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11.30 am
Mrs. Jacqui Lait (Beckenham): I, too, must apologise to the House, as I have constituency engagements that I must fulfil. Coincidentally, one is at a neighbourhood law centre, where the subject of drugs abuse is almost certain to come up. I shall also visit the local police station, where a similar matter is likely to be raised.
It is an honour to follow the hon. Member for Newport, West (Paul Flynn), who has long been known for his campaign on drugs. Although I do not intend to follow his path, as I am sure he will understand, I hope that one or two points of agreement will emerge from my brief comments, which are much more related to my constituency than to national policy.
However, I have one point to make on national policy. I should be grateful if the Minister would either put his answer on the record or write to me, as I shall not be present for the winding-up speeches. The debate about cannabis use focuses on the legal and criminal implications, and makes only passing reference to the health implications. The hon. Member for Newport, West referred to the good that cannabis can do for multiple sclerosis sufferers. I hear similar evidence from my friends in the health professions, but they also tell me that long-term cannabis use leads to chest and heart problems, cancer and mental health problems, which is much more worrying.
I seek an assurance that the full weight of medical views on the effect of long-term cannabis use on people's health will be taken seriously into account in any decision by the Home Office and the advisory council.
Michael Fabricant: Could I tempt my hon. Friend to agree with me that, if one or two doctors agree that cannabis should be prescribed for medicinal purposes—I repeat, for medicinal purposes—it should be prescribed now?
Mrs. Lait: I am not an expert, but I understand that a Government-sponsored research programme is finding out what the effects are. I am a great believer in not doing anything until we have discovered all the evidence, which is possibly why I have criticisms of the Home Secretary's statement to the Select Committee, which was perhaps taken the wrong way. He announced a change in drugs policy before all the evidence was properly examined. We must consider the evidence, and I hope that the full weight of the medical evidence on the effects of long-term cannabis use will be taken fully into account in any decision.
The charity ADAPT is based in Bromley. ADAPT is short for "addicts are people too", and it concentrates on long-term, high-dependency drugs users. The hon. Member for Bolton, South-East (Dr. Iddon) and my hon. Friend the Member for North-West Norfolk (Mr. Bellingham), who hope to catch your eye, Mr. Deputy Speaker, are well aware of that charity. The problem of longer-term, high- dependency users in the current regime instituted by the Home Office is that the treatment they require to stabilise themselves is not being provided.
High-dependency users—there are 45 in Bromley borough alone—have been attending the Laybourne clinic in the east end of London. The clinic has had great success in stabilising those people. As we all know, one problem for drug addicts is their disordered, chaotic lifestyle.
As high-dependency users grow older, they recognise that, to bring some stability to their lives, they need to reconnect with their family and friends and with society in general. They need to be able to write the CVs that will get them the jobs that will bring them back to the mainstream. That requires them to keep their drugs use stable as well.According to ADAPT, under current Home Office policy, those particular users are often told that they must not only reduce their intake by 70 per cent., but go from injecting to oral intake. That may seem simple to those of us who are not drug addicts, but it is an insuperable barrier for many users, and they go straight back to the disordered and chaotic lifestyle that they have been trying desperately to get out of. Since the Laybourne clinic has lost its inspiring light, Dr. Garfoot—the hon. Members I mentioned may expand on that case—four members of ADAPT have died in Bromley alone.
I want the Minister to give an assurance—I did not hear him do so in his introductory comments—that older, high-dependency, injecting users will also be taken into account in the treatment programmes that are being promoted. All the Minister's comments, with the best will in the world, focused on young people, but this group of older people needs to be treated differently.
On 21 August, the Under-Secretary of State for Health, the hon. Member for Salford (Ms Blears), wrote to me saying:
- "Treatment is therefore provided on the basis of clinical need."
- "Hence, treatment of adult drug misusers should not vary according to age per se."
Mr. Bob Ainsworth: I shall consider the hon. Lady's comments, but that is not what I am told. I do not pretend that our treatment facilities are adequate, and we are trying to improve them. I am told that they are oriented towards opiate users, most of whom have used those drugs for a long time. We need to develop policies that will reach out to people from ethnic minorities and cocaine users. We have practically nothing in that area, as was exposed by my hon. Friend the Member for Manchester, Central (Mr. Lloyd). I am not certain that what the hon. Lady says is borne out by the facts, but I shall certainly consider the points she made.
Mrs. Lait: I am most grateful to the Minister for that reassurance. I was not for a moment suggesting that other groups should not have treatment available to them. All the evidence from ADAPT, of which I am a local patron, is that the treatment those people have been offered is being withdrawn. That is the crucial point.
Mr. Henry Bellingham (North-West Norfolk): I have listened carefully to my hon. Friend, who has made an
excellent point. Is she aware that there were 270 patients in the Laybourne clinic a couple of months ago, and between them they had spent 600 years in jail, yet the clinic has a recidivism rate of just 7 per cent. compared with 50 per cent. for the Prison Service? Unfortunately, the clinic is threatened with closure.
Mrs. Lait: I was not aware of those figures, as I have concentrated on the people from Bromley who attended the clinic. However, I was aware of the recidivism figures, and I congratulate the clinic on its success. It is very sad that the General Medical Council struck off Dr. Garfoot.
The Under-Secretary said in her letter that she hoped the National Treatment Agency for Substance Misuse would soon be in a position to start issuing guidance on model treatment services. If the treatment services have been geared so much to long-term users as the Minister says—I do not doubt him; I am sure he has been advised correctly—why are those users finding that the services to which they were accustomed are being withdrawn? Furthermore, why do I find that four members of ADAPT who lived in Bromley are sadly no longer with us—the ostensible reason being that they took brown heroin as opposed to the heroin needed to stabilise them and allow them to remain in the community?
I hope that the Minister will comment, or write to me, on Government policy regarding the treatment of high-dependency, long-term injecting users.
11.41 am
Dr. Brian Iddon (Bolton, South-East): This debate, which I welcome, is the first major drugs debate that we have had since 2 July 1999. Much has happened since then, and I think the mood of Parliament and, especially, the people has changed.
I congratulate Lady Runciman's committee and the Police Foundation. They have, in part, catalysed the change of direction. The Government, fortunately, have accepted 24 of the 81 recommendations, and 20 are still under consideration, including the one on cannabis reclassification. However, I want to move the debate on to new ground, beginning with the proposed legislation arising from the consultation document "New National Minimum Standards for Care Homes", published by the Department of Health last July, and the likely impact of the proposed new regulations on drug and alcohol treatment centres. Because of the summer recess, we have had little time to debate those proposals.
The background to today's debate is the dire shortage of treatment and rehabilitation beds in residential homes throughout the country. I welcome the establishment of the National Treatment Agency for Substance Misuse in April this year, and wish it well. I hope that it will have a major impact not only on the quantity but on the quality of treatment places available.
Single lockable bedrooms, preferably with en suite bathrooms but at the very least with adjacent bathrooms, are proposed as a minimum standard for care homes. Communal facilities for catering and other activities for clusters of between eight and no more than 16 bed spaces are also recommended. The report contains other recommendations, but I shall not dwell on them today.
The cost of treatment is already very high. If those minimum standards are accepted, many homes for the treatment and rehabilitation of drug and alcohol addicts will have to close, at a time of great need. The owners cannot afford the conversion costs, and would price themselves out of the market as a result of the much-increased unit costs arising from such a reduction in the number of bed spaces. It is estimated that 50 per cent. of existing bed spaces would be lost in the sector, and there would be little incentive for the provision of new ones. That is sheer madness at a time like this. Many treatment places are provided by charitable organisations, which already find it difficult to raise the necessary money.
The idea of locked rooms is also unacceptable. The vulnerable people involved might accidentally overdose, or attempt suicide under the pressure of treatment in the centres. Treatment can be very unpleasant, causing the withdrawal symptoms that we know about. Patients and their professional carers therefore prefer at least two people to be in each room, so that one can support the other through a difficult and emotional time. Indeed, sharing is seen as part of therapeutic treatment.
The recommendation for access to visitors to be available 24 hours a day is an open invitation to drug dealers to visit the premises. In any case, it is often better to isolate drug addicts from their peer groups and friends during the detoxification programme. Even close family members are best kept away in certain instances, because they too can exert emotional pressures.
When clients are consulted—we do not consult drug addicts often enough—they are most interested in access to treatment, the quality of staff, structured treatment programmes and well-linked service provision. They rarely mention the quality of accommodation, and the quality of accommodation in this sector is quite high anyway.
I recognise that minimum standards for other care homes will be welcomed, but I ask the Government to think again about the impact of the proposed regulations on drug and alcohol addiction and rehabilitation services. After all, the closure of homes in this sector would have a major impact on the Government's crime reduction strategy. Has my hon. Friend the Minister had any discussions with his colleagues in the Department of Health? If not, may I ask him to do so?
Surely, the minimum standards set out in the consultation document published in July are intended mainly to improve the quality of life for long-term residents in homes, for example the elderly. Are they really meant to affect homes in which people dwell for only a short period? Would it not be better to allow the National Treatment Agency for Substance Misuse to determine care standards for residential homes in this sector?
It strikes me that drug treatment in the past has consisted of methadone, methadone, methadone, and little else. Although methadone is useful as an opiate substitute, I have long argued that addicts should be given a choice of treatment. I am told that methadone is often harder to give up than heroin. For many years, I have advocated the use of other opiate substitutes such as buprenorphine and LAAM—laevo-alpha-acetylmethadol. Fortunately buprenorphine, the drug of choice in France and Australia and easier to give up than methadone, is now more readily
available on prescription in this country than it used to be. I have also advocated the availability of abstinence programmes such as the 12-step programmes, and the use of clinically pure heroin—or diamorphine, as the medics prefer to call it—for long-term addicts who have developed high tolerance levels to that addictive drug.As has been said, the former chief constable for Gwent, Francis Wilkinson, published a paper only this week in which he suggested that we should try to secure clinical treatment with pure heroin for as many as possible of the estimated 300,000 heroin addicts in order, initially, to stabilise their lives before offering further treatment or even detoxification. That would constitute a return to the old British system that we left behind in 1971, under pressure from the Americans, when there were far fewer heroin addicts than there are today. In 1960, for example, there were only 685 registered heroin addicts in this country.
When he bravely announced the reclassification of cannabis, the Home Secretary gave notice that he would make an announcement in the spring about heroin prescribing. Let us hope that he sees a role for the registration and treatment of heroin addicts in the same way. That would constitute a huge harm-reduction programme, not to mention the serious impact that it would have on criminal behaviour. I estimate that up to 70 per cent. of crime in metropolitan areas is drug related.
As other Members have said, the current war on drugs is not working as a strategy. I am pleased that the Home Secretary is prepared to review it, and to think radically. None of us are soft on drugs, but some of us believe that the time has come—as in other European countries—to conduct some experiments in policy.
With regard to the amendment to section 8 of the Misuse of Drugs Act 1971, many of us who are interested in drug addition were concerned about the outcome of the so-called Winter Comfort case in which John Brock and Ruth Wyner were imprisoned for allowing drugs to be used on premises that they were running in Cambridge to help drug addicts. The verdict has had a ripple effect throughout organisations that have known drug addicts on their premises on a care basis, including housing authorities. Since then, section 8, which deals with drug-related incidents on premises, has been amended by a section in the Criminal Justice and Police Act 2001, although I understand that no guidance has been issued by the Home Office on that change. It would be helpful if the Minister were to update the House on that.
The Government say that the amendment of section 8 is unrelated to the conviction of the Cambridge two and that it was introduced to deal with crack houses, which are prevalent in London. There are several concerns about that amendment, but shortage of time allows me to refer to only a few of them briefly.
If, as in the case of several European countries, we eventually introduce supervised consumption of heroin for known addicts, which some hon. Members have called for today, the amendment could conflict with that policy. If possession of cannabis is to be a non-arrestable offence and the amendment to section 8 is implemented, ironically the owner of the premises on which people are in possession of cannabis could be arrested, but not the person in possession of the cannabis, which is silly.
The amendment to section 8 conflicts with the Government's policy of reducing drug-related deaths because drug users will be driven out of premises and
forced into the open air to inject where they are known to be at greater risk. In addition, providers of supported housing are unlikely to provide such housing for vulnerable drug addicts under those circumstances.My final point relates to something that the hon. Member for Beckenham (Mrs. Lait) said. I was recently made aware of a number of doctors who have been subjected to disciplinary action in relation to their treatment of drug users. Those doctors fall into a group of people who believe that drug addicts are victims and need specially tailored treatment and counselling, rather than criminals who should be punished. They are something of a rare breed because the majority of general practitioners—94 per cent. in fact—are unwilling to treat drug users, which leaves the addicts with no alternative other than to continue to use street drugs. Indeed, budding doctors in our medical schools get little training in drug addiction.
I have been closely involved with the case of Dr. Adrian Garfoot, who has long been treating long-term drug addicts in London, many of whom were extremely chaotic and even dangerous when they approached him for help. He has treated such people for more than 24 years. In 1991 he opened the private Laybourne clinic, which has also been mentioned. His method of treatment involved prescribing pure substances such as injectable methadone at an adequate level so as to enable the user to move away from the street drugs that can have a detrimental effect on the user's life.
A new patient would be subjected to a series of tests to determine their individual tolerance level. The prescription would be dispensed on a weekly basis. Throughout the treatment, the drug users would become more stable because of the regular supply of the drugs that they desired. As the prescribed drugs were of a purer form, they were not subjected to the differences in quality of street drugs. As their treatment progressed, it was often possible to reduce the level of drug use. In addition, as the addicts were attending a clinic on a regular basis it was possible to assist with the treatment of drug-related illnesses, such as those caused by HIV and the hepatitis C virus, from which many addicts suffer without their knowledge.
Most of Dr. Garfoot's patients have been able to lead normal lives again following their stabilisation. Many have worked and many have rejoined their families. Without his or a similar doctor's help, a considerable number of them would be dead. I am not a great fan of private medicine, but the public sector seems unable to cope with those long-term patients. I never thought that I would live to see the day when I would be defending private medicine in the House, but since 1982 Dr. Garfoot's activities have been scrutinised by the Home Office drug unit, now known as the action against drugs unit, because he was found consistently to be prescribing high levels of drugs to his patients. For the majority of doctors, that would be seen as irresponsible prescribing, but it is important to remember that his patients were long-term and often chaotic addicts with a high tolerance threshold that required a high dose. Had he prescribed smaller doses, his patients would have gone out on to the streets to top up to get the same high.
Dr. Garfoot was eventually brought before a Home Office tribunal in 1992. The process from inception to a verdict took five years and the conclusion was reached that he should be cleared of wrongdoing. A verdict of abuse of process was recorded in 1997, the last time that
that Home Office procedure was used. Since then, such disciplinary investigations have fallen under the remit of the General Medical Council. I recently asked the Home Office in a written question why its procedures were no longer in use. Its response was:
- "They are cumbersome, time consuming and inflexible."—[Official Report, 24 October 2001; Vol. 373, c. 287W.]
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