by Johann Hari
But John Marks differed from Henry Smith Williams in one important way. Henry thought that drug addicts would need to be given their prescription for the rest of their lives. That was the part of his story that most disconcerted me. It seemed that the only alternative to the drug war forever was being prescribed a drug forever.
But since then, a discovery had been made about addiction—one that Henry Smith Williams couldn’t have foreseen. It was first spotted by a psychologist named Charles Winick, who set up a free clinic for addicted musicians in New York in the 1950s. Winick, like everyone else, used to believe that once you were a heroin addict, you were a heroin addict until you died, but what he found was something very different. “Heroin use was concentrated35 in the 25 to 39 group, after which it tapered to very little,” he wrote. Most addicts simply stopped of their own accord. They “mature out of addiction . . . possibly because the stresses and strains of life are becoming stabilized for them and because the major challenges of adulthood have passed.”
This process—the fancy names for it are “maturing out” or “natural recovery”—is36 not the exception: it’s what happens to almost all of the addicts around you. This finding is so striking I had to read about it in slews of studies before I really took it on board: Most addicts will simply stop,37 whether they are given treatment or not, provided prohibition doesn’t kill them first. They usually do so after around ten years of use.38
So once John Marks knew this, he came to believe his job was a matter of keeping them alive long enough to recover naturally. That’s why every week, the addicts of Widnes turned up at John’s office for a meeting, and left with a prescription for smokable heroin or—in a small number of cases, as we will see shortly—cocaine. John explained to the public: “If they’re drug takers determined39 to continue their drug use . . . the choice that I’m being offered, and society is being offered, is drugs from the clinic or drugs from the Mafia.”
There was one obvious reason why people were worried by John’s experiment. If there is no punishment—if you give people drugs for free—surely they will use them more? This was one of Harry Anslinger’s most reasonable objections. If you reintroduce prescription, he warned, “drug addicts would multiply40 unrestrained.”
It seems like common sense. But John, by contrast, thought the rate of use would hold steady:41 If being ostracized by your family, riven with disease, and plunged into poverty didn’t affect your decision to use, how would a few free heroin reefers make a difference?
It turns out both sides were wrong. Drug use didn’t rise, and it didn’t hold steady. It actually fell—including among the people who weren’t being given a prescription. Research published 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. In Bootle, there were 207.54 drug users per hundred thousand people; in Widnes it was just 15.83—a twelvefold decrease.42
But why? Why would prescribing heroin to addicts mean that fewer people became addicts? Dr. Russell Newcombe, working out of John Marks’s clinic, discovered what he believes is the explanation.43
Imagine you are a street heroin addict. You have to raise a large sum of money every day for your habit: £100 a day44 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 than either of them. You can buy your drugs, take what you need, and then cut the rest with talcum powder and sell it 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.45 “Insurance companies would love to have salesmen like drug addicts,” with that level of motivation, John remarked.
Here’s why drug use went into reverse in John Marks’s clinic. Prescription, it turns out, kills the pyramid selling scheme, by stripping out the profit motive. You don’t have to sell smack to get smack. This explains why when you prescribe heroin, fewer people are recruited to use heroin, and why when you prescribe cocaine, fewer people are recruited to use cocaine.
As Russell Newcombe tells me this, I can’t help but think of a weird little twist of history. Harry Anslinger always said drug addiction was infectious. It isn’t, in normal circumstances—but the system of prohibition he built makes it so after all.
John Marks was being shouted at. The public meeting was getting nasty, and he was being abused. But it wasn’t a right-winger or conservative yelling at him. At this time, Liverpool was run by a Communist group called Militant Tendency, who believed in establishing an immediate socialist revolution in Britain.
John Marks, they declared, was preventing that revolution by tranquilizing the working classes with heroin. The opiate of the masses turned out to be . . . opiates, literally. Marks was blocking Marx.
The father of one of John’s patients stood up, and addressed the crowd. “I was a bit puzzled by John giving Jimmy heroin to start with,” he said, “because I thought the job was to get him off. But you know what—since he started with this Dr. Marks, we now see him at mealtimes, he sits with us and talks with us, he’s even back with his girlfriend, and you know what, lads? He’s got an offer of a job next week.”
John Marks expected that the news of these results would spur people across the country, and across the world, to do the same. Who would turn down a policy that saves the lives of drug users and leads to less drug use and causes dealers to gradually disperse?
At last, this ripple effect seemed to have begun. He was asked to set up a bigger version of the Widnes clinic at the Metropolitan Centre in Liverpool, and then it was decided that every health district in the region from Southport in the north to Macclesfield in the east would have a prescribing clinic of its own.
There was a drop in shoplifting so massive that the department store chain Marks and Spencer’s46 publicly praised the policy and decided to sponsor the first World Conference on Harm Reduction and Drug-Taking in Liverpool in 1990. There, one of the police officers inspired by John’s experiment, Derek O’Connell, explained: “As police officers,47 part of our oath of office is to protect life . . . Clearly, we must reach injectors and get them the help that they require, but in the meantime we must try and keep them healthy, for we are their police as well.” But John was about to whack into the same wall as Henry Smith Williams.
With a few of his colleagues, John was invited to tour the United States to explain how this policy could save American lives.
Everywhere they went, at the end of the meeting, they were told the same thing—that the Republican congressman Jesse Helms had been pressuring the organizers to shut them down and shut them up. Helms didn’t want anybody to interfere with the war on drugs. A few years later, on a CNN phone-in show,48 a caller thanked him for “everything you’ve done to help keep down the niggers,” and he replied by saluting the camera and saying: “Well, thank you, I think.”
After an item about John’s clinic was broadcast on one of the top-rated news shows in the United States, 60 Minutes, in 1991, John was phoned by Bing Spear, the chief inspector of the Drugs Branch of the Home Office.
“We’ve got a lot of heat49 from our embassy in Washington,” he warned. “They’ve got on to [the government] saying, ‘What’s this about somebody in Liverpool giving out crack cocaine? Close it down immediately!’ ”
The Conservative government decided to “merge” John’s clinic with a new health trust, run by evangelical Christians who opposed prescription on principle. The patients panicked, because they knew what being cut off would mean—a return to abscesses and overdoses and scrambling for drugs from gangsters. John was powerless50 to help them.
The results came quickly. In all the time Dr. Marks had been prescribing, from 1982 to 1995,51 he never had a drug-related death among his patients. Now Sydney, the Liverpool docker, went back to buying adulterated cra
p on the streets and died. Julia Scott, who said she would be dead without her prescription, was proved right: she died of an overdose, leaving her daughter without a mother.
Of the 450 patients52 Marks prescribed to, 20 were dead within six months, and 41 were dead within two years. More lost limbs and caught potentially lethal diseases. They returned to the death rate for addicts under prohibition: 10 to 20 percent,53 similar to smallpox.
Dr. Russell Newcombe, who had worked in the clinic, tells me the survivors “were immediately forced back onto the street . . . People who had jobs lost them. It split relationships up. People rapidly went back into debt and crime. The average person thrown off John Marks’s prescription regime would have been back in acquisitive crime within a month.” Whenever he’d see one of them in the street, he’d ask them what they were doing now. “Grafting,” they’d say—the local word for stealing to support your habit.
Today, Merseyside is riddled with drug addiction, and drug gangs are killing each other in the war for drugs.
John found he was blacklisted within his own country. He ended up literally at the other end 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 in 2012.
“I was exiled,” John Marks told me. One day, the Royal Astronomical Society asked him to play Galileo at an open day. He had to playact being burned at the stake. His voice softened at the irony. But when I said to him this story made me angry, he replied, flatly: “Whatever gave [you] the idea folk in authority operate according to reason? Your trouble is you’re being rational.”
And so his story was supposed to go the same way as Henry Smith Williams’s. It was supposed to be forgotten. But this time, something was different.
I got on a plane to Geneva, the Swiss city where Harry Anslinger first went to the United Nations to force his vision on the world. It was there, in a sweet twist of history, that his grip was finally being broken. I sat with the woman who—along with others—pioneered this change, and she began to tell me her story. It had been inspired—without him knowing it—by John Marks.
The police officer who accompanied Ruth Dreifuss had tears in his eyes. He was taking the future president of Switzerland through an abandoned railway station in Zurich, down by the river. All the local drug addicts had been herded there, like infected cattle.
Ruth had been looking out over scenes like this for years now. A few years before, she had been to the park in Bern that played the same role there. There were girls being openly prostituted out and there were addicts staggering around, out of control, incoherent. There were people injecting themselves “in places you couldn’t imagine,” she says, because every other vein couldn’t be traced, as if it was trying to escape. Above the bustle, dealers were yelling their prices at the top of their voices. As she heard them, Ruth thought of Wall Street54 brokers, barking on the trading floor. The threat of violence hung over everything as dealers fought for customers.
Most Swiss people had never seen anything like this. The police were not just crying; they were afraid. This was Switzerland in the 1980s and 1990s, but it was an affront to everything the Swiss thought55 about themselves.
Switzerland has always been the place on earth where it is easiest to pretend nothing ever changes, and everything makes sense. My father is a mountain boy from the Swiss Alps, and in his village, you were raised to believe that the country’s last major upset was when Hannibal invaded the mountains with his elephants in 221 b.c. All the country’s symbols are about order and cleanliness and permanence. Swiss watches will tick-tock with scientific precision even after a nuclear holocaust. The postcards show the thirty-foot-high cleansing jet of blue water waving out from Lake Geneva into the sky, with the Alps motionless and unchanging in the distance. It is, the Swiss will tell you gravely, a criminal offense to flush your toilet56 after ten o’clock at night, because it might disturb your neighbors.
But now, Switzerland was watching as drug prohibition created tornadoes in the middle of its pristine clockwork cities. Ruth Dreifuss didn’t know it yet as she walked through this scene, but soon she was going to become the first female president of Switzerland and the first Jewish president of Switzerland.
Even more significant, she would become the first president in the world since the 1930s who decided to run not away from drug reform, but toward it. She dedicated her presidency to sitting with addicts, listening to addicts, defending addicts—and getting them a legal supply of their drugs.
I first learned about her when drug policy experts began to say that there was one political leader in the world who really understood what was wrong with the drug war better than anyone else. I wrote to her at once. That’s how I found myself, in early 2013, in her apartment, as she chain-smoked and flicked her ash into a big yellow ashtray. She apologized for the smoke. “I am an addict!” she said, and laughed.
When Billie Holiday was in prison for heroin possession in the United States, the only people who tried to help her were Swiss. “A wonderful couple57 in Zurich, Switzerland, sent me a thousand dollars,” she wrote, “and a telegram telling me that America would never accept me when I got out, so I should come to them in Europe.”
Switzerland is—like all countries—in a constant tussle between its compassion and its cruelty. As that letter was being written, Ruth was at a Swiss school where the other kids would sometimes taunt her, saying that the Jews had assassinated Jesus and would have to be punished forever. Later, Ruth was told that as a woman, she was hysterical and emotional and couldn’t be entrusted with the vote. If they ever let her cast a ballot, the country’s politicians warned, Switzerland’s families would fall apart and the nation would descend into chaos. It was only after she and thousands of others marched and demanded for years that Swiss women were finally enfranchised in 1971. So Ruth Dreifuss had seen how even the most concrete of certainties can fall apart and seem crazy to the next generation.
When Ruth was put in charge of Switzerland’s health policy in 1993, there was a corpse waiting in her in-tray. Switzerland had the worst HIV epidemic58 in Europe, and nobody could see an end to it. This country has no ghettoes where addiction could be hidden away. There are no Us and Them in Swiss chalets: if chaotic drug use is happening, it happens where everyone can see. So she gathered into her office representatives of the country’s most despised minorities—gays, prostitutes, and junkies—because she suspected that they held not only the problem but also the solution to the AIDS crisis. She found that sex workers, if you arm them with condoms and information, are actually “very good public health agents. But you have to trust them. You have to accept their job. So prevention begins with respect.”
As a socialist, she had always believed that everyone—no matter how seemingly lost—can be empowered if you do it right. But she looked at the drug addicts and asked herself: How?
In the fight against AIDS, Switzerland had already built good needle exchanges, provided safe consumption rooms where addicts could go to take their drugs, and prescribed methadone. Still the disease raged. It turned out that many addicts loathe methadone: they compare it to a flavorless lump of dough when you have a ravenous craving for steak. One day, some of the street doctors Ruth talked to all the time told her that they had been59 to visit an experiment in Liverpool, England—a program with startling results, even though the ideologues were shutting its doors.
It had been discovered a few years before in Switzerland that there was a clause in Swiss law that allowed heroin to be given to citizens, provided it was part of a scientific experiment. So far that had been done with only a tiny handful of people.
So Ruth said—Okay, we are going to have a really large experiment.60 We are going to make it much easier for any addict who wants it to get methadone, and for the people who can’t cope with that, we will prescribe them heroin. Switzerland has a political system built on consensus. No one official can drive a policy on her own. She needed to persuade her colleagues, and
the cantons. So Ruth fought for it. This is an emergency, she explained, and in emergencies, you take dramatic steps.
Twenty years later, Ruth Dreifuss lives across the street from one of the heroin-prescribing clinics in Geneva that were made possible by her political battle. At seven in the morning, I hurry past the seagulls squawking on Lake Geneva. It is as dark as midnight, and in the neat little Swiss cafés, men and women in suits are reading newspapers and drinking coffee. Nobody seems bleary-eyed. The Swiss go to bed early, and they wake in the darkness without complaining.
In the white corridor of the heroin clinic, I find a young man with big headphones and an old man in a tweed suit with leather elbow patches sitting in chairs next to each other. They are waiting patiently to shoot up.
The older man follows a nurse into the injecting room, and he emerges a little while later to sit for twenty minutes alone, and then he agrees to talk to me, in a room, to one side. He looks like the secretary of state for a minor Central European nation, with his carefully polished shoes and lined, distinguished face. After we are introduced by the doctors, he says he will tell me his story provided I do not use his real name, because he was admitting to criminal offenses he had carried out before the drug laws were changed. I will call him Jean.61