hatching a drug addict having a fix is a disturbing eXperience. Nothing emphasises so well the gulf between addict and non-addict than seeing the absolute seriousness and concentration of an addict injecting heroin into his arm. The total dependence on the contents of a 2cc syringe is incomprehensible to someone not on drugs. I watched, not understanding, with ^elings of pity, helplessness and revulsion at the sheer physical abuse of tissue as Larry searched, with jhe needle deep inside his arm, for the best place to shoot' the heroin. Larry is eighteen. He has been 'hooked' for about a year. His arm is scarred with 'tracks' left by injecting dirt with the drug when fixing in a hurry. He is unkempt, spotty, swathed in several sweaters, intelligent hut inarticulate. I watched him having his fix in the neat office of a psychiatric nurse. The heroin had n?t come from a pusher working furtively in a club or bar but from a dangerous drugs cupboard, suppled by an amiable young Irish male nurse who helped Larry loosen and tighten the plastic belt he was using as a tourniquet on his upper arm. Larry is lucky enough to be an out-patient at the drug addiction unit at All Saints Hospital, Birmingham. Potential gravity

Lhe addiction

clinics and units in London, under the direction of the Ministry of Health, opened their doors last month. These facilities are an attempt to comply with the recommendation in 1965 of the ^rain Committee on Drug Addiction to take measures 'designed to prevent over-prescribing which do not prevent or discourage addicts from obtaining supplies'. The All Saints unit was opened 'u 1964?before the potential gravity of the addiction Problem in Britain was recognised in Whitehall. By


chief psychiatric social worker, gravitated to the unit because that was where there was the immediate problem. The unit's chief male nurse, David Hill, was originally apprehensive about the job, but is now completely involved and looks on the past four years as the most satisfying of his career. A firm, benevolent man from a Staffordshire mining family, David Hill is the link man of the unit who works at gradually establishing a relationship with the addicts. 'They look on me as a dad,' he says cheerfully.

Community co-operation always regarded drug addiction as multi-factorial problem within society and not just a medical one. His immediate aim in Birmingham was containment and he knew that any attempt to clamp down on the spread of addiction could not work without the co-operation of the community. He Dr. Owens has


asked all general practitioners to leave the prescription of heroin and cocaine to his staff. They agreed. Then he asked city chemists to leave the dispensing of these prescriptions to three or four chemists in the Birmingham area. Again he was successful. The chemists concerned are introduced personally to each addict and use only prescriptions posted to them from the unit. From the beginning the police co-operated with Dr. Owens?in fact, it was a sergeant in the drug squad who brought the first patient to the unit. Members of the squad are now frequent visitors to the hospital. They come with new referrals, to discuss a patient's progress or just for tea and a chat to keep in touch. Drug education is now part of the curriculum in many secondary schools around Birmingham and all members of staff at the unit have more speaking engagements than they can handle. They go to sixth

in the treatment of drug: addicts f?65


40 heroin addicts receiving prescripnow there are 10; 30 out of 50 Edicts treated since 1964 have now been off heroin up to 20 months. There have been no new addicts January 1967, and out of all addicts treated since 1964, the unit has lost touch with only seven. The unit at All Saints was not hastily created to c?pe with a problem on the verge of getting out of were

tions from the unit,

fpr sjnce


It was conceived as a regulating, preventive a?d treatment centre by Dr. John Owens, a consultant psychiatrist with initiative and unconventional 'deas. He had worked with alcoholics and was interin all types of addiction before coming to All



Dr. Owens, a dynamic Scot with enormous energy, collected around him a small team of workers who Quickly caught his enthusiasm. Michael Nyman, his

forms, P.T.A. meetings, Mothers' Unions and all of clubs and organisations to discuss addiction. Michael Nyman spends a great deal of his time involving patients' families in the treatment. Once he convinces them that addiction is sickness rather than delinquency he finds they co-operate. He also deals with other social agencies in the city on the addicts' behalf to try to find work and accommodation for them. Dr. Owens' first priority has been to get the heroin addicts coming to the unit and they must?to get manner

come of their own free David Hill puts it.) With the legal sources of supply and distribution rigidly and voluntarily controlled, Dr. Owens and the staff have concentrated on reducing the amount used. This


prescriptions. ('They

will?under pressure,'


11 h-

has meant not only persuading the addict to take less but also cutting off the black market supply.

Fringe addicts They knew that if they gave





supply he would finish it in about four days by injecting too much or selling to fringe addicts or both. So they issue one- or two-day prescriptions. Addicts unable to plan even 24 hours ahead become day patients at All Saints.

With the addicts coming to the unit every so often for their prescriptions the staff has been able to work on building a relationship with each patient. They encourage the addict to build relationships with more than one member of staff so as to get continuity and not overburden one person. David Hill now assumes most of this work, since the case load has become small enough. The relationships are built on understanding and mutual trust. For this reason Mr. Hill is totally against the use of placebos for addicts in distress. It is usually only after a long association and the development of trust that the addict will come in for withdrawal. The addict undergoes deep narcosis?a comparatively new form of treatment which removes much of the fear of withdrawal pains. He is put to sleep for about a fortnight (there is no rigid time

A nurse helps an addict to

adjust his tourniquet



and awakes with his

mind?free from heroin. There is


body?if not his period of rehabi-

litation, after which the addict is encouraged to leave and take a place in the community. Psychiatric treatment can continue and Michael Nyman is there to make the way back easier. As he says. They trot back when they're in trouble.' one London teaching hosgovernment grant of ?50,000 to establish a drug clinic. For all the pioneering work of the All Saints unit and the useful information it has accumulated no government money has been forth-

Dr. Owens is bitter about

pital having



The expense has been borne out of the


mal hospital appropriation fund. The staff of the unit

dubious about the London because he does not believe a treatment centre can work without the kind of community co-operation that he has achieved in Birmingham. There is also the problem of checking that an addict does not try to get supplies from more than one unit in the same area at the same time. He is convinced that his methods could be applied anywhere given enough co-operation and determination to make them work. The lesson learnt in London this year should indicate how much the London drug scene needs Dr. Owens' ideas. scene. Dr. Owens is



Photos: John Brooke

Control and Trust.

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