In the midst of current concern about drug-related problems and of endless dialogue about what should or should not be ‘done’ about them, it is interesting and valuable to consider the historical background to the present situation in the UK. Interesting because it increases our understanding about how present policies have evolved, and useful because of the possibility of learning from previous experience. This chapter considers the epidemiology of substance misuse in the UK and globally, and reviews the policies of countries that have adopted different approaches from the UK.

Drug dependence in the UK

It is perhaps surprising to learn that opium was widely used in Britain during most of the nineteenth century; so widely used, so ordinary that it aroused little interest or concern. It was available in a variety of patent medicines, obtainable from any sort of shop without any legal restriction, and crude opium was sold for eating or smoking. The first attempts to restrict its sale were probably more for the sake of pharmacists trying to obtain a monopoly of this profitable trade, than because of concern about the effects of opiates. Medical interest in the topic became keener with the introduction of the hypodermic syringe and the concept of ‘morphinomania’ emerged. Despite an awareness of the addictive properties of opiates no prescription was necessary to obtain opium or its preparations. These could be purchased from a pharmacist by anyone known or personally introduced to the pharmacist, as long as the Poisons Register was signed.

Growing international concern about opiate use led to the First Opium Convention in The Hague in 1912 and Britain, as one of the signatories, agreed to the principle of adopting controls over opium, morphine and cocaine.