Select Committee on Home Affairs Second Special Report

DRUGS AND PRISONS

The Home Affairs Committee has agreed to the following Special Report:

Levels of drug use in prison

  31.  While the random MDT results have provided much more information than was previously available, the results understate the overall level of drug use. In particular, there are problems with estimating the levels of use of harder drugs. It certainly cannot be concluded that a positive test rate of around 5 per cent for opiates means that only 5 per cent of prisoners take opiates while in prison; the actual rate—at least for occasional use—may be very much higher (paragraph 91).

  The Government shares the Committee's view. The MDT results provide a guide to the levels of drug misuse in prisons. While the actual levels of misuse are likely to be higher it is clear that the trend is that drug misuse in prisons is falling steadily. Also, the Committee may have misunderstood the results themselves—a monthly random positive rate of 5 per cent for opiates for example, does not mean that 5 per cent of prisoners have taken opiates. It means that of the total tests in that period 5 per cent showed positive traces of drugs. No inference about the likely proportion of the population should be made on the basis of that figure.

  32.  There is a need for continuous attention to be paid to improving the effectiveness of the MDT programme as a means of assessing levels of drug use in prison . . . but unless and until the MDT results are sufficiently reliable there is a need also for continuing research into levels of drug use by other methods, including survey evidence (paragraph 92).

  The Government notes the Committee's conclusion. The Government has seen no evidence to show that the MDT results are unreliable—the key issue is the interpretation of the results. The Government shares the Committee's view that it is necessary to supplement the MDT programme with other research methodologies. Two independent pieces of research have already taken place, with another planned.

  33.  The random MDT results provide evidence consistent with a downward trend in the use of cannabis within prison; we are not sure however that we can go much beyond this to be confident that there is a clear downward trend in drug use overall. We see no indication that there is any downward trend for use of opiates (paragraph 93).

  The Government shares the Committee's conclusion.

  34.  The levels of drug use—whether at around 20 per cent or higher than this—are still high, and there are still prisoners (though not necessarily significant numbers) who use drugs for the first time while in prison. The levels of use entirely justify the continuing development of a major anti-drugs programme and the sums which have been directed towards it (paragraph 93).

  The Government shares the Committee's view.

Assessment of Mandatory Drug Testing

  35.  Steps need therefore to be taken to improve the efficacy of the random MDT process. These steps include:

—  an audit of the extent to which the procedures set down for the actual administration of the tests are being followed by all staff;


—  an increase in weekend testing (and we accordingly welcome the fact that the Prison Service has already issued instructions for the rate of weekend random testing to rise to 14 per cent of all random tests);


—  further research into whether alternative kinds of tests, such as hair tests or saliva tests, might be more reliable and/or might record traces of opiate use for significantly longer periods than the current urine tests (paragraph 96).

  The Government shares the Committee's view: an audit system is in place; weekend tests are in place; and there is ongoing contact with drug testing companies, both here and abroad which provides learning on the effectiveness and reliability of the different methodologies.

  36.  We recognise that random MDT may have a limited deterrent effect on drug use by prisoners serving medium or long sentences (though any such effect can only be weakened by the reduction to a 5 per cent testing rate per month). But we doubt very much that it can be having any significant deterrent effect on those serving only a few months, the very group which is in some ways the most important target for the drive to reduce drug use (paragraph 99).

  The Government has concluded that in fact the opposite effect takes place. Prisoners serving shorter sentences are much more likely to be deterred by the prospect of days added to their sentences because of a positive MDT than those serving long sentences.

  37.  We accept that there are severe practical obstacles in the way of introducing a system of 100 per cent drug testing of prisoners at least if the tests are to be used as the basis for disciplinary proceedings as well as for measurement of overall levels of use. Nevertheless, there might be merit in the Prison Service assessing the feasibility of running occasional tests of a much higher proportion (than 10 per cent) of the inmates of a single prison, using the simplest and cheapest test available (paragraph 103).

  The Government shares the Committee's view and will explore the possibility of conducting such exercises.

  38.  We conclude that this [relative or actual shift from use of cannabis to harder drugs] has arisen from a variety of different factors, of which the MDT programme is only one. But we acknowledge that the MDT programme has failed if it has reduced cannabis use but has had no effect on heroin or has even increased its use. Further examination of this issue must form a part of the continuing research into levels of drug use in prison for which we have called above (paragraph 108).

  The Government rejects the Committee's view. There is no evidence of a shift from cannabis to more harmful drug use in prison. While the MDT results shows a fall in cannabis use, they do not show a rise in the use of other drugs. Furthermore, the MDT programme is only one element in the fight against drug misuse. Much more influential are good security and good treatment.

Disciplinary and other responses to drug use

  39.  [A number of general principles about punishments and disciplinary responses have emerged from the evidence:]

—  The use of "added days" must be available as a punishment for drug use but its use must be kept to a minimum.


—  Significant use must therefore be made of alternative responses such as loss of privileges, with corresponding incentives for drug-free behaviour; one of the main ways of achieving this is through linkage to the Incentives and Earned Privileges Scheme.


—  There should be a reasonable consistency within the system in the response to positive MDT tests and other drug offences in prison and responses must distinguish between the level of seriousness of different cases (particularly between the supply of drugs and the use of drugs).


—  The response regime must be linked also to the process for identifying those in need of treatment and to the provision of treatment; and it must be sufficiently flexible to recognise that all drug users cannot necessarily be expected to stop drug use at a stroke (paragraph 112 to 116).

  The Government shares the Committee's conclusion.

Distinguishing between use of cannabis and use of harder drugs

  40.  There is a danger that instead of developing a strategy which successfully targets hard drug use (and reduces cannabis use in the process), a strategy is developing which successfully targets cannabis use but leaves hard drug use virtually unchanged (paragraph 117).

  The Government does not accept the Committee's conclusions. The fall in MDT positives reflects the effect of the previous drug strategy. The Committee concluded its enquiry at the beginning of a 3-year programme of work to implement the new drug strategy. The Committee has no evidence on which to base its conclusion.

  41.  We do not agree that cannabis use in prison should be the subject of a policy of quasi-tolerance. We do however think it right that the primary objective should be a reduction in the use of hard drugs, and that the elements of the prison anti-drugs strategy should reflect this (paragraph 121).

  The Government shares the Committee's view.

  42.  We think that further steps may be needed to ensure that the new strategy impacts more powerfully on hard drug use than cannabis use (paragraph 123).

  The Government shares the Committee's view but it is far too early to draw conclusions about the effect of the new drug strategy on the use of individual drugs.

  43.  We welcome the moves being taken towards greater differentiation in punishment for use of cannabis and for use of harder drugs . . . . The automatic application of targeted frequent testing on those who have tested positive for harder drugs (already being introduced) should be combined with greater targeting of such users for places on treatment and offending behaviour programmes (paragraph 124).

  The Government shares the Committee's view.

  44.  Work on developing improvements in methods of detecting drugs on visitors and addressing other modes of entry for drugs must concentrate on harder drugs (paragraph 125).

  The Government accepts the Committee's conclusion but it is essential that the improvements in the detection of and testing for harder drugs does not take place at the expense of the detection and testing for cannabis or other drugs considered by some to be less harmful. The Government remains committed to preventing the use of all illicit drugs in prisons.

  45.  In the continuing process of identifying better tests and testing procedures priority should be given to possible developments which are more effective in respect of harder drugs (paragraph 125).

  The Government accepts the Committee's conclusion but it is essential that the improvements in the detection of and testing for harder drugs does not take place at the expense of the detection and testing for cannabis or other drugs considered by some to be less harmful. The Government remains committed to preventing the use of all illicit drugs in prisons.

  46.  We recommend that the Key Performance Indicator used for addressing drug abuse be recast in such a way as to give greater emphasis to the fight against harder drugs; this could be done either by setting a target for harder drugs alone, or by setting a separate sub-target for harder drugs within the overall target (paragraph 126).

  The Government notes the Committee's view and the Prison Service will consider the creation of a different KPI.

General observations [on treatment plans]

  47.  Overall, we agree that the planned expansion in, and overall design of, provision of treatment services under the new strategy builds well on the foundations laid under the previous strategy and represents a major step forward. It should in particular reduce the inconsistency in provision around the prison system. The Prison Service must take steps to ensure that this consistency enables prisoners to maintain continuity in treatment across their time in prison (paragraph 132).

  The Government shares and welcomes the Committee's view.

  48.  We recognise that the sums made available under the Comprehensive Spending Review were relatively generous in public expenditure terms. Nevertheless, we cannot rule out the possibility that time may yet prove that further sums are needed. Certainly there will be a need for sustained funding beyond the present CSR period (paragraph 135).

  The Government shares the Committee's view.

  49.  We have not received compelling evidence that the Prison Service has been unduly slow and we accept that properly designed new services cannot be established overnight (paragraph 135).

  The Government shares and welcomes the Committee's view.

  50.  We welcome [the Government's stated intention to commission independent research on the longer-term effectiveness of UK prison treatment programmes], and call for the research to be commissioned as soon as possible. In the meantime, we note that the Prison Service's bid for funds for drug work beyond the CSR period must be assessed against forecast results, and not against conclusions drawn prematurely from existing outcomes (paragraph 136).

  The Government shares the Committee's view.

Design and provision of treatment programmes

  51.  We agree that successful delivery of the treatment programmes under the New Strategy will require significant contributions from both outside agencies and the Prison Service. We consider that the office of the UK Anti-Drugs Co-ordinator is best placed to ensure that the correct balance is achieved, and we recommend (i) that the UK anti-Drugs Co-ordinator has a formal role in approving the arrangements made for any new services; and (ii) that the new Prison Service area drug co-ordinators, as part of their task of monitoring how the resources provided for the strategy are being used, should also report to the UKADC periodically on (a) whether the intended balance between internal and external provision is being adhered to in practice and (b) the extent to which there is any de facto diversion of resources intended for drug work to other prison needs (paragraph 140).

  The Government notes the Committee's view. The office of United Kingdom Anti Drugs Co-ordinator has been consulted on the development of all specifications for the new treatment services being introduced across the prison estate and has approved all of them. Beyond that, there are formal procurement procedures which must be followed. The Prison Service already reports to the UKADCU via its Headquarters Drug Strategy Unit. It would be inappropriate for the Area Drug Co-ordinators, who report direct to Prison Service Area Managers, to undertake this task.

  52.  We strongly endorse the need for any Prison Service staff deployed to the new treatment programmes and services under the new strategy to be properly trained and qualified. We recommend that the training strategy currently being devised should include the setting of minimum standards (or competencies) for such staff, and that the training is externally audited (paragraph 141).

  The Government shares the Committee's view. It is crucial for all staff involved in providing drug treatment, both Prison Service staff and community drug agency staff, to hold minimum levels of competence and training. The Prison Service is currently conducting a training needs analysis to identify what type of training framework is needed to ensure that all staff working in prisons have appropriate knowledge and skills about drug misuse.

  53.  It is clear that a fully effective drug strategy will depend not only on effective specialist training for those staff working directly on drugs programmes but will also require effective minimum levels of training in drugs issues for all staff (paragraph 142).

  The Government shares the Committee's view.

  54.  We support the process of requiring accreditation for drug treatment programmes in prisons. We would however be surprised if courses recognised as successful in tackling drug use were not able to gain accreditation. We call on the Prison Service to consult closely with outside course providers on the criteria on which accreditation should take place, before taking action not to accredit any otherwise successful courses (paragraph 144).

  The Government notes the Committee's view and will take it into account in proceeding with the accreditation process.

Observations on particular elements of provision

  55.  It seems that almost all observers have pointed to a need for assessment procedures on induction to be improved, through better exchange of information, through ensuring that correctly trained staff and health professionals are available, and through ensuring that procedures are such as to enable the new prisoner to be confident that information he imparts will be used for therapeutic rather than disciplinary purposes . . . We recommend that it should be mandatory to subject all prisoners on admission to dip tests for the more widely used hard drugs. Prison and indeed probation provide a perfect opportunity to tackle drug addiction and this can only be done if drug addicts are identified as soon as they come into contact with the criminal justice system. This can only be done by a system of 100 per cent testing. The objective should be to ensure that all regular users of hard drugs are identified on admission (paragraph 149).

  The Government notes the Committee's view. The assessment process is crucial and is improving as the new CARATs system takes effect. The case for 100 per cent testing on arrival is not straightforward. All drug testing, of whatever type, has significant resource implications. In addition, the practical implications for busy local prisons with large numbers of new receptions would be considerable. Furthermore, it is by no means true that all prisoners arrive with no information on whether they have a drug misuse problem. Though inconsistent, there is a considerable amount of information on a number of prisoners, which would make 100 per cent testing wasteful.

  56.  Provision of appropriate prescription courses for drug misusers is, quite correctly, a matter ultimately for clinical judgement; nevertheless it is clear there is continuing dissatisfaction from qualified observers as to the lack of consistency in present practice. We trust that the new strategy, through increased availability of services, will enable some of the inconsistencies to be removed, but the Prison Service needs also to review whether further guidance needs to be prepared and distributed and whether implementation needs to be more closely monitored (paragraph 152).

  The Prison Service is developing a new Health Care Standard on Clinical Services for the Treatment of Substance Misusers. This will reflect the evidence based content of "Drug Misuse and Dependence—Guidelines on Clinical Management" issued by the health departments in 1999, copies of which have already been sent to prison doctors. Compliance with the directions in the Standard will be reviewed as part of the Prison Service's usual audit procedures. A training package is being developed for use in conjunction with the new Standard.

  57.  We agree that basic drug education should be a part of the induction process for prisoners. It must however be delivered in an effective way, and levels of understanding of drug issues amongst prisoners should be continuously monitored (paragraph 153).

  The Government shares the Committee's view but it is essential that drug education is not restricted to the induction process, particularly for those prisoners serving long sentences.

  58.  We concur with the Prison Service's present position, namely that at this stage disinfection materials should be provided but not needle exchanges. This issue should be kept under review, depending on evidence of prisoner behaviour and the prevalence and spread of the relevant communicable diseases (paragraph 154).

  The Prison Service reintroduced disinfecting tablets, on a trial basis, in 11 establishments in 1998. It is currently considering a report from the London School of Hygiene and Tropical Medicine evaluating this pilot project. The Prison Service has no current plans to introduce needle exchange schemes in prisons in England and Wales but continues to monitor developments in the field, both at home and abroad.

  59.  Drug treatment in prisons has focused on longer-term prisoners. The same attention needs to be paid to remand and short-term prisoners. They are more likely to be in prison for drug-motivated crime and treatment is more urgent because they will be released sooner. They are the greatest challenge if the cycle of addiction, crime and imprisonment are to be broken. We recommend that the Prison Service should make more drug rehabilitation programmes available to remand and short-term prisoners beyond what is currently envisaged under the CARAT service. We commend the suggestion of the Magistrates' Association that short-term custodial sentences for drug-related crimes should be combined with a requirement to receive treatment in the community on release (paragraph 159).

  The Government agrees with the Committee's view. However there is a limit to what can be delivered to offenders serving short sentences as at times there is simply insufficient time to deliver a recognised drug treatment programme. For such prisoners, the CARATs system will be the only intervention. The key will be good quality assessment and the ability of community drugs agencies to accept such offenders immediately on release.

Post-treatment support for prisoners

  60.  We support the development of minimum standards for Voluntary Testing Units. We do not think it necessary to go as far as establishing a formal accreditation system for VTUs though an examination of each unit against the required standards should be an automatic part of HM Chief Inspector of Prisoners' assessment of a prison (paragraph 164).

  The Government agrees with the Committee's view.

  61.  If a VTU is not run effectively, so that drug use is not identified and dealt with, and at the same time there are non-drug related incentives for going on to a VTU, then there is a risk that the VTU will attract drug users who will negate the benefit of the VTU for those genuinely seeking to remain drug-free. Access to a VTU should not therefore be directly linked to the "enhanced" level of privileges unless the prison authorities have satisfied themselves that its procedures are robust enough to identify drug users (paragraph 166).

  The Government agrees with the Committee's view.

  62.  It is clearly of vital importance for the effectiveness of the rest of the strategy that aftercare for prisoners is more than just an afterthought. The extension of a limited form of support, in the form of continued contact with the CARAT Service in prisons for up to eight weeks following release, is a move in the right direction, and the stronger links envisaged between prisons, probation services and Drug Action Teams should also be beneficial . . . The Prison Service must establish procedures for the effective monitoring of how the new strategy is performing in this area, and be ready to take the steps necessary to address any deficiencies. The ultimate target must be that there is an automatic right of referral to a place on a relevant programme in the released prisoner's home area, and that, where appropriate, contact has been made between the prisoner and that programme before release (paragraph 171).

  The Government agrees with the Committee's view.

21 January 2000

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Prepared 3 March 2000