Heroin problems have been hitting the headlines recently, in the USA, in Europe and elsewhere. In the USA, heroin remains a serious problem, albeit less 'newsy' than cocaine. Although trends in the extent of use of heroin and related problems seem quite volatile, declining in some parts of that country whilst rising in others, a consistent trend in the mid-1980s has been the availability of heroin of higher purity (NIDA, 1985). In Britain and other European countries, there is no doubt that heroin has become widely available in many regions and neighbourhoods in reasonably high purity (see Chapter 1) and that it is the main drug of public concern — however minor its contribution to mortality and morbidity compared with the records of alcohol and tobacco. In the Third World, Pakistan — the country generally credited with supplying much of the heroin used in Europe in the 1980s — is itself caught up in an escalating cycle of heroin distribution and consumption; similar problems are to be found in several other Asian countries.
In other words, there is a problem — and it is international in scope. In this respect, we have to agree with statements made by a number of governments throughout the 1980s. Although statements about the need for 'a war on drugs' at home and abroad may be making up in excitability for a deficit of effective control measures, it would be wrong to suggest that governments are fighting phantoms. Anybody trading places with a doctor or social worker, with a parent or other relative of someone heavily involved with heroin, with a heroin user him or herself, with a drug trafficker or law enforcement agent would be hard put to maintain that their concerns were purely fictional. 'The issue is not whether or not there is a problem but what sort of problem it is and, hence, how it is best tackled.
This realisation requires of us that we give up certain habits of thought to which we may still cling. During the 1960s and 1970s it was fashionable in social science and liberal circles to question whether the prevailing concern about drugs use might not be an example of what was termed a 'moral panic' (cf. Cohen, 1980). This term and the paradigm that supported it have now fallen into relative disuse or have been considerably re-cast (Ives, 1986). Nowadays, social scientists have turned from pronouncing that popular ideas are examples of 'mystification' or 'false consciousness' and have begun to ask how and why popular or leading ideas (e.g. about drugs) win acceptance.
One possible — and perhaps obvious — answer is that modes of thought become popular because they make sense of the social position in which social groups find themselves. This is so in relation to heroin in two senses. First, there really has been a significant increase in the availability of heroin in Britain, and young adults in particular are experimenting with its use in ways that can cause a variety of objective problems. Some of these problems are discussed in this book. Secondly, and less directly but no less powerfully, the spectre of heroin hits a political nerve in Anglo-American cultures — self-indulgence, unbridled pleasuring of self, abuse of the body, the ultimate in empowerment within, a private world alongside disempowerment within society. It is noticeable that, when viewed historically, concern over the misuse of heroin and other drugs has only relatively recently arisen in relation to the mature, white, male adult in Western societies. In Britain, from the nineteenth century onwards, the spotlight of concerned reaction has moved from middle class women who used opiates for 'selfish pleasure', to working class female child-minders who dosed their charges to keep them more mangageable (Berridge and Edwards, 1981). In the United States, the focus of concern originally centred upon a range of ethnic minorities (Helmer, 1975) and remained so well into the 1970s. In the post-War period in most 'developed' countries the spotlight fell upon young people. There does seem to be some common thread running through this history. Drug abuse generally, and heroin use specifically, signifies the very opposite of the idealised stereotype of masculinity Drug users are often seen — and, indeed, may sometimes celebrate an identity — as weak, vulnerable, lying, cheating, concerned with pleasure, turning away from responsibility in the world. There is more here than can be captured by the term 'moral panic'.
Given the historical construction of the imagery surrounding heroin, and some contemporary experience of the practice of its widespread use, it is not surprising that public concern runs deep. Although, like others, this social problem is socially and historically constructed, it is sufficiently entrenched to resist being blown away by a few puffs of sociological rhetoric or `deconstructive' analysis. Heroin problems are as real as, let us say, economic recession. One can no more get rid of them by attempting to define them out of existence than one can get rid of unemployment by such means (although this strategy has indeed been attempted in Britain). However, this is not to say that the problem cannot be mitigated if correctly understood.
So far this framework remains very schematic. Selected aspects will be filled out in the following chapters. Let us first however, continue with our overview, which can be represented diagrammatically as shown in Figure 1.
First and most obvious, there has to be some quite substantial level of production of a drug before international trafficking, domestic distribution and individual consumption of it can take place in a widespread manner. In the case of heroin, the essential element in production is cultivation of the opium poppy and harvesting of the milk from its seed pods, for which the chief requirements are hot sun and cheap labour. Since the late 1970s, there has been an increase in cultivation of poppy and production of opium for the manufacture and export of heroin in the Third World — although there have also been shifts in the balance of production between countries. In Chapter 2, Gerry Stimson describes the geo-economic background to this, showing how Third World production of opium fits into the economic and political position of these countries vis-à-vis the international order. A colonial history of cash-cropping for export to the more developed countries, the current debt crisis, and the adverse balance of trade provide the conditions in which heroin production is an attractive option for many Third World communities who lack other means of subsistence and advance. The chapter goes on to describe ways in which heroin is imported into developed countries, including Britain, and the prospects for law enforcement at these levels are discussed. Stimson concludes that only genuinely bilateral agreements — recognising the interests of producer and recipient countries — have any prospect of reversing the current trend in international drug supply.
The next 'level' in our general framework for understanding the problem (Figure I.1) is that of the position of social groups in Britain and other Western countries in relation to recent developments in the economy. At this intermediate level (between large-scale supply and individual consumers) the activities of those in the drug-distribution business are of great importance. Recently, popular and academic attention has been drawn to the hidden, unofficial, 'grey' or informal economy, and to the extent to which this may expand in times of recession and restructuring of the formal or regular economy. Many aspects of this informal economy are of no consequence for the drug problem; for example, doing odd jobs 'off the books' or neighbourly reciprocation of goods and services in kind rather than in cash. Other aspects such as home-brewing or wine-making for household consumption or local sale are of potential interest, increasing amounts of alcohol being produced in this way, at low cost and duty-free. The part of the informal economy that is of greatest interest from the point of view of concern with drugs use and availability is its 'irregular' part. This encompasses more overtly criminal activities such as theft, 'fencing' stolen goods, dealing in illegal services, etc. The distribution system for heroin and other drugs inhabits the broader, vigorous irregular economy. This should not however be considered as something entirely separate from the regular economy, as many studies have described the link between the two: the irregular economy (and drug dealing) is simply a high-risk, high-return extension of the regular or formal economy. Persons bridging these sectors (for example, historically, the Mafia) are the mainstay of higher-level drug distribution. They are the focus for law enforcement strategies, such as the increase in the maximum penalty for supply of drugs to life imprisonment and confiscation of assets resulting from crime. Judging from past decades' experience however, increases in penalties alone cannot deter drug distribution — rather, such increases appear to force out relative amateurs and to `hardén' the trade.
Turning now to lower-level distributors, who may also be quite likely to be users of the drugs in which they deal, we can situate this type between the irregular economy and a third sector — the depressed sector of the economy (see Figure I.1). User-dealers with limited licit sources of finance operate in an opportunistic style within the local street economy, interspersing petty theft, burglary, dealing in drugs and generally providing services at the edge of and beyond the law. A key aspect of this role is the highly active, yet erratic pattern of economic and social life (Johnson et al., 1985); drug use occurs here within a context of a life-style of survival on one's wits. Such individuals make a contribution to the recorded rate of property crime, but it is by no means clear that property crimes are caused by involvement with drugs: rather, both may be part of the broader pattern of 'making out' (see Chapters 1 and 3).
Next — and in terms of the world literature, most familiarly — we come to the depressed and marginalised classes of society. By this we mean those who at best have only a modest pool of material resources on which to draw and who have been hardest hit by the recession. In most countries, including the UK (and particularly in the north, and parts of London), there are severe pockets of deprivation in which poor housing and industrial collapse coexist. In such contexts young people have little prospects of employment, every prospect of lifelong poverty and no alternatives — except, perhaps, to hustle in the irregular economy, which does not fit the cultural orientations of everyone. If heroin becomes available in such areas then, as Pearson describes in Chapter 3, it is likely to be spread by the hustlers and irregulars to the wider set of young people sharing the experience of economic and social depression. This is the most socially destructive pattern of heroin use, potentially drawing in people of a retreatist frame of mind who have few foci of economic and social involvement or pleasure other than the drug. Furthermore these communities are least well served by health and welfare services and the parents and other lay responders to such problems have few material rèsources with which to conduct any kind of fightback.
Nevertheless, as Donoghoe et al. suggest in Chapter 4, difficult cifcumstances can draw out strong responses. In part of this chapter, these authors describe the way in which women in one metropolitan area in the north of England (many of them mothers of heroin users) utilised and extended existing tenants' organisations to confront local dealers, to demand better state services and collectively to control and care for their young people. More generally, Donoghoe et al. describe how family members, mothers especially, respond when they discover that a child of theirs has taken drugs. Initially, there is a period characterised by shock, feelings of disorientation, anger and guilt, followed by discussion within the family and with neighbours and by a variety of strategies of care and control of the wayvvard young user. In the longer term some families then turn to public forms of action. Several case studies are outlined, showing how — depending upon the social and cultural resources available — parents may organise collectively to attack the problem locally, or may leave it in the hands of state and other services, or may work alongside and with such services.
Although spending on health-system responses to drug problems has increased, these responses have not kept pace with the growth of such problems. In the penultimate chapter, Susanne MacGregor and Betsy Ettorre describe the current state of services, pointing up the changes in balance between the statutory services (Drug Dependency Units, colloquially known as 'clinics') and the non-statutory services, and discuss the limits and possibilities for future developments. The authors see the relationship between statutory and non-statutory systems of care as having passed through several phases. In the late 1960s, the statutory sector was assumed to be adequate to care for and control heroin users and the non-statutory sector was not recognised as capable of making more than a peripheral contribution. Throughout the 1970s, the non-statutory sector became seen as an important adjunct to the statutory sector. During this time, the concerns of policy-makers focused on the need to provide an integrated system of care and control in those areas of Britain in which the heroin problem was then concentrated. In the latest and current phase, services have been extended geographically, in response to the spreading of the problem, through the government's Central Funding Initiative. In many localities, practitioners are becoming more aware of the problems of women and of ethnic and religious minorities, though this awareness is still a rare and fragile thing and is not generally reflected at the policy-making level or in the provision of serviees. Overshadowing current activities is the knowledge that central government 'pump-priming' through the Central Funding Initiative (CFI) was designed to be a short-term measure intended to stimulate the setting-up of services that thereafter attract local funding. There is considerable uncertainty about the likely pattern of services from 1987 onwards, when the CFI begins to wind down, and prospects for statutory and non-statutory services that are innovative or oriented to special needs do not look particularly encouraging at present.
For a minority of those affected by drug problems, there is the option of private, fee-for-service treatment and rehabilitation. It is no longer novel to observe that middle-class people — even upper-class people — are as prone to using heroin as are other social groups. A high level of disposable income allows easy expenditure on leisure pursuits such as the use of legal and illegal drugs, and we have indicated this possibility in Figure I.1 by the term 'yuppie' Cyoung, upwardly-mobile') drug use. Nearly every Western political administration has faced the embarrassment of sons or daughters of Ministers or others of high office being exposed as users of illegal drugs such as heroin. Sometimes such exposure has been precipitated only by the event of death through overdose. More generally, heroin use seems quite at home in the middle and upper-middle classes, and provides a fair trade for the purveyors of private treatment.
That heroin problems are to be found at all levels of society is now generally acknowledged. The question, then, is what to do about it? The contributors to the volume examine specific aspects of the problem — supply and enforcement, treatment and rehabilitation, the relationship between socio-economic conditions and heroin problems, family and community responses — and whilst they share a broad perspective upon the nature of these problems they do not constitute a tightly-bounded 'school of thought' with a policy manifesto. This being the case, the editors themselves have attempted to provide a final chapter in which proposals are made for diminution of heroin-related problems. Our general conclusion is that action to prevent production and supply at international level will continue to be only partially effectrve. The problem must therefore be tackled within Western countries through a mixture of innovative strategies to control distribution (hence, availability and consumption) and 'harm-reduction' strategies building upon the existing practices of a range of practitioners, both professional and lay. Whilst the other contributors to this volume have seen a draft of this final chapter they carry no responsibility for it. If our conclusions are controversial and perhaps not spelled out in as much detail as the reader would wish, then we apologise and plead the case that an outline statement is at least useful as a starting-point for criticism and counter-proposals.
The chapters by Gerry Stimson, Susanne MacGregor and Betsy Ettorre, Geoff Pearson and our other colleagues are prefaced by an initial chapter giving a straightforward description of what heroin is, how it 'works', and what the patterns of use and associated dangers may be, as well as brief, introductory discussions of some issues relating to heroin and crime and to heroin and treatment. This chapter is closely based upon an extended briefing paper prepared by ISDD staff and updated for publication here. For some readers this material may be familiar 'old hat' but we have included it for both theoretical and practical reasons. At a theoretical level, we believe that the social and economic sciences have to recognise the material facts of biology and the body. Practically speaking, accurate knowledge can save lives if it informs policy and practice.
One thing this book does not offer. The contributors abstain altogether from the kind of chapter which begins:
From ancient times immemorial Man [sic] has sought relief, transcendence and happiness by all manner of means . . .
We hope that this collection is the more immediately relevant (and readable) for this abstention and that it proves of general interest and practical value to all those concerned with issues of health, enforcement, self-help, social welfare and social policy generally.