Prescribing heroin: John Marks, the Merseyside clinics, and lessons from history

Abstract

The prescribing of heroin has a long and contentious history as a method for treating people with heroin problems. This paper revisits a controversial ‘experiment’ with heroin prescribing in Northwest England between 1982 and 1995, led by the psychiatrist Dr. John Marks. Marks’ work has been shrouded in myth and misinformation for many years and the paper presents an evidence-based reconstruction of this episode, drawing on archival sources, published and unpublished documents, and a small number of interviews with key informants. During this 13-year period, Marks worked across clinics in Liverpool and two neighbouring towns, founding his practice on the long-term maintenance prescribing of opiates, including injectable heroin and smokable heroin reefers. The high media profile of the work, in the context of a febrile local politics in Liverpool, a powerful British addiction psychiatry establishment and an always-heated international politics of drug control, brought immense political pressure and led eventually to the closure of the clinics. The Marks ‘experiment’ raises important challenges to the premises, practices and philosophy of heroin maintenance – particularly the questions of thresholds and criteria for access, and the purposes of intervention – as well as to the wider regime of prohibitive drug laws.