‘Grave Cause for Concern’? Private Practice, Professional Disputes and the Treatment of Heroin Addiction in Britain During the 1980s

Abstract

This article examines the debate surrounding the role played by private doctors in the treatment of heroin addiction in Britain during the 1980s. Whilst there were a number of problems connected with the treatment of addiction in private practice, this debate was something of a surface issue masking a deeper professional dispute. The involvement of general practitioners, whether in private or National Health Service practice, posed a threat to the recently established specialist status of psychiatrists working in the field. This came at a time when the specialist psychiatric approach to drug addition was increasingly being challenged by other non-medical agencies.

Keywords:

• Heroin
• Addiction
• Psychiatry
• Private Practice
• General Practice

Notes

  [1] ACMD, Treatment and Rehabilitation, 54.

  [2] ‘Editorial: Drug addiction: British System failing’, Lancet (9 Jan 1982), 83.

  [3] Strang, ‘Personal view’, 972.

  [4] Dally, A Doctor's Story, 62. Dally, ‘Personal view’, 857.

  [5] On the dispute over pay beds see Webster, Health Services Since the War , Vol. II, 620–27.

  [6] Higgins, Business of Medicine, 185.

  [7] ‘Conversation with Philip Connell’, 15.

  [8] Mold, ‘Opening of DDUs’, 501–17.

  [9] Smart, ‘DDUs in England and Wales’, 138–9.

 [10] Home Office, Statistics of Drug Addicts.

 [11] Stimson, ‘British drug policies in the 1980s’, 477–88.

 [12] Berridge, ‘AIDS and British drug policy’, 140–41; MacGregor and Ettorre, ‘From treatment to rehabilitation’, 126–7.

 [13] Harding, Opiate Addiction, Morality and Medicine; Berridge, Opium and the People; Berridge, ‘Morality and Medical Science’, 67–75.

 [14] Thom, Dealing With Drink, 26–56.

 [15] Ministry of Health, Drug Addiction: Report of the Interdepartmental Committee, 9; Ministry of Health, Drug Addiction: Second Report of the Interdepartmental Committee, 8.

 [16] ‘Conversation with Max Glatt’, 240–41.

 [17] ‘Conversation with Thomas Bewley’, 885.

 [18] Mold, ‘The opening of DDUs’, 506–8.

 [19] The National Archives, Kew. MH 50/369, Ministry of Health, ‘HM 67 (16): the treatment and supervision of heroin addiction’, 1967.

 [20] Spear, Heroin Addiction Care and Control, 206–10.

 [21] Figures quoted in Stimson and Oppenheimer, Heroin Addiction, 102.

 [22] Figures quoted in Stimson and Oppenheimer, Heroin Addiction, 102

 [23] Strang, Ruben, Farrell, and Gossop, ‘Prescribing Heroin’, 198; Mitcheson, ‘Uncertainty within the Drugs Clinics in the 1970s’, 45.

 [24] Mitcheson, ‘Uncertainty within the Drugs Clinics in the 1970s’, 44.

 [25] Mitcheson, ‘Uncertainty within the Drugs Clinics in the 1970s’, 42.; Strang, Ruben, Farrell and Gossop, ‘Prescribing Heroin’, 198.

 [26] Hartnoll, Richard, et al. ‘Evaluation of Heroin Maintenance in Controlled Trial’; Mitcheson, ‘Uncertainty within the Drugs Clinics in the 1970s’, 45.

 [27] Mitcheson, ‘Uncertainty’, 45.

 [28] Stimson and Oppenheimer, Heroin Addiction, 5.

 [29] Smart, ‘Drug Dependence Units in England and Wales’, 138–9.

 [30] F. A. Jenner and P. V. Gill, ‘Helping Heroin Addicts Kick the Habit’. Letter to the British Medical Journal 291 (3 Aug 1985): 344–5.

 [31] Davenport-Hines, The Pursuit of Oblivion, 364; Power, ‘Drug trends since 1968’, 34–5.

 [32] ACMD, Treatment and Rehabilitation, 130.

 [33] Home Office, Statistics of Drug Addicts.

 [34] ACMD, Treatment and Rehabilitation, 25.

 [35] Ministry of Health, Drug Addiction: Report of the Second Interdepartmental Committee, 8.

 [36] ACMD, Treatment and Rehabilitation, 26–7, 37; MacGregor and Ettorre, ‘From treatment to rehabilitation’, 145.

 [37] Lancet (9 January 1982), 83.

 [38] ACMD, Treatment and Rehabilitation, 120.

 [39] There are no figures indicating the precise number of private practitioners treating addict patients in this period.

 [40] Contemporary Medical Archive Centre, Wellcome Library, London (hereafter CMAC). Private Papers of Ann Dally (hereafter PP/DAL).

 [41] Dally, A Doctor's Story, 85; Notices, Lancet (12 December 1981) 1358.

 [42] DHSS, Guidelines of Good Clinical Practice; House of Commons, Misuse of Drugs, Evidence of AIDA, 27 February 1985, 108–24.

 [43] Dally, A Doctor's Story, 44, 57.

 [44] CMAC PP/DAL/E/17, Transcripts of the General Medical Council Professional Conduct Committee Hearing, 1986–1987, (hereafter GMC Hearing, 1986–7), 27 January 1987. Interview between Dr Ann Dally and the author, 8 June 2005.

 [45] Dally, A Doctor's Story, 57–8.

 [46] Dally, A Doctor's Story, 62. See also Dally, ‘Personal view’, 857.

 [47] CMAC PP/DAL/E/4/20, ‘Analysis of My Addict Practice’ by Dally, prepared for her lawyers, January 1987.

 [48] CMAC PP/DAL/E/4/20, ‘Maintenance’, by Dally, prepared for her lawyers, January 1987.

 [49] CMAC PP/DAL/E/4/22, Draft statement of Dr Ann Dally, 20 October 1986.

 [50] CMAC PP/DAL/E/4/17, GMC Hearing 1986–7, 26 January 1987.

 [51] Dally, A Doctor's Story, 80

 [52] CMAC PP/DAL/E/4/20, ‘Maintenance’, by Dally, prepared for her lawyers, January 1987.

 [53] CMAC PP/DAL/E/4/20, ‘Maintenance’, by Dally, prepared for her lawyers, January 1987

 [54] Dally, A Doctor's Story, 82

 [55] Dally, A Doctor's Story, 79.

 [56] Aliases have been used where addicts' real names are mentioned. CMAC PP/DAL/E/4/11, Reply from ‘John’ to Dally's letter of December 1985.

 [57] CMAC PP/DAL/E/4/11, Reply from ‘Mark’ to Dally's letter of December 1985.

 [58] CMAC PP/DAL/E/4/11, Reply from ‘James’ to Dally's letter of December 1985.

 [59] Dally, A Doctor's Story, 75, 78.

 [60] CMAC PP/DAL/E/4/20, ‘Analysis of my Addict Practice’ by Dally, prepared for her lawyers, January 1987. CMAC PP/DAL/E/4/17, GMC Hearing 1986–7, 26 January 1987.

 [61] Higgins, Business of Medicine, 144.

 [62] CMAC PP/DAL/E/4/12, Statement of Annette Lingham, 20 November 1986. CMAC PP/DAL/E/4/9, Miscellaneous statements from patients, 1986. CMAC PP/DAL/E/4/20, ‘Frequency of my prescription’ by Dally, prepared for her lawyers, 28 January 1987.

 [63] CMAC PP/DAL/E/2/4, GMC Hearing 1983, 5 July 1983.

 [64] Interview between author and Dally.

 [65] ‘Editorial’, Lancet (9 January 1982), 83.

 [66] Bewley & Ghodse, ‘Unacceptable face of private practice’, 1877.

 [67] CMAC PP/DAL/E/4/17, GMC Hearing, 1986–7, 9 December 1986.

 [68] This was actually the second time Bewley attacked the treatment of addiction in private practice in an article in the BMJ; see also his 1980 article, Bewley, ‘Prescribing psychoactive drugs to addicts’, 497–498.

 [69] A. B. Robertson, ‘Prescription of Controlled Drugs to Addicts’, letter to BMJ, 287, (9 July 1983), 126.

 [70] D. Beckett, Prescription of Controlled Drugs to Addicts', letter to BMJ, 287 (9 July 1983) 127.

 [71] Dally, A Doctor's Story, 46–7.

 [72] Bewley, ‘Prescribing Psychoactive Drugs to Addicts’, 497; Bewley & Ghodse, ‘Unacceptable Face of Private Practice’, 1877. See also ‘Editorial’, Lancet (9 January 1982), 83.

 [73] Burr, ‘The Piccadilly Drug Scene’; Burr, ‘Increased Sale of Opiates’.

 [74] Burr, ‘Increased Sale of Opiates’, 884.

 [75] Bewley and Ghodse, ‘Unacceptable Face of Private Practice’, 1877.

 [76] ‘Editorial: Drug Dependence in Britain: A Critical Time’, Lancet (27 August 1983) 493.

 [77] Bewley and Ghodse, ‘Unacceptable Face of Private Practice’, 1877.

 [78] Burr, ‘The Piccadilly Drug Scene’, 8.

 [79] Stimson, ‘The War on Heroin’, 39–41.

 [80] Bewley & Ghodse, ‘Unacceptable Face’, 1877.

 [81] D. Beckett, letter to British Medical Journal, 287 (9 July 1983) 27.

 [82] Spear, Heroin Addiction Care and Control, 288, 287.

 [83] Dally, A Doctor's Story, 115.

 [84] ‘Conversation with Thomas Bewley’, 890.

 [85] ‘Conversation with Philip Connell’,15.

 [86] Social Services Committee, Misuse of Drugs (6 March 1985) Evidence of Philip Connell, 125.

 [87] Spear, Heroin Addiction Care and Control, 283.

 [88] Perkin, The Rise of Professional Society, 347.

 [89] Webster, ‘Psychiatry and the Early National Health Service, 103–4.

 [90] This can be seen, for example, in the reluctance of some psychiatrists to take on the treatment of addiction in the late 1960s. See Mold, ‘British System’, 511–12.

 [91] Digby, Evolution of British General Practice, 290.

 [92] Honigsbaum, The Division in British Medicine, 2, 298–302.

 [93] Jefferys and Sachs, Rethinking General Practice, 47.

 [94] Armstrong, ‘The Emancipation of Biographical Medicine’.

 [95] Marinker, ‘“What is wrong” and “how we know it”’, 71.

 [96] Glanz, ‘The Fall and Rise of the General Practitioner’, 61.

 [97] Berridge, ‘Drug Research in Britain’, 10.

 [98] Berridge, ‘AIDS and British Drug Policy’, 141.

 [99] MacGregor et al., Drug Services in England, 45.

[100] CMAC PP/DAL/E/2/4, GMC Hearing 1983, 5 July 1983.

[101] CMAC PP/DAL/E/2/4, GMC Hearing 1983, 5 July 1983, 9.

[102] CMAC PP/DAL/E/2/4, GMC Hearing 1983, 6 July 1983.

[103] CMAC PP/DAL/E/2/4, GMC Hearing 1983, 5 July 1983; CMAC PP/DAL/E/2/4, GMC Hearing 1983 6 July 1983.

[104] CMAC PP/DAL/E/2/4, GMC Hearing 1983, 6 July 1983.

[105] CMAC PP/DAL/E/2/4, GMC Hearing 1983, 6 July 1983

[106] CMAC PP/DAL/E/2/4, GMC Hearing 1983, 6 July 1983

[107] CMAC PP/DAL/E/2/11, ‘Some thoughts on a lost case’, by Dally, 18 July 1983. The assertion that the charge was changed to allow the prosecution to win the case was also reported by Michael O'Donnell in his column in the BMJ. See O'Donnell, ‘One man's burden’, 990.

[108] CMAC PP/DAL/E/2/4, GMC Hearing 1983, 6 July 1983, 93.

[109] CMAC PP/DAL/E/2/4, GMC Hearing 1983, 6 July 1983, 93

[110] Brahams, ‘Medicine and the Law’, 979.

[111] Robinson quoted in Stacey, Regulating British Medicine, 196.

[112] O'Donnell, ‘One Man's Burden’, 990.

[113] O'Donnell, ‘One Man's Burden’, 990, Dally, A Doctor's Story, 122.

[114] Guardian (8 July 1983), 2.

[115] O'Donnell, ‘One Man's Burden’; ‘Editorial: GMC Professional Conduct Committee: Right of Appeal’, Lancet, (22 Oct 1983) 951.

[116] J. Walton, ‘Verdict of the Professional Conduct Committee’ letter to the BMJ, 287, (29 October 1983), 1300.

[117] Ashton, ‘Doctors at War’, 15.

[118] Ashton, ‘Doctors at War’, 14.

[119] Dally believed there was a ‘campaign’ against her, led by what she termed the ‘drug dependency mafia’. See Dally, A Doctor's Story, 139.

[120] For a detailed examination of the impact of HIV/AIDS on drug policy see Berridge, ‘AIDS and British Drug Policy.’

[121] ACMD, AIDS and Drug Misuse, 17, 1.

[122] Home Office, Changes to the Misuse of Drugs Legislation.

[123] B. Beaumont et al., ‘Alternatives to Licensing Doctors’, letter to Druglink, January/February 2001, 9.

[124] The case began in February 2004, but was adjourned until July 2005 because of the ill health of one of the doctors concerned. The case is still [in February 2006] before the GMC. For earlier coverage of the case highlighting the key issues see: The Guardian, 24 February 2004, 5; The Independent, 24 February 2004, 19; O. Dyer, ‘Seven Doctors Accused of Over-prescribing Heroin’, BMJ, 328 (28 February 2004), 483.

Additional information

Notes on contributors

Alex Mold

Alex Mold is a Research Fellow at the Centre for History in Public Health, London School of Hygiene and Tropical Medicine.