Examination of Witnesses (Questions 340
TUESDAY 20 NOVEMBER 2001
340. Mr Hayman?
(Mr Hayman) I understand the debate you are proposing.
I just think the right people to be asking that are the medical
people. When you look at the evidence it does not necessarily
follow that prescription of heroin would give you the results
that you are describing, but they will know better than we will
Chairman: We are going to be asking them.
341. We are trying to get the police perspective
on this point. I was quite interested in something you said that
most deaths from heroin are from overdoses. I think I am right
in saying that 39 people died last year from unclean heroin in
Edinburgh. That is a huge amount, is it not?
(Mr Hayman) Yes, one is.
342. If these addicts had access to prescription
heroin none of those people would have died.
(Mr Hayman) I am tempted not to get into the medical
bit but what I have read is that the overwhelming evidence is
that by getting them into treatment is a better gain and more
satisfactory long-term gain than it is prescribing heroin. Again
I would have to bow to other people's expertise on that.
343. What proportion of property crime is drug-related?
(Mr Hayman) We know that, do we not? If you look at
the issue that is going on with the drug testing of arrestees,
we have got figures of 80 per cent. It just so happens I thought
it was a very interesting brief read, the NTORS study
344. What is it?
(Mr Hayman) National Treatment Outcomes
Research Studies. It is a very, very easy flip read. If you look
at drug-related crime: "During the course of the studywhich
has been going on for some years now"there were marked
reductions in criminal activitythis is following treatment"
At one-year rates acquisitive crime had approximately halved among
both residential and community clients. These improvements were
maintained at the two-year and four- to five-year follow-ups."
NTORS is not the only research that is being done. There are other
bits of research and others are more informed than I am. Every
indication is that with drug-related crime if you get people into
treatment you can cut this revolving door syndrome of continual
345. This is where I think the police and the
medical fraternity are coming quite close. Everyone agrees that
the way to reduce crime is to get people into treatment. Do you
think a heroin addict is more likely to get into treatment when
they come into contact with the criminal justice authorities because
of the crimes they are committing or if they are having heroin
prescribed by a doctor and they are already in a medical environment?
(Mr Hayman) Whether you are in the scenario of a doctor
prescribing will not necessarily have an impact on the level of
drug-related crime, they may still be committing that crime. I
think we need to get a much more informed view on this. It follows
that at the three points of intervention for treatmentand
I do not think like the word "control" but I am sure
you understand what I am saying herewe are in control of
the situation that client. We know the client will go in and out
of treatment and it is problematic but nevertheless the agencies
there are working closely with that client, and the end game is
that they, hopefully, will come off that addition and drug-related
crime will come down. I am not sure that the evidence indicates
that by prescribing heroin that is the same end game. It does
not improve the situation too much other than what you have said
in highlighting those 39 deaths.
(Mr Howard) Could I pick up a couple of points. Again
I do not recognise necessarily the evidence base for some of those
comments. If we look at the Swiss experiment on the prescribing
of heroin particularly for intractable cases (I think you may
have had copies of the recent Lancet article made available
to you) the evidence there is very sound; that in certain circumstances,
for certain groups of people, prescribing heroin is very, very
successful is reducing crime and, indeed, can be a bridge into
treatment. Not necessarily treatment in its own right but it is
a bridge into treatment. Can I pick up the other question Mr Cameron
raised and that was about the link to drug-related crime. This
is an incredibly complex area. We commissioned Professor Mike
Hough as part of our evidence to you to do an international review
of the evidence base about what the linkage is between drugs and
crime. What he found is that for most people who have heroin problems
their drug addiction, if I can put it that way, their drug dependency
is so inextricably inter-linked with their criminal behaviour
that trying to derive causative effects is very, very difficult.
What is found is that most people's criminal careers started well
before their drug use started. These people were engaged in criminal
behaviour well before their drug behaviour. For most other forms
of drug use, recreational drug use, there are those people who
are essentially law-abiding citizens who use ecstasy or cannabis
at the weekend. Their major crime is obviously in the possession
of it. And there are other criminals who are, if you like, engaged
in a lifestyle where drugs is part and parcel of that lifestyle
and it is not necessarily a driver, it is not a causative factor,
so disentangling the extent to which drugs cause crime is difficult.
I think Andy is quite right to say and as I said earlier, treatment
is really the jewel in the strategy crown. The evidence base does
demonstrate that you can reduce criminal behaviour by targeting
particularly heavy heroin users and crack cocaine users as well.
346. Just to follow on from that, Mr Howard.
You say in your submission that there are 100,000 people, those
people with so-called "chaotic" lifestyles who are engaged
in crime to finance their habit, and the figures show that the
average veteran heroin addict requires £13,000 of street
heroin to finance their habit. When you were talking about the
possibility of people being prescribed heroin, were you talking
about those 100,000 people?
(Mr Howard) I think some of those 100,000, the intractable.
We know that a lot of people go into treatment and fail, come
back out again, and go through this cycle. We have commissioned
research in the past and a lot of people, especially youngsters,
are triggered into more severe use by instances like bereavement.
There are some people where heroin prescribing can be a very useful
bridge into treatment. There are others who can successfully benefit
from methadone programmes and there are others who can successfully
benefit from much more structured abstinence based programmes.
I think one size does not fit all and I think we need to be aware
of that and we need a range of responses. The only thing I would
add is that in this country, of course, doctors can prescribe
heroin if they have a licence, and we have had some of that going
on for some time, although not on the scale and not perhaps in
a structured way as in other countries.
347. The Home Secretary in his submission to
us announced a five-fold increase in the prescription of heroin
from 300 to 1,500. In your view, is that an appropriate number
of people who would benefit from the prescription of heroin?
(Mr Howard) I cannot honestly answer you and say and
it should be 1,500 or 2,000. You need a clinical assessment and
you need to look at the individual careers of people. I do not
think we have enough evidence to be able to say there is this
solid number of people who are intractable and everything else
has failed and really we need to focus on those. I cannot answer
348. Would you agree with the statement that
says if you prescribed heroin to veteran heroin addicts it stabilises
their drug use and you then can attack the causes of their addiction.
(Mr Howard) Yes.
Chairman: Mr Prosser has some questions now
for Mr Ledger.
349. For more than 20 years ago the Probation
Service and other service workers have been pressing for the whole
issue of addiction and drugs to come under the umbrella of health
and education rather than the criminal justice system. I suppose
you were pretty discouraged when the new strategy came in which
did not really address that?
(Mr Ledger) We had concerns about the proportions.
Obviously we are at a different end from the police about the
breakdown of the budget and the way in which the money has been
distributed. From our perspective it seems to be looking at it
from the wrong end of the telescope. I need to return to some
of the comments that have been made. From my members' concerns
and working in the communities with drug users who are on probation
or on court orders, where we see the problem they are, of course,
by definition, criminals if they are using and they are therefore
driven underground in terms of obtaining their supply and the
way in which they keep themselves addicted or using. The problems
that arise out of that are a significant number of health concerns.
People put themselves at risk by sharing needles, by the way in
which they use the drug (it is cheaper to inject than to smoke
it for instance) and therefore they increase the likelihood that
they are going to put themselves at harm. I do not accept Andy
Hayman's point about not changing the impact of not just death
but health as well, hepatitis and HIV risks. People also are less
able to take care of themselves and their dependents, if they
have any, and other people around them. They are also less able
to find the basics they need, whether it is for their drug use
or anything else so they are more likely to resort to crime. We
see it as self-fulfilling in the way in which the process works
at the moment. We start from the point that we know about people
on the basis of their crime rather than the basis of their problem
and we would like to see a shift around that. If we can achieve
that maybe we will start to feel differently. We have called for
decriminalisation and obviously my Association's policy has been
that for over 20 years, certainly in relation to cannabis. It
is very welcome to see the debate now going on and it is a very
responsible debate and people obviously have a different perspective
on this. We do not call for or think that there should be a radical
or single approach. You obviously need to give signals to people
in changing the way in which we see possession, for instance,
of all drugs. You have to also look at what you provide to people.
Drug use is still a problem even if it is not criminal. So the
focus on health and education as well as treatment is absolutely
essential. We do not want that to be an isolated event. We want
it to be part of the package. It probably involves shifting the
budget, shifting the way resources are distributed at the moment.
One more thing in a long answer to a simple question concerns
harm reduction. Certainly the Probation Service's approach is
predicated along the harm reduction technique and of course that
in itself acknowledges that people are likely to be engaged in
criminal activity. You are trying to reduce the harm, you are
not necessarily achieving abstinence. You hope to achieve abstinence
but it is through a process of harm reduction. It is built into
the system at the moment that one acknowledges there is some form
of criminal activity continuing while you are trying to help and
assist the person, whether it is the Probation Service or other
350. If the Government were looking at ways
of legalisation, relaxation or decriminalisation of drugs of any
category, might not a less radical approachand you have
explained in your answer this change need not be a radical shiftmight
not a less radical approach be to look again at the present restrictions
and criteria for prescribing drugs so that the licence is relaxed
and starts to widen and provide more people rather than just suddenly
changing them all overnight?
(Mr Ledger) I think we would support that because
I have been trying to indicate that an evolutionary approach tends
to be the best way. We need to be sensitive and certainly we need
to look at the evidence and maybe have pilot projects so that
we can establish these things very gradually. Whilst obviously
it is very important, imperative, that you speak to the medical
authorities about this, we would see that as a much more constructive
signal because, not least ,it starts to redefine the way drug
users see themselves, not as criminals, people who are looking
over their shoulder, constantly wondering whether they are about
to be back in court or imprisoned, but people who have got a significant
problem. It is a problem for them, it is a problem for their families
and those who rely on them, it is a problem for the communities
where they live because of their pattern of offending behaviour.
It starts to shift the way in which people see themselves and
the way society sees them as well so that could be very positive
and, yes, it is a very gradual and careful approach.
351. On the question of treatment, on occasions
I get drug addicts coming into my surgery looking for treatment
crying for help, looking for a way out and it is much more difficult
to engage them in rehabilitation or detox if they are that category
of people who have just managed to keep a roof over their heads
and keep their family together and are surviving, as opposed to
the common picture of the addict, living a chaotic, harum-scarum,
unstructured life, and they make the point to me that if they
were to widen their habit and become more involvedsome
of these people are supporting support their habit out of their
own funds their own earningsif they were in the other category
and committing serious crimes then they would have more chance
of accessing the services they are seeking than otherwise. Have
you got a view on that?
(Mr Ledger) Anecdotally I was talking just yesterday
to a colleague in the North of England who works as a probation
officer delivering drug treatment testing orders and he was saying
that they had an initiative in his area where people can fast-track
if they are on those orders for treatment. He comments that it
is still very difficult to actually obtain funding via local authorities,
which has been the case for some years. Yes, there would be an
irony if that were the case. I do not think our experience is
that that is the case. We have a huge and very difficult problem
now getting even doctors' referrals. There are some hostel workers
who have people in probation hostels awaiting trial or perhaps
as part of the sentence, who are saying it can be six to eight
weeks to get a doctor's appointment, let alone then move on to
the stage of detoxification and then into treatment or rehabilitation.
So actually you can be looking at a process over several months
and for people who are quite chaotic and somewhat desperate that
does not work. No, there cannot be rewards for offending and I
understand the concerns about that, that would not be right. At
the moment the only waynot the only waya significant
way in which we pick up people who have got drugs problems is
via their appearance in courts and their processing to agencies,
such as ourselves, who then can refer them on. If there is a different
way of thinking, if there is a way that actually means that people
do not feel they have to go underground for their drug use, then
maybe we can draw people into the community and ensure that everybody
gets a fair and equitable opportunity to get treatment.
352. The union has held its opinions for a long
time but to what extent are those opinions guided by the academic
studies that you have told us about as opposed to actual every
day, on the ground anecdotal stories from people who are dealing
with them day-in and day-out? Why do you think that the views
of your members vary so significantly from the views of the Superintendent
members and the Police Federation members?
(Mr Ledger) Obviously, although we are in the same
system we have a different job to do. As I indicated when I first
answered earlier, we work with people at the other end of the
system after court rather than in terms of apprehension and prevention.
Obviously the police are charged with protecting the community
through direct apprehension and prevention in that way. We are
then dealing with the people in terms of why they have done it.
We are beginning to ask the questions why are they here with us,
why have they done this, what are the problems and issues around
that? That obviously gives us a different perspective. Yes, we
have probably drawn anecdotally more over the years on what our
members have been saying throughout England, Wales and Northern
Ireland in terms of their experiences rather more than the scientific
studies, although obviously evidence is mounting and we have quoted
some of it, the people next door to me are quoting a great deal
of it. That seems to be influencing the debate more broadly so
we are probably less exceptional in the view that we have been
expressing now than we used to be and that is very welcome.
353. Mr Howard, I am going to ask you about
the National Drugs Strategy. I know you have submitted evidence
to say the performance indicators need to be changed but if we
could focus on the current strategy and then talk about what you
want to see changed. Do you think the current strategy is working
and, if not, can you highlight areas where it is not?
(Mr Howard) If I can leave the law aside just for
a moment. I think there are three broad positive areas that we
must recognise. One is I think there is a very clear political
leadership and a priority given and a readiness to address the
issues. I say that not only for the UK but in Scotland, Northern
Ireland and Wales where there are corresponding strategies. I
think it has given a strong focus for bringing people together,
for giving this issue a profile, helping the debate locally, nationally,
and leading to a much better understanding of the issue. I think
that is one very important area. The second area, as Andy indicated
earlier, is I think there are more resources going into, if I
can put it this way, the right areas of the drugs strategy. If
we look at the evidence, as I said, about treatment, the success
of treatment, there is more money going into treatment and that
is good. Whether it is sufficient to keep pace with the expectations
and the growing demands, members from my organisation have quite
severe doubts on. I can elaborate on that if you like. I think
that is leading to better service development, better treatment
options for an awful lot more people. I also want to add I think
there are more resources going in to education and prevention
work, which is very welcome, money and resources going into help
local communities so that tenants' groups, residents' groups and
people like that begin to address the problem, and that is good.
The Chancellor in the last Budget announced extra money for people
going into work based programmes. All these are very, very good.
One of your colleagues mentioned process factors and I do not
think we should under-estimate these. These are very, very critical
in trying to get a better response; long overdue, I would hasten
to add from the view of my members. The other issue, as Andy Hayman
has recognised and my members are saying, is it has brought together
people better at the local level. That is not to say it is all
well. A lot more needs to be done. They are the good things. As
I say, on the downside of this, we have 900 member organisations
drawn from a whole range including police, probation, education
and health.We are unique in that respect, having a very broad
membership base. We surveyed them and what they were saying to
us was that they felt the strategy was too skewed to the criminal
justice, the enforcement aspects. Much more needs to be done in
reinforcing public health issues, treatment and areas around prevention.
Much, much more needs to go into that. I mentioned the balance
of spending earlier. I mentioned about the strategy targets, that
these are not responsive to local needs. An inner city area in
Birmingham does not need necessarily the same sorts of targets,
or cloning the targets that come down from on high, as in, say,
Worcestershire or somewhere like that. There needs to be much,
much more local sensitivity there. Where we have to ask the question
"is this strategy working" is in the prevalence rates.
We still have the highest prevalence rates of drug use across
Western Europe broadly speaking and we have the harshest penalties.
There must be some questions raised in our minds, all our minds,
is that right, is that what we want to achieve?
354. Could you just say why you think that is
(Mr Howard) I do not think there is any simple explanation
for drug use, for crime even. I think there is a whole mixture
of reasons for that. There are cultural reasons. I just think
we need sensitivity around this. If we had a simple answer we
would have cracked this problem a long time ago. It is a very
rich, difficult problem.
355. Sure. If we were to recommend changes to
the National Drugs Strategy, what would be your main priorities?
What would you say we should do?
(Mr Howard) We have said in our evidence to you we
support what the Home Secretary has proposed in the reclassification
of cannabis. Our members were overwhelmingly in support of that.
We would also say that the Government ought not to lose the opportunity
to look at the fine tuning of the classification of other drugs
as well. I think a contemporary risk assessment would suggest
that some of the drugs, and other people have talked about ecstasy
and LSD, are not of the same order as heroin and cocaine. I think
we would recommend that the Government ask the Advisory Council
on the Misuse of DrugsI declare an interest having been
a member of thatto look at that and argue a risk assessment
be done. We would want to see that. We would also say, and this
may be more controversial, we think that for simple possession
of any proscribed drug criminal proceedings, criminal sanctions,
are not the most appropriate vehicle for dealing with this problem.
Having said that, you will be thinking, "does this send a
wrong message", and do we abrogate from international treaties?
We do not say that. We recognise that we are obliged under international
treaties to prohibit drugs, in fact to criminalise them. What
we would say is there are a raft of other measures that have been
adopted throughout Western Europe, in Australia, in Alaska, and
I know that has been an issue before you. There are other alternative
measures that can be used to actually show disapproval and signal
disapproval. In Italy they take driving licences away and there
are other measures that can be used. In Australia they use fines.
There are other measures that can be used to signal disapproval
but which do not involve the full weight of the criminal law being
exerted on users.
356. So we are back to this de facto
decriminalisation, if I can take you through that. Are you saying
de facto decriminalisation should apply for all drugs?
(Mr Howard) Andy Hayman has come up with the issue
around language. All I would say is let us ask the question,"
are punitive sanctions and the weight of the law the best way
to deal with the drugs problem facing the world today"? I
think the international evidence that we have before us from other
countries where they have adopted a less punitive approach is
they do not put people in prison for minor offences. Where they
use other sanctions, is there is no evidence that this has led
to increased drug use, drug consumption, nor that it has led to
increased crime. That is what we want. We do not want to see crime
go up, we do not want to see consumption go up. We have to ask
the question is the law an effective vehicle for that? I think
on the evidence that we have we have to raise questions about
357. If I can take you through the specific
drugs. You have been very clear on cannabis and you have said
that the Government should consider reclassification of ecstasy
and LSD as well.
(Mr Howard) All other drugs we would say.
358. Other than cocaine and heroin?
(Mr Howard) We would say that the Advisory Council
ought to look at the whole issue because it is about bench marking.
Some are more serious than others.
359. Okay. With ecstasy, do you think that the
law currently prohibits effective harm prevention strategies?
I am thinking in particular of purity kits and licensing laws.
Would you be in favour of broadening the law to allow purity kits
in clubs, for example?
(Mr Howard) The European Monitoring Centre for Drugs
and Drug Addiction recently published a report looking at pill
testing arrangements that operate in different States and found
these to be quite an effective measure in terms of harm reduction.
What I would say though is my understanding from the Forensic
Science Service and all the analytical information, is that by
and large, most of the substances that are found that go under
the name of ecstasy or whatever are relatively pure. Whether there
is a harm reduction need in terms of risk of toxicity and things
like that, I think there is a question there. But in terms of
getting out much better health information, much better harm reduction
informationit was the Police Foundation that made the commentwe
are sending the wrong signal to youngsters by classifying ecstasy
and LSD alongside heroin and cocaine. I think it acts as an obstacle
to some of that important harm reduction work
Mr Watson: I just want to focus on heroin and
crack cocaine. You have said there should be an extension of the
prescription of heroin to long-term offenders. I just want to
talk to you about some of the important practical points in relation