that day. There was a press furor about how two sinister forces were bringing these chemicals into the British Isles—the “sickening crowd7 of under-sized aliens” who made up the wave of Chinese immigrants, and the “nigger ‘musicians’ ”8 playing jazz. (They put quotation marks around the word “musician,” not the word “nigger.”) Drugs were banned to save the country from these racial poisons. After the ban, the News of the World reported with relief: EVIL NEGRO CAUGHT,9 and added “the sacrifice of the souls of white women” would finally stop—and it was all cheered on by the U.S. government, delighted to see that other nations shared its concerns.
But for a long time, there was one loophole. Back when the United States was ordering its doctors to block up all legal supplies of heroin and breaking Henry Smith Williams’s brother, doctors in Britain flatly refused to fall into line. They said addicts were ill and that it was immoral to leave them to suffer or die. The British government, unsure of how to proceed, appointed a man called Sir Humphrey Rolleston,10 a baronet and president of the Royal College of Physicians, to decide what our policy should be. After taking a great deal of evidence, he became convinced that the doctors were right: “Relapse,”11 he found, “sooner or late
r, appears to be the rule, and permanent cure the exception.” So he insisted12 that doctors be left the leeway to prescribe heroin or not, as they saw fit.
And so for two generations, Henry Smith Williams’s policies prevailed in Britain, and nowhere else on earth. The result was that while heroin addiction was swelling into the hundreds of thousands in the United States, the picture in Britain was different. The number of addicts never exceeded a thousand, and, as Mike Gray explains,13 “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.” British doctors insisted there was such a thing as a “stabilized addict,”14 and they said that when you prescribe, this was the norm rather than the exception.
When Billie Holiday came15 to London in the 1950s, she was amazed. They “are civilized about it and they have no narcotics problem at all,” she explained. “One day America is going to smarten up and do the same thing.”
Whenever Anslinger was challenged about this evidence in public, he simply denied the British system existed. His evidence was that they didn’t have it in Hong Kong,16 which he said “is a British city.” In private, however, he worked hard to shut down the British system. In 1956, the British health secretary told the House of Commons that, under pressure from the United States, he was going to have to cut off the manufacture of heroin. British doctors were outraged, explaining that “the National Health Service exists for the benefit of the sick and suffering citizen.” They would not back down, and Anslinger couldn’t crush them17 the way he did his own country’s doctors, and so the policy stayed.
But then, in the 1960s, this system was suddenly ruptured. The British government announced that there had been a catastrophic increase in the number of heroin addicts, because it had gone up18 from 927 to 2,782. This appeared to be happening for two reasons. The swinging sixties were changing attitudes across the world, prompting more drug experimentation—and it turned out that in London specifically, a handful of doctors in the West End had been effectively selling heroin prescriptions to recreational users. So the British government moved closer to the American model—but not all the way. The power to prescribe heroin was kept, but it was restricted to a smaller cadre of psychiatrists.
That’s hardly unreasonable, John thought, as he surveyed the addicts who came into his clinic. They were “maybe a few dozen lads, the occasional girl, who came and got their pot of junk. Workers, bargemen, all walks of life really.” He told them to stop19 using, and they argued back, telling him they needed it. He decided after a few years to shut the program down so he could move on to exploring schizophrenia and manic depression and genuinely interesting conditions. “I found this a bit of a headache,” he said to me, “and I had bigger fish to fry.”
But as he prepared to do this, there was a directive from Margaret Thatcher’s government, inspired by her friend Ronald Reagan’s intensified drug war across the Atlantic. Every part of Britain had to show it had an antidrug strategy, it said, and conduct a cost-benefit analysis to show what worked. So John commissioned the academic Dr. Russell Newcombe to look into it. He assumed Newcombe would20 come back and say these patients were like heroin addicts in the United States, and 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 these 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 normal lives.
After receiving this report, John looked again at these patients. There was a man named Sydney, who was “an old Liverpool docker, happily married, lovely couple of kids,” John recalled. “He’d been chugging along on his heroin for a couple of decades.” He seemed to be living a decent, healthy life. So, in fact, now that John thought of it, did all the people prescribed heroin in his clinic.
But how could this be? Doesn’t heroin inherently damage the body? Doesn’t it naturally cause abscesses, diseases, and death? All doctors agree21 that medically pure heroin, injected using clean needles, does not produce these problems. Under prohibition, criminals cut their drugs with whatever similar-looking powders they can find, so they can sell more batches and make more cash. Allan Parry, who worked for the local health authority, saw that patients who didn’t have a prescription were injecting smack with “brick dust in it, coffee, crushed bleach crystals, anything.” He explained to journalists22 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.”
You could immediately 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 recalls, “like a pizza of infection. It’s mushy, and the cheese you get on it is pus. And it just gets bigger and bigger.” A combination of contaminated drugs and dirty needles had given a home to these infections in the addicts’ flesh and they “can go right through the bone and out the other side, so you’ve got a hole going right through you. You have that on both legs and your body’s not strong enough—it’ll cut right through. You had situations where people were walking and their legs snapped.” They often looked like survivors of a war, with amputated limbs and flesh that looked charred and scarred.
The addicts on prescriptions, by contrast, looked like the nurses, or the receptionists, or John himself. You couldn’t tell them apart.
Harry Anslinger thought this contamination of drugs was a good thing, because it would discourage people from using. By 1942, he was boasting:23 “The addict is now using heroin which is over 99 percent adulterated.” But Allan Parry saw the effects in this clinic. “These shitty drugs—when you try to inject them they block up [your veins] and they really make a mess of you,” he tells me. “The trouble is, with dirty heroin, one vein more or less goes with one hit.” Then, “if you damage that vein, you’ll try another one, and eventually you work your way around your body looking at what veins you’ve got and sticking stuff in them,” destroying your body as you go.
Faced with this evidence, John 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, they started to call the infections and abscesses and amputations “drug war wounds.” So he “slowly got,” he told me, “that this clinic was working wonders” by bypassing criminality and providing safer forms of the drug. John began to wonder: If prescription is so effective, why don’t we do it more? If it is preventing people from getting HIV, and injecting poisons into their veins, and dying in the gutters, why not expand it?
He decided to embark on an experiment. He expanded his heroin prescription program from a dozen people to more than four hundred, and with a local pharmacist, he pioneered the prescription of “heroin reefers”—cigarettes soaked in heroin.24 He also prescribed cocaine,25 including smokable cocaine, for a small number of people who had become addicted to street crack. He knew that, like alcohol, cocaine is harmful to your health over time, but he explained: “If you were an alcoholic26 in the Chicago of the 1930s, and had just stolen your grandmother’s purse to buy a tot of adulterated methylated spirits at an exorbitant price from Mr. Capone, I would have a clean conscience in prescribing for you a dram of the best Scotch whisky.”
The first people to notice an effect were the local police. Inspector Michael Lofts studied27 142 heroin and cocaine addicts in the area, and he found that in the eighteen months before getting a prescription from Dr. Marks, they received, on average, 6.88 criminal convicti
ons, mostly for theft and robbery. In the eighteen months afterward, that figure fell to an average of 0.44 criminal convictions. In other words: there was a 93 percent drop28 in theft and burglary. “You could see them transform in front of your own eyes,” Lofts told a newspaper,29 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.” It was just as Henry Smith Williams had said, all those years before.
One day, a young mother named Julia Scott came into his clinic and explained she had ended up working as a prostitute to support her habit. Confronted with patients like this, John told an interviewer, he was starting to feel “anger. It makes me furious that a group of young able people . . . should suffer from the same death rate as people with smallpox, between 10 and 20 percent. I’m not a bleeding heart, and I don’t think there’s anything glamorous about drugs; I try to make my clients realize that what they are doing is boring, boring, boring.”30
He wanted Julia to be bored, not terrified and in danger—so he wrote her a prescription. “I stopped straightaway,” she said later to Ed Brantley of CBS’s 60 Minutes when they came to report on the Liverpool experiment. “I went back once31 just to see, and I was almost physically sick just to see these girls doing what I used to do.”
Now she was working as a waitress, and able to be a mother to her little girl. As Julia pushed her daughter on a swing, Bradley asked her: “Without that prescription, where do you think you’d be today?”
“I’d probably be dead by now,” she said. “I need heroin32 to live.”
The changes taking place as John Marks expanded his prescription program weren’t limited to his patients. On the streets of the neighborhood, the drug gangs started to recede. John overstated it33 at the time when he said drug dealing had been totally wiped out—the writer Will Self, reporting on the ground, asked around and learned there were still dealers to be found. But the police said there were far fewer than before—Inspector Lofts explained at the time: “Since the clinics opened,34 the street heroin dealer has slowly but surely abandoned the streets of Warrington and Widnes.” It was as if time was running backward—to the era before the drug war. In a small brick building by the River Mersey, a California dream was being reborn.