APPENDIX 2
Supplementary memorandum submitted by
the Home Office following its oral evidence of 12 February 2002
1. The offence
of possession with intent to supply (Q 1218).
The Committee asked about the offence of possession
with intent to supply a controlled drug and whether there is a
problem with people in possession of small quantities of drugs
being erroneously charged with this more serious offence. The
Committee also asked if a statutory threshold would be advantageous.
As the Minister explained in his evidence, setting
a threshold would prove difficult. Dealers would ensure that they
stayed the right side of any threshold and with some drugs, purity
would be as valid a criterion as weight. But beyond the practical
difficulties, it is important to remember that it is the intent
that is central to the offence. This might be proved by the quantity
of the drug found, but not necessarily so. The circumstances of
the offence (eg observation of evidence from the office concerned,
or an informant), or the amount of money held or other evidence
(eg such as a diary) might all be factors. These would be lost
if a threshold was introduced.
If any of the inquiry witnesses have evidence
of the inappropriate application of this charge, we would be interested
to see it. There will always be cases where a defence of simple
possession is adduced and it will be for the court to assess the
evidence and argument. Analysis of sentencing data does not assist,
as this will not include the circumstances of the offence. We
have since checked with the Police, the Crown Prosecution Service
and the Lord Chancellor's Department and none are aware of any
evidence to suggest that the law is currently being improperly
applied.
2. Resourcing the Strategy (Q 1276).
The Committee asked for a copy of the data on
resources, which the Minister used in his evidence session. This
is attached at Annex A and draws on information in the April 2001
publication Communities against drugs, enclosed for reference.
Annex A also includes key statistics cited by the Minister, which
you may find useful.
3. Action being taken to reduce drug-related
deaths (Q 1327).
The Government's target is to reduce drug-related
deaths by 20 per cent by 31 March 2004. An Action Plan to tackle
the problem of drug-related deaths was launched by the Government
in November 2001. This three-five year programme of campaigns,
surveillance and research will fund research projects into drug-related
death, encourage improved reporting of the problem by working
with coroners to make better use of the information from inquests,
and provide guidance to Drug Action Teams into running confidential
inquiries into drug-related deaths. It will involve work at a
national and local level and agencies from the statutory and voluntary
sectors. An expert steering group, which will also advise the
Department of Health on research projects and the direction of
future campaigns, will monitor its success.
In order to monitor the success of the Action
Plan, a baseline figure for drug-related deaths was established.
It was agreed by the Advisory Council on the Misuse of Drugs that,
for the purposes of the Action Plan, drug-related deaths should
be defined as "Deaths where the underlying cause is poisoning,
drug abuse or drug dependence and where any of the substances
listed in the Misuse of Drugs Act 1971, as amended, were involved."
Using the latest figures from ONS and this definition, there were
1,568 deaths in 1999 in England and Wales (1,480 in England).
It is, as yet, too early to detect proof of progress against this
baseline, which will continue to be monitored by ONS.
ONS data published in Health Statistics Quarterly
9 (Spring 2001) shows rising numbers of deaths from heroin. However,
the picture is different for methadone. The same report in HSQ
9 shows a drop in the number of times methadone was mentioned
on death certificates, from a high of 421 in 1997 to 298 in 1999.
The National Programme on Substance Abuse Deaths run by St George's
Hospital Medical School, Centre for Addiction Studies, also shows
a significant decline between 1999 and 2000 in the number of deaths
from methadone alone and from methadone implicated alongside other
drugs (Annual Review 2000 (October 2001)). New figures
for deaths from drug poisoning in 2000 will be published in the
next HSQ on 28 February 2002.
4. Safe injecting rooms (Q 1341).
The Committee asked for a note setting out the
Government's position on the use of safe injecting rooms. These
facilities, which offer a space, usually staffed by medically
trained personnel who supervise all injections on the premises,
have been operating in Switzerland for over 10 years. There are
some in Germany and others planned in Austria and Australia.
The International Narcotics Control Board, in
its 1999 Annual Report has indicated that the development of injection
rooms contravenes international treaty obligations (See Annex
B). However Germany and other countries, on the basis of public
health considerations, have not seen this as a block to introducing
national legislation to allow them.
There are various arguments for and against
the development of injecting rooms. Arguments supporting the development
of injecting rooms in the UK include:
— A reduction in public nuisance.
— Improvement in health of a very vulnerable
and unhealthy group of injecting drug users.
— Ability to treat overdose rapidly.
— Health promotion messages and basic
medical care can be available to a group not usually in contact
with treatment agencies.
— They have been well tolerated in
some communities.
— Some users of the premises have taken
up the offer of formal treatment.
— German and Swiss claim a considerable
reduction in overdose deaths.
Arguments against include:
— International legal position means
that the rooms could be (but have not been) open to legal challenge.
— The Government could be accused by
the media and others of opening "drug dens".
— No guarantee that public or political
tolerance will be the same as Switzerland.
— Will directly increase health service
costs as they would be a new service provision requiring additional
capital and revenue costs.
— Still leave the possibility of unsafe
injecting during the hours they are closed.
— There may be problems in some areas
on occasion with drug dealers congregating near to venues, leading
to reduced local tolerance for the presence of injecting rooms
in their neighbourhood.
— Likely to raise the issue of policing
low level dealing in the vicinity of injecting rooms.
The current Government position is that injecting
rooms for illicit drugs should not be introduced in this country
whilst we have no evaluations of those developed in other European
countries. We would only consider contributing to any evaluation
through the World Health Organisation in view of the uncertain
legal status of injecting rooms. We would not wish to consider
any research initiative that could cause the UK to undermine the
UN Conventions as that would not set a positive example to other
signatories.
5. Application of guidelines excluding current
injecting drug users from treatment for hepatitis C. (Q 1341).
The National Institute for Clinical Excellence
(NICE) has published guidance on the use of combination anti-viral
therapy for hepatitis C infected individuals. In regards to continuing
injecting drug users the NICE guidance states:
"Therapy . . . is not in general recommended
for patients who are continuing intravenous drug users. Only where
the prescribing clinician can be reliably assured that re-infection,
compliance and drug interactions pose no problems should patients
in this group be considered for combination therapy."
"Former intravenous drug users including
those on oral maintenance therapy need not be excluded from therapy".
Hence there is no exclusion of drug dependent
patients or those with a history of illicit drug use per se (who
form the majority of those infected).
The treatment is liable to severe side effects
and requires considerable active compliance by patients (eg injections
three times a week). Those continuing to inject illicit drugs
are therefore not generally considered suitable although they
can be given treatment if the conditions of reasonable stability
are met. Drug services working with more chaotic patients who
continue to inject can work with them towards a goal of meeting
treatability criteria if appropriate.
There are concerns that this may lead to an
undue exclusion of patients because of their illicit drug usage
rather than being based on the clinical grounds raised by NICE.
The Department of Health Hepatitis C Strategy Steering Group is
currently developing a strategic approach to hepatitis C that
is considering these issues as part of a wide ranging review (including
user representation).
6. Treatment in prisons and links to pre-imprisonment
and post-release care packages (Qq 1300-2).
The Committee raised this issue during the Minister's
evidence session. You may find the following information a useful
supplement to our initial memorandum.
DRUG TREATMENT
IN PRISONS
Drug assessment and treatment services have
been introduced in every prison in England and Wales to meet the
needs of prisoners with low, moderate and severe drug misuse problems.
All prisoners identified as having drug-related problems are referred
to CARATs (Counselling, Assessment, Advice, Referral and Through-care
services) for an assessment which leads to the development of
a care plan based on individual need and taking into account the
length of imprisonment. Care plans can include the following components:
— Detoxification services manage the
symptoms, especially physical symptoms, that arise from drug dependence.
Detoxification programmes are available in all local and remand
prisons. During 2000-01, 32,000 prisoners entered these programmes.
This exceeds by 18 per cent the target of 27,000 entrants per
annum by 31 March 2004;
— CARATs meet the non-clinical needs
of the great majority of prisoners and are the foundation of the
prison drug treatment framework, providing low threshold, low
intensity, and multidisciplinary drug misuse intervention services.
In 2000-01 CARATs assessed 37,000 prisoners. This exceeds by 48
per cent the Prison Service target of 25,000 assessments per annum
by 31 March 2004;
— Intensive Treatment Programmes meet
the needs of prisoners with moderate to severe drug misuse problems
and related offending behaviour. The quality of these treatment
programmes is at least equal to anything provided in the community.
There are now 50 intensive treatment programmes (43 rehabilitation
programmes and 7 therapeutic communities) and in 2000-01, there
were 3,100 entrants onto these programmes. Funding has since been
provided for additional places and the Prison Service is working
towards a target of 5,700 entrants per annum by 31 March 2004.
A new Prison Service Standard for Health Services
to Prisoners (1999) requires all establishments to have in place
a written and observed statement of their substance misuse service
in line with the latest Department of Health guidance (1999) on
drug misuse and dependence.
TREATMENT OF
OPIATE ADDICTION
IN PRISONS
Statistics show that 43-54 per cent of male,
female, remand and sentenced prisoners are dependent on opiates,
alone or in combination with other drugs, during the year prior
to imprisonment. The 1997 ONS Study of Psychiatric Morbidity
Amongst Prisoners in England and Wales showed that only one
in 10 men and one in four women were in contact with local drugs
services in the month prior to custody.
The general health examination/assessment prisoners
receive on first reception into custody details past and present
drug usage and engagement with community drugs teams. A decision
is then made about the next steps in management, which will be
either detoxification or substitute prescribing. The principal
criteria for the inclusion of prisoners in maintenance prescribing
programmes in prison are:
— Being on remand or serving a short
sentence and having been maintained to beneficial effect on methadone
in the community;
— HIV positive and terminally ill prisoners
already on methadone maintenance.
LINKS TO
COMMUNITY TREATMENT
ON RELEASE
The responsibility of the Prison Service ceases
at the point of release, but the Service has a role in facilitating
the link to support in the community. Research has demonstrated
that the availability of community support immediately after release
is vital to build on and maintain treatment gains made in prison.
CARATs are the key through-care link. The CARAT
worker has responsibility for attempting to access appropriate
support in the community. If a link cannot be made with a community
agency, or responsibility for the offender does not pass to a
statutory body such as probation, the post-release element of
CARATs ensures that, where possible, support is made available
to offenders for up to eight weeks after release. The post-release
element of CARATs was never intended as more than a safety net
and is no substitute for appropriate community facilities. There
are clear limits to what this can achieve:
— because of the pressure on CARAT
workers to deliver the CARAT services to those prisoners who are
in custody;
— the long distances travelled by many
prisoners on release make it difficult for CARAT workers to establish
links in the community;
— and because ex-offenders fail to
keep appointments.
The Prison Service, Home Office Drugs Unit,
National Probation Directorate and the National Treatment Agency
are working together to improve the availability and quality of
community support for ex-prisoners with drug problems and to ensure
that an effective infrastructure is in place to bridge the gap
between prison and community. Attached at Annex C are examples
of existing through-care initiatives.
DRUG RELATES
DEATHS POST
RELEASE
There is a very real risk of overdose on release
from custody as a result of loss of tolerance of opiates and other
drugs, including alcohol. The interim results from a recent study
undertaken by the Office of National Statistics show that of 12,437
discharges from prisons between June 1999 and December 1999, 64
deaths (56 per cent of total deaths) were drug related 21 months
after release. Of these 64 drug related deaths, 17 occurred in
the first month. The drug related mortality rate decreased from
4.7 per cent in the first week after release to 1.7 per cent in
the second week and 0.3-0.5 per cent thereafter. This study is
part of a review of drug related deaths amongst newly released
offenders being conducted by ONS and the National Addiction Centre
for the Home Office. The report of the review is scheduled for
publication in June 2002 and the Prison Service will consider
its present responses to the problem in the light of the findings
and any recommendations.
Measures the Prison Service already has in place
to tackle this problem include:
— Health education and harm minimisation
advice provided through CARATs workers and health care.
— An overdose awareness card prepared
for prisoners in custody and on release.
— A video issued in January 2002, which
warns prisoners that they are at an increased risk of overdose
after their release. CARAT teams use it to engage prisoners in
conversation about the issues raised including what to do with
a drug misuser who is in need of urgent medical help.
1 March 2002
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