Intended for healthcare professionals

Feature Christmas 2016: Being Well

Morality and non-medical drug use

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i5850 (Published 09 December 2016) Cite this as: BMJ 2016;355:i5850

Re: Morality and non-medical drug use

‘Drugs came under legal control in Britain for the first time in 1868, not for reasons of moral distaste but to protect the business of pharmacists, who wanted the sole right to dispense them’.

As the sentence reproduced above was a core element in Professor Graylings argument, I felt that it required more critical engagement and elaboration. I appreciate space may have limited Professor Grayling’s discussion of the history of prohibition, and while I also tend to veer towards political economy explanations (Windle, 2012), the sentence is only partly true and hides the complexity of trajectories towards prohibition. Prohibitions are the result of decades of interaction between individuals and institutions with different and competing interests and values. The brief discussion below is drawn from my own research on the history of opium prohibition (Windle, 2013).

The move towards prohibition reflected a combination of developments in medicine and moral entrepreneurship coupled with issues of foreign policy (see Collins, 2015), racism, chauvinism and class. As David Courtwright (1982) shows, there were changes in the demographic of the consuming population: The perception of harm increased as opium become less popular with middle/upper-class consumers and more popular with lower/working-class consumers. There were also moral panics surrounding opium use by Chinese migrants in both the UK and US (Dikötter et al., 2004).

Prohibition also reflected the economic and institutional self-interest of moral entrepreneurs and professional bodies. Pharmacists were but one of a number of moral and economic entrepreneurs lobbying the state to prohibit opium. Not only did medical evidence of the harmful effects of opium begin to emerge but religious missionaries lobbied the British government to prohibit opium at home and cease the facilitation of opium smuggling to China. These missionaries, who had lived in China and were influenced by the Chinese prohibitionists they had met, reported to their congregations in the UK how they had witnessed the harmful effects of opium on the Chinese peoples (Windle, 2013).

Opium is a harmful drug, as is heroin. Professor Grayling argues quite rightly that alcohol is as harmful as cannabis, if not more so. He then compares alcohol, not to cannabis, but to cocaine and opiates, arguing that alcohol can be legally traded and consumed simply because the ‘arbitrary fact of alcohol’s greater social acceptability resulting from longer public use’. This appears to imply that heroin is no more harmful than alcohol or cannabis. Heroin was, however, ranked by Nutt and colleagues (2010) as the most harmful drug to the user, and the second most harmful drug to society, after alcohol. Furthermore, many Asian countries with long histories of opium consumption prohibited the drug long before the British.

Undoubtedly, some of the harms associated with heroin are a consequence of, or heightened by, prohibition, however, heroin is a great drug for ‘blacking out’ emotional and physical pain. As such, legalisation would likely result in increased prevalence rates amongst the most vulnerable and socially excluded, which is likely to create a greater strain on already overburdened families and communities.

Reference list
Collins, J. (2015). Regulations and Prohibitions: Anglo-American Relations and International Drug Control, 1939-1964. Doctoral dissertation, London School of Economics and Political Science.

Courtwright, D.T. (1982). Dark Paradise: Opiate Addiction in America Before 1940. Cambridge: Harvard University Press.

Dikötter, F., Laamann, L. P., & Xun, Z. (2004). Narcotic Culture: A History of Drugs in China. Hong Kong: University of Chicago Press.

Nutt, D. J., King, L. A., & Phillips, L. D. (2010). Drug harms in the UK: a multicriteria decision analysis. The Lancet, 376(9752), 1558-1565.

Windle, J. (2012). Insights for contemporary drug policy: A historical account of opium control in India and Pakistan. Asian Journal of Criminology, 7(1), 55-74.

Windle, J. (2013). How the east influenced drug prohibition. The International History Review, 35(5), 1185-1199.

Competing interests: No competing interests

17 December 2016
James Windle
Senior Lecturer in Criminology and Criminal Justice
University of East London
University of East London, School of Business and Law, University Square Stratford, 1 Salway Road, London, E15 1NF