MEMORANDUM 23
Submitted by the Ethnicity & Health
Unit, University of Central Lancashire
The inquiry seeks evidence on the following:
— Does existing drugs policy work?
— What would be the effect of decriminalisation
on (a) the availability of and demand for drugs (b) drug-related
deaths and (c) crime?
— Is decriminalisation desirable and,
if not, what are the practical alternatives?
The inquiry will also examine the effectiveness
of the 10-year National Strategy on drug misuse launched in 1998
and the preliminary results of the three year research programme
costing six million started in 1999/2000. It will look at the
revised role of the UK Anti-drugs Coordinator and assess the effectiveness
of Drug Treatment and Testing Orders (DTTOs).
In providing evidence the Ethnicity & Health
Unit have drawn on four key areas of recent study:
— A substantial literature review covering
the last fifteen years and including various reports and surveys
undertaken at local levels.
— The national Scoping Study on the
delivery of drug treatment and prevention services to Black and
minority ethnic communities.
— A series of service reviews undertaken
by the Ethnicity & Health Unit.
— The Department of Health drugs misuse
and Black and minority ethnic needs assessment project.
Our main area of concern is with the overall
effectiveness of the national strategy and local area service
planning and delivery for Black and minority ethnic communities.
It should also be borne out that while we are able to draw on
initial findings and learning from the process the Department
of Health-funded needs assessments project is not yet complete
and final analysis of this data is currently under way.
"Tackling Drugs to Build a Better Britain"
(1998) recognises the evidence that has consistently shown that
Black and minority ethnic drug misusers regard much of the existing
treatment services as run by, and for, white people, that drug
workers require training on not only race but also wider equality
issues, and highlights the need for better targeting and design
of services to capture these client groups. Drug Action Teams
(DATs), in the undertaking of needs assessments, are encouraged
to take a detailed look at patterns of drug misuse in Black and
minority ethnic communities and consider the diversity of cultures
that may require services. Consideration is also given to the
development of specialist, race-specific services as a method
of targeting Black and minority ethnic drug misusers and of harnessing
the skills within the Black and minority ethnic communities to
tackle drug problems.
However, the Drugs Prevention Advisory Service
(DPAS) Scoping Study on the delivery of drug treatment and prevention
services to Black and minority ethnic communities (Ethnicity &
Health Unit and Goldsmith's College) found little evidence of
effectiveness in meeting the aims set out in the national strategy
regarding these issues. This National Scoping Study was commissioned
in order to inform the development of the Government's drugs and
ethnicity initiative and it aimed to "Provide a clear overview
of the issues surrounding the delivery of drug prevention and
drug services to minority ethnic communities, and; Identify issues
and prioritise areas of work that require further attention."
Detailed case study analysis of six Drug Action
Teams were undertaken, the six teams were chosen from six different
geographical points of England, which has a large number of Black
and minority ethnic representation, as well as newly established
communities such as Vietnamese and Somalian, they also provided
a good geographical spread and a diverse range of community types.
A total of 99 commissioners, planners and providers of services
such as the police, service providers, drugs workers, teachers,
and youth workers were interviewed. In addition to these interviews,
a community consultation exercise also took place, which was made
up of 13 group discussions with 130 representatives from African,
Caribbean, South Asian, Somalian and Vietnamese communities and
14 individual interviews were conducted with practitioners and
policy makers who were not based in areas studied but were known
to have expertise in the area of ethnicity and drugs. Analysis
was also undertaken for statistical indicators looking at client
representation in the case study areas.
The study found that:
— In most of the DAT areas no local
needs assessments among Black and minority ethnic communities
have taken place, neither has there been any effectiveness audits
addressing the appropriateness of mainstream drug treatment interventions
for Black and minority ethnic drug users.
— Many of the areas that do have evidence
of local initiatives are undertaking these outside of the DAT
structure.
— Many community groups do not feel
able to form effective partnerships with statutory bodies.
— Many of the methods for approaching
communities, such as talking with traditional and religious leaders
often leaves more isolated individuals and families un-represented,
this is particularly true in relation to consultation with Black
and minority ethnic drug users themselves.
There is even less awareness regarding the emerging
trends and patterns of drug misuse among young Black and minority
ethnic people or in relation to vulnerable children. Yet it can
be expected, given the emerging knowledge about drug use within
Black and minority ethnic communities that young people in these
communities will be equally at risk. A number of recent action
research projects focusing on Black and minority ethnic communities,
clearly show this to be the case, highlighting that these groups
have drug taking patterns similar and in some cases more problematic
than the white population (Ahmed 1997; Awaih et al, 1992; Bentley
and Hanton 1997; Bola and Walpole 1997; The Bridge Project, 1996;
Chantler 1998; D.P.I 1998; Gilman, 1993; Khan et al 1999; Mistry
1996; Patel, 1998; Patel et al 1995; Patel 1997a; Patel et al
1997; 1999; Patel N et al 1996; Perera 1998; Shahnaz 1993; Sherlock
et al 1997).
In the Government's 10-year strategy for tackling
drug misuse, guidance notes it states:
"Information, skills and support need to
be provided in ways which are sensitive to age and circumstances,
and particular efforts need to be made to reach and help those
groups at high risk of developing very serious problems"
(Chapter three, Helping young people resist drug misuse in order
to achieve their full potential in society). (Tackling Drugs to
Build a Better Britain. 1998).
In relation to drugs education and prevention
the government strategy goes on to state,
"Drug education and prevention is best delivered
by building cumulatively on knowledge, attitudes and skills. Teachers
should ascertain what their pupils already know. This is particularly
important at transition points such as the move from primary to
secondary education. Drug education and prevention should also
be appropriate to the child's age, experience, gender and race".
The HAS report (1996) examined risks in relation
to young people and identified young offenders, truants, school
excludees, those in local authority care and those from families
where drug misuse was already taking place as being at most risk
of developing a drug problem. Black and minority ethnic young
people in many communities are over-represented in most of these
areas yet standard drugs education often fails to address particular
cultural and linguistic barriers. These are issues for Asian children
who often miss significant periods of schooling, as a result of
the family returning to visit India or Pakistan. For younger children
this often has a serious impact on language development making
the reception of standard drug education messages problematic.
Focus groups undertaken by the Ethnicity and
Health Unit have revealed some instances where young people have
taken leaflets home from school on drugs education and have been
"hit" or verbally abused by the family for bringing
such pictures in to the home. Young people themselves have complained
of the lack of appropriate literature that they can give their
parents who don't speak English fluently, in order to help them
understand what drugs education is for and why it takes place.
The Government's 10-year drug strategy supports
a programme of action to ensure that:
1. Young people from all backgrounds, regardless
of their culture, gender or ethnicity, have access to appropriate
programmes of intervention.
2. All problem drug users, irrespective
of their age, sex or ethnicity, have proper access to support
from appropriate services with specific support services for ethnic
minorities when they are needed.
Black and minority ethnic drug misusers remain
under-represented in drug treatment services. Very few mainstream
or even specialist drug services have managed to attract or work
with these groups of drug misusers. The ACMD (1998) suggest "the
under-representation of Black people among populations of drug
users known to agencies might, for example, be a consequence of
the failure of agencies to make themselves accessible and meaningful
to all members of a multi-cultural society".
Concern has been voiced by a number of Black
community groups about the rise in crime and drug use (MuAAD 1997,
Pratt 1997, 1998). Black African-Caribbean drug users are under-represented
in the majority of drug services. Furthermore, the over-representation
of Black African-Caribbean men in the criminal justice system
and the new drug treatment projects planned within the context
of prison and probation services suggest an urgent need to develop
drug treatment approaches which are culturally meaningful and
sensitive. There is now increasing evidence that the number of
young Muslim men entering the criminal justice is increasing,
many with drug-related offences.
Current responses are, often poorly assessed,
planned, or commissioned and often fail to address the lack of
culturally sensitive services, institutional racism and under-representation
of Black and minority ethnic drug users.
In summary, drug treatment services are largely
failing to address whether their services adequately respond to
the diverse needs of Black and minority ethnic clients. There
is a lack of understanding about the social, political and economic
structures within which racism is constructed and experienced
and this is important when planning service delivery. Drug services
have not adequately considered what is needed and what they can
do to improve service delivery, retention and outcome to all members
of the community:
"It is incumbent upon every institution
to examine their policies and practices to guard against disadvantaging
any section of our communities" (Macpherson 1999).
Earlier this year important legislation in the
form of the Race Relations (Amendment) Act, (RRA Act) came into
force, this challenges all public services to eradicate discrimination
and disadvantage and the RRA Act will require public organisations
to have clear race equality action plans. Effective consultation
with local Black and minority ethnic communities and the effective
collection and analysis of ethnic data must be a crucial starting
point, yet these are areas that were found in the scoping study
to be particularly problematic.
The following is drawn from a series of drug
service reviews undertaken by the Ethnicity & Health Unit
since the summer of 2000. The reviews covered Drug Action Teams
areas with predominantly South Asian populations, mostly Pakistani
and Bangladeshi communities. Interviews and focus groups were
conducted with commissioners and planners of services, providers
in both statutory and voluntary agencies and community members
including current and ex-drug users, parents, religious leaders
and local residents.
Among young South Asian men in the focus groups,
in addition to use of heroin and cocaine there were reports of
high levels of recreational drug use with cannabis and ecstasy
cited as the most commonly used drugs, though participants had
experience of a wide variety of different substances including
heroin, crack cocaine, ecstasy, LSD, amphetamines and alcohol.
Alcohol use in particular is reported as being more common, even
within the Muslim communities including those under eighteen years
old. There are a number of reports of increasing steroid use by
South Asian men, many of whom obtain their drugs from the local
gym.
Strong links were made between substance use
and mental health problems and there were reports of widespread
tranquilliser and other pharmaceuticals use, particularly among
South Asian women.
In one area the local drug service provider
estimated that in the past year, nearly 50 per cent or more of
all weekly referrals had come from Black and minority ethnic communities,
predominantly Pakistani and Bangladeshi clients.
Some young people reported that smoking heroin
is "safer" than injecting and is less addictive and
that "weekend" use of heroin is "safe" as
they have seen their older brothers and their friends doing this
regularly with no problems.
Several young people and ex-users agreed that
heroin had become easier to obtain than cannabis.
". . . if you go outside and walk past 10
people, there may be only one person who might be able to get
you cannabis, but if you ask the same 10 people about heroin,
at least five of them can get you heroin" (ex-user, male,
Pakistani).
"you can get heroin as quick as a click
of the finger . . . if I ring someone now . . . within 10 minutes
there will be someone outside with a bag to sell" (user,
male, Bangladeshi).
Crack cocaine is reported as being used by Pakistani
and Bangladeshi, and services in one area have recently seen Bangladeshis
as young as 18 coming forward for help with problems from crack
use.
In one area there were several reports of young
Pakistani girls (from 14 years old) using crack cocaine and heroin.
This was linked to reports of increasing numbers of South Asian
girls engaging in prostitution.
Among participants who identified themselves
as drug users this in itself was not viewed as a matter of concern
and the young men did not view themselves as having a "drug
problem".
Issues related to identity and generational
conflicts were the predominant problems cited by the young people.
A significant number of the young South Asian
men interviewed in one area reported involvement in criminal activities
as a means of funding drug use and also for "thrills"
or "kicks" such as stealing cars and joy riding.
Boredom and lack of recreational activities
and unemployment were most commonly cited as factors in both drug
use and offending by respondents in the focus groups.
Knowledge and awareness of drug issues and service
provision within Black and minority ethnic communities
Awareness of, and knowledge about, drugs, and
services in particular, was generally poor among community respondents,
though among parents there were strongly expressed concerns for
their children whom they felt unable to protect from the destructive
influences in the community around them.
It was a common belief of service providers,
verified by users and young people, that drugs are being sold
by young South Asians, with even younger South Asian boys used
as "runners" to deliver drugs. Respondents agreed that
the financial incentives for those from areas characterised by
poverty are very appealing, not only to the dealers, but also
to their families, who may ignore the issues around drug use because
of the advantages of the extra income.
In some areas community respondents could name
particular streets, which they felt, had become especially associated
with a pattern of decline and abandonment that had direct links
with increasing drug use in the community.
It was reported that young Asian men who are
involved in drug use often leave home and that families are particularly
concerned about the stigma of drug use and the subsequent impact.
Some said the ability of families to address these problems was
affected by a lack of knowledge of service provision and language
barriers.
Some South Asian respondents reported that parents
employ a number of protective strategies when drug use is identified
within the family which is initially believed to protect the drug
user from engaging in further criminal activity ie family members
and parents provide funds for drug use in an attempt to contain
the situation.
However, these protective strategies are not
viewed as generally effective often resulting in more extreme
responses such as sending the person to India or Pakistan or forcibly
detaining the person in the home while they undergo a "cold
turkey" detoxication. It is also suggested by the evidence
that some of these protective actions prevent young drug users
entering treatment earlier only to create a more serious crisis
at a later point that often results in entry to the criminal justice
system.
The lack of knowledge about drug misuse, coupled,
with issues in relation to community stigma create, for many,
a high level of fear about drugs. This often means that drug users
who turn to family members for help or who are "caught out"
do not get the support and treatment they require. Practices such
as home detoxication without suitable medical intervention have
been known to pose significant health problems for the user.
In some cases highlighted in the Ethnicity and
Health Unit's work, young Asian drug users were sent to Pakistan
or Bangladesh in an attempt by the family to "remove them
from western drug using influences" and "stop their
access to drugs". Instead the young people returned some
months later with hugely increased drug habits, due in the main
to the availability and cheapness of drugs, particularly heroin,
in the countries of origin.
Utilisation of services
Very few of the participants with experience
of drug use had ever made any contact with drug service providers.
Of these, some were not aware at all of the types of services
available. Amongst others, there was the feeling that service
providers had not attempted to establish contact with their communities:
"I think they (service providers) have failed
to make connections with the Asian community. We sometimes get
asked but it's always a bit last minute, tokenistic."
One agency dealing with domestic violence reported
increasing drug use among young South Asian women accessing the
service but that there is little or no contact between these women
and drug agencies.
Among those drug users who did have experience
of drug services all of them identified a local private clinic
where they would be "knocked out" and "heavily
sedated so you don't feel anything" as a preferred treatment
choice. They expressed strong feelings against the use of and
value of methadone prescribing.
Two within the group had experience of residential
rehabilitation and spoke about this in very strong terms ie "pork-infested
utensils", "being the only Asian in the white group"
and "embarrassing".
While experience of drug services among respondents
was low, where it had occurred this was almost always a negative
experience.
"Then one day we decided after getting into
trouble too many times and ending up in prison and causing stress
to my folks at home, around 10 of us decided we'd come off it
together. We went to one service; they said 'sorry we can't offer
you an appointment you need to come back in two weeks'. But we
were desperate, we couldn't wait that long, so can you believe
it we walked to the next service and then to the next, they all
gave the same answer". (Ex-user, Male, Pakistani).
One group were very critical about the local
drugs agency complaining about its location and saying that they
felt uncomfortable in the waiting room. The service was viewed
as a white service for white clients and the group felt it did
not offer choices about treatment or support or that they were
"listened to".
The group identified the need for community
services, especially community-based detoxication and they all
wanted more help to combat boredom and to find employment.
Service awareness of and responses to drug use
within Black and minority ethnic communities
The majority of drug agency respondents reported
the existence of an equal opportunities policy, however a number
of issues were identified in relation to the implementation of
these policies. Staff did not feel a sense of ownership or involvement
in designing and initiating the policy and the policies were not
specific to drug service provision or drugs workers. There was
a general lack of knowledge of the existing policy, with many
of the respondents knowing that a policy existed but having little
or no knowledge of its content or how it could help in their work.
There were no examples of practical implementation
of policies, ie there was no formal training on the application
of the policy and no reviews. Many of the policies had existed
for quite some time and had not been reviewed or amended according
to the needs of the workers and service users.
Commissioning bodies did not require service
providers to demonstrate how equal opportunities policies were
being implemented into everyday practice and as a result policies
were seen as a "paper exercise" rather than a practical
tool.
Strategic planning and capacity of commissioners
In each of the five areas there were no specific
strategies for addressing the needs of Black and minority ethnic
communities. In each area serious questions were raised by service
providers and members of Drug Action Teams as to the capacity
of the DAT to address commissioning issues in relation to meeting
the needs of Black and minority ethic communities.
Apart from more general concerns about expertise
in commissioning and availability of appropriate needs assessments
there were particular concerns about the representation of Black
and minority ethnic communities on the DATs and the degree of
connection with local Black and minority ethnic communities.
The history of service commissioning and planning
in relation to Black and minority ethnic communities in each of
the areas studied is largely ad hoc and marked by short-term initiatives.
Where specific pieces of work have been undertaken these are often
marginalized or take place outside of the mainstream DAT structures.
The Ethnicity and Health Unit is in the process
of completing a large-scale project of £1.2 million invested
by the Department of Health, which has led to 47 community needs
assessment projects on drug misuse representing 25 separate ethnic
groups. These needs assessments have been completed with guidance
and instruction from the Ethnicity and Health Unit incorporating
a rapid appraisal model and training in both drug issues and research
techniques for more than 350 people.
The final reports represent a significant body
of new knowledge about drug issues within these communities as
more than 11,000 contacts have been made in the process of completing
the needs assessments. This is significantly higher than the total
booster sample for the British Crime Survey (BCS) and while we
are only currently analysing the final results from the 47 reports
there is clearly a different picture of drug use and concerns
about drug use within these communities than is shown in the BCS:
— There is a general perception amongst
the community groups that drug use within them is increasing across
a wide range of substances—cannabis, amphetamine, heroin,
crack, LSD, solvents. In some of the research samples 25-50 per
cent of respondents admitted to having taken drugs at some time,
with up to 10 per cent or more admitting to being regular users.
— Communities increasingly recognising
that it is a myth that they are not affected by drug use.
— For the most part, Black and minority
ethnic communities are unable to identify supporting agencies.
Even when they can identify an agency, they are unaware of the
wide range of services that that agency might offer. Some communities
have such little faith in local services that they prefer to use
private facilities.
— Increasing drug misuse is linked
by many of the communities to wider deprivation issues such as
unemployment, housing, low educational achievement, etc., and
accordingly, the solutions that communities would like to see
developed to prevent drugs misuse are wide ranging and holistic
(eg recreation facilities, economic regeneration etc.).
— Patterns of drug misuse in Black
and minority ethnic communities in this country often takes part
against a backdrop of cultural and political norms (sometimes
"imported" from the "mother" country) that
workers here often know little about (eg strong anti-drugs norms;
tensions between British and other cultures; war; torture; refugee
status, etc.).
— The issue of drug problems among
asylum seekers and refugees is highly significant. Some people
arrive in this country traumatised and with drug problems already.
They won't identify themselves as drug users for fear that it
will adversely affect their claims for asylum.
— Issues such as stigma and shame can
prevent families from seeking help, even when they are experiencing
very real problems.
— Communities are very concerned about
crime and community safety. For many communities this is the major
issue for them when they talk about drugs—they and the communities
in which they live feel unsafe.
— A number of communities are concerned
about substances which are specific to them (eg Khat, Paan). Concern
over Khat use centred mainly around the excessive use of Khat
by (mainly, but not exclusively) men, who use more heavily in
this country than they would have done in Somalia or the Yemen
(eg no work, so more time). This impacts upon families in terms
of the money and time spent chewing Khat. No services seem to
be able to respond to the needs that families and communities
may have in relation to these substances.
— A number of communities have specific
words for drugs that are not mentioned (or probably even known
about) by those who produce drugs information booklets and leaflets.
— The issue of language is a complex
one (eg 137 languages spoken in Brent alone; issues to do with
generation, literacy, and dialect). However, it needs to be addressed—many
communities have no access to drugs information because of the
language barrier.
— Drugs education is seen as very important
both by, and for, young people and community elders. If there
is one theme that comes out again and again and again, it is about
the lack of knowledge and information.
— Religion is equally complex—some
communities see religion as a protective factor, but some don't.
Many communities think that religious bodies can and should be
drawn into drugs prevention work (eg have access to people, and
centres used for many activities, not just worship). Some children,
who are educated in religious schools receive no drugs education
at all.
— Black and minority ethnic workers
are not seen as the answer—but the lack of them in most
services is seen as a problem.
— Some commissioners and service planners/providers
are completely unaware of the make up of the communities on their
own doorstep.
— Communities see themselves as both
able, and willing, to be part of the solution, but most have never
been seriously engaged before.
— Statistics about many ethnic groups
are completely unavailable, either because they are not collected
at all, or because they cannot be disaggregated.
One of the central issues raised by communities
is in relation to criminalisation and there is something of a
mixed response here in terms of different groups and different
substances. For instance, there is evidence that Khat use among
certain African communities is problematic and is even described
in one area of London as "the new cannabis". Khat is
currently legal in this country yet there is a call within some
of these communities for it to be made subject to greater controls
in order to restrict the number of people that are using Khat
problematically. However, this has generated considerable debate
as there is evidence that the use of cannabis in other Black African
and Black Caribbean communities has resulted in an adverse effect
on young people within these communities due to the criminalisation
of cannabis and so criminalising Khat could create similar problems.
The Scoping Study also found evidence that Black
Caribbean drug users in particular were adversely treated within
the criminal justice system as a result of their dominant patterns
of drug use ie stimulants such as crack and cocaine for which
there are as yet very few options for treatment. The result of
this is that as more Black Caribbeans use these drugs they are
faced with less options within new initiatives such as Drug Testing
and Treatment Orders (DTTOs) and are therefore more likely to
fail or receive a custodial sentence.
Of course, this does not necessarily point to
the need for de-criminalisation but rather the need for an increase
in the available treatment for stimulant use. However, in any
review of the current legal classifications of drugs the adverse
impacts on Black and minority ethnic drug users need to be considered,
even more so given the requirements of the RRA Act.
Furthermore, with regard to this aspect of the
review, it is often stated that cannabis acts as a gateway drug
and that this is why it needs to be classified as it is. However,
many Pakistani and Bangladeshi youths despite the evidence of
increasing experimentation with a range of drugs, commence drug
use with Heroin, not only bypassing cannabis but alcohol also.
It is clearly evident that within these communities cannabis is
not acting as a gateway drug.
CONCLUSION
The Scoping Study makes particular recommendations
regarding national and local strategy development and service
planning and delivery. Firstly, the Government need to be co-ordinating
and financing the development of a strategic response to the needs
of Black and minority ethnic communities in relation to drug treatment
and prevention services. An emphasis on ethnic equality should
be included throughout all aspects of the national drugs strategy,
with specific indicators built in.
Any funding which is released should focus on
initiatives which specifically seek to address issues such as
Black and minority ethnic representation, community ownership,
capacity building and cultural sensitivity—this could be
achieved if the Government invested in a national executive and
regional structure which represented the interests of Black and
minority ethnic communities, who would also have a key role in
monitoring progress in the development of services.
The study also demonstrated the potential value
of improving data collection methods and analysis, which needs
to be set up with sufficient monitoring and reviewing methods.
This would be achieved through the production of clear guidelines
to ensure ethnic monitoring is consistent and co-ordinated, with
the training of front line staff who implement ethnic monitoring
to increase the capacity of Drugs Action Teams to make use of
statistical data and other research in planning and commissioning
of services.
These recommendations begin to indicate the
need for far reaching changes within drug treatment and education
service provision in order to meet the needs of Black and minority
ethnic communities, which have been ignored and sidelined for
years. Furthermore, these changes are unlikely to take place or
be effective unless they are clearly set within a context of addressing
institutional racism and are located within the framework provided
by the national drugs strategy.
The key area in which the national strategy
can be said to have failed in relation to Black and minority ethnic
communities is in ensuring that adequate needs assessments take
place and that the communities are actively involved and engaged
in the processes of planning and delivering drug services. The
issue of engaging communities and how local area DATs and services
can achieve this is one that needs substantial development. The
Department of Health funded work in this area provides a crucial
starting point for this development but this is in the early stages
and will need several months further investment and capacity building
before it will be possible to provide a more comprehensive contribution
to this review.
What is clear at this stage is that a model
for achieving this has been created and that a significant number
of people who have so far been actively involved in the needs
assessment work have been brought to a particular level of skill
and understanding that will bring additional value to the field
once further capacity building takes place.
September 2001
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