The British system

This term is not contested but awareness and understanding of the British System is very limited and yet it is a very useful perspective from which to view some treatment, for example, heroin assisted treatment (see heroin assisted treatment) rather than imagining, as seems to be the thrust of much media and political discussion, that such approaches are ‘foreign’ or ‘work abroad but couldn’t work here’. The British System also contextualises substitution treatment (see medication assisted treatment) including methadone-based treatment which are sometimes regarded as imported from the US or elsewhere within a long traditional of British medical practice.


The term ‘British System’ refers to the treatment system in the UK that evolved from the recommendations of the report of the Rolleston Committee (1926) which was established by the UK Health Secretary John Wheatley MP in 1924. This held that people who had, for whatever reason, developed a dependency on a drug should be prescribed that drug or the nearest pharmaceutical equivalent. The system lasted well into the 1960s and prevented the development of a street drug market like the one that developed in the face of stricter prohibition and unsympathetic medical practice elsewhere, for example, in the USA.

The system effectively controlled the drug market and supported people with dependency well into the 1960s. The system failed largely due to the poor practice or malpractice of a small number of prescribers including Isabella Frankau and Dr John Petro which created a small illegal market. This resulted in media and then public concern and backlash from the UK Government. Government action to further control prescribing dissuaded doctors from prescribing to people who were dependent. This comparatively small group of dependent users were then forced into the illegal drug market then created by criminals and organised crime.

The very last remnant of the British system was the practice on Merseyside led by Dr John Marks from 1982 to 1995 which was eventually closed through local police and political action.

The British System is sometimes used to explain the role and benefits to individuals and wider society of prescribing substitute medication (see medically assisted treatment; see heroin assisted treatment; see opiate substitute treatment).

Explore further:

Sneddon, T (2020) ‘Prescribing heroin: John Marks, the Merseyside clinics, and lessons from history’ International Journal of Drug Policy Volume 78