Until the middle of the nineteenth century there was a free market in drugs in Europe and the United States, with access to everything from alcohol to opium and coca restricted only by the depth of one's pocket. Two developments did much to upset the status quo. In 1805, a pharmacist's apprentice separated a chemical from raw opium and named it morphine after the Greek god of dreams. Isolation of codeine, thebaine, and papaverine soon followed. Then in 1858 a Scottish surgeon invented a device that could deliver a dose of morphine directly to the point of pain, and this became known as a hypodermic syringe. The combination of powerful synthetic drugs and parenteral routes of administration greatly increased the scope for abuse. Combatants on both sides of the American Civil War were issued with morphine and syringes, and for many years afterwards morphine addiction was known as the 'soldiers' disease's.
In Britain, opium dependency was recognized but generally not vilified, although this tolerance extended only to 'opium eaters'; smoking the drug was regarded as a rather vile alien indulgence (as in the United States). Doctors were keen to get into the act, and the medicalization of addiction coincided neatly with the birth of the new specialism of 'psychiatry', which sought to redefine interpersonal and social problems according to moral and medical principles. Concern was growing about the mortality among children sedated with opium when left unattended by women whose efforts fuelled the Industrial Revolution. But the main drive towards the introduction of the Pharmacy Act 1868, which also restricted sales of cocaine, was professional self-interest. Why allow grocers to corner such a profitable market? Controls over patent medicines soon followed, and the Act was made still more restrictive in 1908.
Such controls were slower to arrive in the United States, but in 1906 the Federal Pure Food and Drug Act required ingredients to be specified on the label. Public concern about opiates made the issue a vote winner, and importation of smoking opium became illegal in 1909. America was instrumental in organizing international conferences in Shanghai and The Hague, and in 1912 it was agreed that the 30 participating countries should enact legislation to restrict opiates and cocaine to medical indications on prescription only. The Harrison Act duly entered the United States's statute book in 1914. Then in 1919 the Supreme Court ruled that maintenance prescriptions of morphine or cocaine to addicts did not constitute acceptable medical practice, and a punitive response to addiction was established which lasted until the HIV epidemic in the 1980s forced a change in philosophy. This coercive approach to recreational drugs gathered momentum. A national prohibition of alcohol was enacted in 1919 and was only repealed in 1933 because of a desperate need by the Roosevelt administration for taxation income. Many states banned cannabis, and its use was effectively outlawed nationwide by the Marijuana Tax Act 1937. By the same year, the majority of states had adopted the Uniform Drug Act to standardize their approach to recreational drugs. In a further effort to overcome what was regarded as a fragmented approach to enforcement, the Comprehensive Drug Abuse Prevention and Control Act came into force in 1970.
In Britain, the Establishment was startled out of its laissez-faire position during the First World War by the discovery that soldiers were finding life in the trenches more bearable if they had a supply of cocaine to take back after leave in London. The Defence of the Realm Act Regulation 40B (1916) prohibited sale of cocaine or opiates to soldiers. After some fairly sordid newspaper reports of London nightlife in the immediate postwar period, including lurid descriptions of the drug-related death of a well-known actress, this entered civil law as the Dangerous Drugs Act 1920. For a while, the response to drug problems looked set to follow the American penal route, but in 1926 the government-appointed Rolleston Committee recommended that addiction should be regarded as an illness rather than a crime. Long-term maintenance on an opiate prescription for addicts who were unable to abstain was validated, and the 'British system' was born. In deference to the 1925 Geneva Convention, cannabis was outlawed in 1928 but prescription remained possible until final prohibition under the Misuse of Drugs Act 1971.
The United Nations Commission on Narcotic Drugs (UNCND) was established in 1946 to take over from the League of Nations the determination of policy for international drug control. The signatory nations to the Single Convention on Narcotic Drugs (1961) and the Convention on Psychotropic Substances (1971) are required to 'limit to medical and scientific purposes the cultivation, production, manufacture, export, import, distribution of, trade in, use and possession of' a long list of drugs which includes opiates, cannabis, stimulants, sedatives, and hallucinogens. UNCND has delegates from each member state of the United Nations and all other signatories of the 1961 Convention.
Most governments are firmly against arguments for legalization or decriminalization, but the Dutch have pioneered a different approach. In 1976, a policy of non-enforcement was initiated whereby possession or trade in small amounts of cannabis (<30 g) would no longer be prosecuted. The impact of this policy has been assessed by MacCoun and Reuter.(2) Between 1976 and 1983 depenalization resulted in 'little if any effect upon levels of use', but prevalence of cannabis use 'increased sharply' between 1992 and 1996. However, rates increased equally rapidly over this period in countries with rigorous prohibition, and prevalence and street price of cannabis is currently similar in Holland and the United States. But there is some evidence that the Dutch have been succesful in separating 'hard' and 'soft' drugs; only 22 per cent of Dutch cannabis smokers have tried cocaine compared with 33 per cent in the United States. The conclusion is that depenalization did not significantly increase consumption, a finding which has been replicated in several states of the United States, Italy, and Spain. Decriminalization of cannabis in Canberra, Australia, had no impact on prevalence of use among university students.(3) Very few abstaining students would start smoking cannabis if it was legalized.(4) The Dutch surge in prevalence after 1983 is probably explained by increased promotion and commercialization.
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