Prescribing and Proscribing: The Public-Private Relationship in the Treatment of Drug Addiction in England, 1970-99

Abstract

People dependent on illicit drugs have prompted a range of policy responses. In England, the medical profession has played a major role in this area since the nineteenth century, prescribing drugs such as heroin and morphine to those addicts considered unable to give up using them. In the late 1960s, amid important regulatory changes, drug dependent patients were transferred out of primary care and into new National Health Sendee ‘Clinics’ based in hospitals. This thesis starts just after these major changes and traces the relationship between doctors treating drug users within the NHS — initially inside the Clinics, and later also in general practice — and doctors prescribing privately and paid by fee. A debate about appropriate prescribing to drug users is traced from its origins within the Clinics in the 1970s to include the role of doctors working outside both privately and in the NHS in the 1980s and ’90s. Conflict emerged between these doctors and manifested itself in regulatory activities and in the general and medical media. The role of formal and informal regulation in these battles and the involvement of the media arc particular foci of the research which considers the parts played by the Home Office Drugs Inspectorate, the General Medical Council, and the production of clinical guidelines, as well as the formation of professional interest groups representing different doctors. The study used oral history materials (53 interviews were carried out with key individuals and private prescribers), archival research, published reports, the medical and general press and academic journals, as well as broadcast radio and television programmes.