Select Committee on Home Affairs Third Report


Treatment for Hepatitis C

246.  We have received some evidence that injecting drug users are denied treatment for Hepatitis C. A group of drugs treatment professionals, Action against Hepatitis C, told us that although deaths from Hepatitis C can be prevented by treatment, some guidelines exclude current injecting drug users. They told us:

    "This is a major concern because drug users form the greatest number of those who are infected with [Hepatitis C Virus]. It ignores the human right to life and will considerably increase the morbidity and mortality of drug users".[229]

247.  While the Home Office told us that this exclusion was based on clinical concerns of reinfection and non-compliance, our evidence contradicted this.[230]

248.  We recommend that the Government reviews existing guidelines on the treatment of injecting drug users for Hepatitis C and amends the guidelines if necessary to ensure that users are not excluded from treatment.


249.  Other harm reduction activities are obstructed by the regulations in the Misuse of Drugs Act relating to drugs paraphernalia—the equipment used by people taking drugs. Professor Stimson told the Committee:

250.  Mrs Christine Glover, of the Royal Pharmaceutical Society, reiterated this point:

    "We have an ironical situation where we are not allowed to supply the paraphernalia which also helps with harm reduction. It is not appropriate that we are in a situation where we cannot make a supply of citric acid or a swabs order for injection because we are breaking the law...It is a nonsense".[232]

251.  The Minister seemed unaware of this concern:

    "Overwhelmingly the provision of equipment has been about syringes and needles, for obvious reasons, because it is blood borne infections that people that have been worried about, Hepatitis B, Hepatitis C and HIV. If there is a case that can be made for the provision of other equipment we will be happy to look at it".[233]

252.  We recommend that the Government reviews Section 9A of the Misuse of Drugs Act 1971, with a view to repealing it, to allow for the provision of drugs paraphernalia which reduces the harm caused by drugs.


253.  The Committee has also heard numerous representations concerning Section 8 of the Misuse of Drugs Act, which regulates premises used for the consumption of drugs. Section 8 has been recently amended to make it more comprehensive in its reach. The Section makes it an offence for landlords knowingly to allow use of any drug on their premises, which makes it difficult to look after people who are known drug users.

254.  Drugs agencies have expressed concerns that Section 8 will make it impossible for them to continue to help individuals known to be using drugs, and impossible for them to help them to take their drugs in safer ways on their premises. Professor Stimson told us:

255.  DrugScope showed a similar concern:

    "Section 8 of the Misuse of Drugs Act should be reviewed and amended as appropriate to ensure that services and individuals helping vulnerable people and drug users do not fall within its purview. There is considerable disquiet that the recent hasty amendment to the Misuse of Drugs Act 1971 was ill-conceived and potentially damaging to those working with at-risk groups".[235]

256.  Mr Ainsworth did not seem to see this as a major problem:

    "There is some worry and we took representations over a period of time in order to try to satisfy ourselves that Section 8 provisions were appropriate, where necessary, and would not lead to people being criminalised in an inappropriate situation...If we were to give some kind of exemption to people in any given circumstance then we could find ourselves in a situation where facilities were being abused and the prosecuting authorities would have no ability to deal with the issue. We are only aware of a couple of problems...As long as people are sensible about how they use these provisions we would be very loathe to lose them with the consequences that could arise in terms of facilities being abused rather than used."[236]

257.  We recommend that Section 8 of the Misuse of Drugs Act 1971 is amended to ensure that drugs agencies can conduct harm reduction work and provide safe injecting areas for users without fear of being prosecuted.


258.  We heard from the Royal Pharmaceutical Society that antiquated regulations make it much more difficult for community pharmacists to dispense controlled drugs such as methadone to users in a sensible and efficient way:

  • Prescriptions not satisfying legal requirements

  • Instalment dispensing

  • Requests for collections by clients representatives

  • Dispensing for public and local holidays...

    The key areas relate to:
  • the rules for prescribers' handwriting exemptions on controlled drugs prescriptions should be reviewed by the Home Office

  • pharmacists should be able to amend instalment prescriptions after contacting the prescriber

  • the Misuse of Drugs Regulations relating to instalment dispensing need updating and amendment of facilitate action when a client fails to collect

  • the Regulations should be amended to allow an instalment scheduled for supply on a day when the pharmacy will be closed to be supplied on the preceding day

  • there should be a review of the legality of dispensing prescriptions for methadone mixture where the client asks for variation from the formulation prescribed

259.  Mr Ainsworth told the Committee that:

    "this is not an issue that has been raised with me...I have to admit that I have not talked directly with pharmacists...We will need to pick that up and find out whether or not there is an issue...If there are issues that pharmacists want to raise obviously we will look at them".[238]

260.  We recommend that the Home Office and the Department of Health urgently review the current legal framework on the dispensation of controlled drugs by community pharmacists in consultation with the Royal Pharmaceutical Society.

Treatment through the criminal justice system

261.  One of the Government's innovations has been the enhancement of treatment options available to drug users through the criminal justice system, through Drug Treatment and Testing Orders and Arrest Referral Schemes. Drug Treatment and Testing Orders are community sentences which require offenders—with their consent—to undergo treatment and other programmes, designed to tackle their drug misuse and offending, at a specified place for a period of between six months and three years. Under the terms of the Order, offenders must also be tested regularly for illegal drugs, and attend court for periodic reviews of their progress. Under Arrest Referral Schemes, drugs workers visit police custody suites to offer advice and services to drug users. In the main, evidence to the Committee has been positive about the impact of such initiatives, although the Substance Misuse Faculty at the Royal College of Psychiatrists told us that they "do not believe that evidence supports the efficacy of coercive treatments".[239]

262.  The Committee has heard representations that the schemes have, in some places, been set up in such a way that offenders receive preferential treatment over non-offenders: "in some districts, the quickest way to access treatment is to commit a serious crime".[240] We consider it highly undesirable that it should be easier for a drug addict to access treatment through the criminal justice system than in the community. This is a further reason, if any were needed, for the Government to provide more treatment in the community.

263.  A new sanction being piloted in sentencing drugs offenders is the Drug Abstinence Order, which requires the offender to remain abstinent as a condition of his or her sentence. Mr Roger Howard, Chief Executive of DrugScope, told us that his organisation had lobbied for conditions of treatment to be attached to these Orders, without success. Their view was that "the requirement for someone with a potential drug problem to remain drug free without adequate access to treatment is irresponsible".[241] Mr Ainsworth assured the Committee:

    "For those for whom it is felt appropriate, we should be offering drug treatment and testing orders. For people who have a lower level of dependency, then it may well be that drug abstinence orders are appropriate...we have no desire or intent to roll these pilots out and to make them available nationwide before we have the treatment capacity in order to be able to refer people on...Drug abstinence orders should not be being used, and I have heard the allegation, 'setting people up to fail', but they should be used in circumstances where people should be able to cope with the commitment that they are being expected to make without the testing requirement and we should not be pushing them in there if there is no treatment available".[242]

264.  We recommend that Drug Abstinence Orders are amended to carry the requirement of access to treatment.

229   Action on Hepatitis C, Ev 17. The "UK guidelines" referred to are the Report of the National Institute for Clinical Excellence: Guidance on the Use of Ribavirin and Interferon Alpha for Hepatitis C, 2000, Clinical Guidelines on the management of hepatitis C, British Society of Gastroenterology, 2001, and Consensus Statement, EASL International Consensus Conference on Hepatitis C, 1999, Journal of Hepatology, 30, pp. 956-961. Back

230   Vol III, Ev 227; our evidence cited two articles, Is it Justifiable to Withhold Treatment for Hepatitis C from Illicit Drug Users? Edlin, B.R., Seal, K.H., Lorvick, J., et al, 2001, New England Journal of Medicine, Vol 345, No 3, pp. 211-214 and Treatment of hepatitis C infection in injecting drug users, Backmund, M., Meyer, K., Von Zielonka, M., & Eichenlaub, D., 2001, Hepatology, 34, (1), pp. 188-193, cited in Ev 17-18. Back

231   QQ. 522; 524-5. Back

232   Q. 961. Back

233   Q. 1333. Back

234   Q. 526. Back

235   Ev 46. Back

236   Q. 1332. Back

237   Ev 176. Back

238   Q. 1335; 1337. Back

239   Ev 174. Back

240   Substance Misuse Faculty, Royal College of Psychiatrists, Ev 174. Back

241   Ev 46. Back

242   Q. 1303. Back

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Prepared 22 May 2002