MEMORANDUM 65
Submitted by Mike Trace
My name is Mike Trace. I have worked in the
drug field for 16 years, the majority as a practitioner and manager
in drug treatment services. In November 1997, I was appointed
as Deputy UK Anti-Drug Co-ordinator, a position which I held until
June 2001 and in which I was closely involved in the creation
of the National Drug Strategy (Tackling Drugs to Build a Better
Britain), and its first three years of implementation. My current
role is Performance Director of the National Treatment Agency.
I am also currently the Chair of the European Monitoring Centre
on Drugs and Drug Addiction, and continue to work on the demand
reduction aspects of the UNDCP follow up to the international
agreement made at UNGASS in 1998. With this background, I feel
I have a unique perspective on the progress of the strategy, and
of related public policy issues.
My concern at much of the domestic and international
discourse on drug policy is that it concentrates on single policy
decisions (cannabis policing, heroin prescribing or abstinence
based treatment) without setting them in the context of the overarching
objectives of policy, and the evidence of what best achieves them.
This is what we tried to achieve in the UK drug strategy we launched
in April 1998—we asked what are the problems we want to
solve, what are the objectives (and targets) that would show that
we have made progress, what actions can be pursued to achieve
these objectives, and what evidence exists to show that these
actions are effective? I still believe that this is the right
approach to such a complex area of social and health policy where,
too often, rhetoric rather than reason has guided policy. The
structure and approach of the UK strategy has been seen as a model
by the international community which has been emulated since by
many countries (eg Eire, Portugal, Czech Republic).
However, there are a number of flaws in the
original document, and the evidence base that has developed since
it was written is beginning to point to some different conclusions.
The main weakness of the original strategy is in its choice of
headline objectives. The four chosen—Reduction of Young
People's use of heroin and cocaine, Reduction of Drug-Related
Crime, Increase in Treatment for Addiction, and Reduction on Availability
of Drugs, were broadly appropriate, although a couple have problems
with counting mechanisms. Of greater concern is the omission of
two areas that I would argue are important objectives of drug
policy—Reduction in Harm to Public Health from drug use,
and Reduction in Social Exclusion caused by drug use. I am going
to structure my evidence according to these objectives that, with
hindsight, should have formed the basis of the drug strategy.
Reduction in young people's use—the strategy
objective here is to reduce reported levels of use of cocaine
and heroin by Young People (under 25) by 50 per cent by 2008,
working from a baseline set in 1999. The thinking is that a lower
level of use of these most harmful drugs is in itself a good thing,
any reported use being an indicator of addiction or high-risk
behaviour. It was suggested in the strategy that a concerted programme
of education in schools, backed up by more intensive programmes
targeted at socially excluded children and adolescents, would
achieve these targets. The evidence base for this hope was thin
at the time and looks thinner now. While good drug education in
schools, and investments in programmes for marginalised kids may
be a good thing in their own right, they are unlikely to have
an impact on the overall prevalence of young drug use, and will
certainly not get anywhere near the target of a 50 per cent reduction.
The reality of the last three years is that more and more young
people are using cocaine as part of their social scene which is
likely to push the prevalence figures upwards (while not necessarily
meaning an increase in addiction or other harms). In my view,
the target would only be achieved if a significant shift of youth
culture and attitudes towards drugs took place, or enforcement
action led to a sustained drought of these substances. Neither
scenario looks likely. I will address the availability issues
later, but in terms of youth culture and attitudes towards took
place, or enforcement action led to a availability issues later,
but in terms of youth attitudes, the inexorable move towards greater
freedom of choice and purchasing power means that it is inevitable
that we will need to become accustomed to high prevalence levels,
concentrating instead on minimising the harmful consequences.
Reduction in drug-related crime—the objective
here is to reduce the amount of property crime committed by addicts
to fund a drug/crime lifestyle. This analysis holds true—most
addicted users of heroin or cocaine raise hundreds of pounds per
week through property crime, contributing significantly to the
overall level of such offences in the country. Furthermore, programmes
designed to identify, assess and refer these addicts through the
Criminal Justice System (Arrest Referral Schemes, DTTO's, Prison
Programmes) have shown they can be successful in reducing these
forms of drug related crime. As the national rollout of these
initiatives continues, I am confident that the benefits in terms
of reduced property crime committed by addicts will approach the
50 per cent target reduction by 2008. The problem with this objective
is that it relates only to property crime, neglecting the crime
and disorder associated with drug markets. The fact that a form
of drug-related crime that causes significant concern to communities
is not reflected in drug strategy objectives or actions is worrying.
Violence associated with drug markets, from minor assaults to
murders over turf, profits or debts is significant and unrecognised.
If we realised its extent, we may have to re-evaluate the levels
of harm caused in our society by the widespread existence of illegal
drug markets, and find new ways of preventing them.
Increase in addiction treatment—the objective
here is to double the number of addicts treated by 2008, from
a baseline established in 1999. The thinking is that the state
provided treatment for addiction is humane on a personal level
but also, where successful, can deliver on wider social objectives
such as crime reduction, increased public health, and reduced
social exclusion. This is an area of the strategy where the analysis
holds true, and the programme of action is progressing well—treatment
activity levels have been increasing nationally at a rate of 16
per cent since 1999, and the much needed improvements in the quality
of addiction treatment services are being addressed through the
newly established National Treatment Agency.
Reducing the availability of drugs—the
objective here is to reduce the availability of heroin and cocaine
on our streets by 50 per cent by 2008. One of the main actions
in the strategy was to ask enforcement bodies (Customs, NCIS,
NCS and Police Forces) or prioritise their resources on these
substances, moving away from the easier target of cannabis. They
have been broadly successful in doing this—seizure rates
for heroin and cocaine have increased dramatically in the last
two years. However, previous trends have been confirmed in that
the level of seizures and arrests seem to have had no effect on
the price, purity or availability of these substances. The thinking
in the strategy was that, if enforcement action passed a certain
threshold of success, then heroin and cocaine would be less accessible
to young people, and a lower number would be "recruited".
The evidence of the last three years seems to support the argument
that prevalence is demand led—as long as there is a demand,
the market will supply it. Enforcement agencies in the UK should
be congratulated for their operational effectiveness in recent
years, and the disruption of criminal groups is an important objective
in it's own right, but it is not delivering a reduction in availability
of drugs.
Reducing harm to public health—the transmission
of HIV and Hepatitis (B and C) through injecting drug use has
been a major public health concern since the mid-1980s. In terms
of HIV, early responses in the UK (needle exchange, widespread
health education, and access to treatment) were effective in keeping
HIV levels amongst drug injectors down to one of the lowest rates
in the world. The drug strategy did not prioritise action in this
area because it was felt that existing actions were sufficient.
However, it is becoming clear that this area of activity does
need further attention, as new generations of injectors who have
not been exposed to previous campaigns emerge. In addition, Hepatitis
C rates amongst injectors remain high, with no co-ordinated national
approach to prevention or treatment. Similarly, the number of
overdose deaths caused by illegal drug use in this country is
unacceptably high. Most injectors take their drugs in isolated,
unsanitary conditions so that where an overdose occurs, first
aid responses that could save a life are rarely available. In
some areas of the country, innovative schemes have had a big impact
on death rates. For example distribution of naloxone, first aid
training for users. (Injection rooms established in other countries
are also showing promising early results.) The strategy should
add a fifth key objective of reducing the number of deaths and
infections relating to injecting drug use, with a well-resourced
programme of actions aimed at reducing infections and overdoses.
Reducing drug-related social exclusion—the
impact of drug use on the process of social exclusion—school
failure, unemployment, homelessness—is difficult to define
and seemingly impossible to measure. It was for these reasons
that a key indicator on this issue was not included in the original
strategy. However, the relationship between drug use and these
social harms needs to be given more central consideration within
the drug strategy. There is no doubt that some patterns of drug
use contribute to the process of marginalisation—teenagers
preferring a drug using lifestyle to school or the search for
a job, addictive patterns of use making the addict unemployable
or unable to sustain a home—but it is also true that the
effects of our anti-drug policies can also contribute to this
process. Hundreds of children are still excluded from school annually
for drug possession, thousands receive a criminal record for the
same offence. Of even greater concern in my view is the corrosive
effect in poor communities of the existence of illicit drug markets.
The choice facing hundreds of thousands of adolescents who are
at risk of failing at school is whether to commit to the hard
work necessary to pass exams and build a career, or take the easy
route to money on the fringe of the illicit drug market. The existence
of money-making opportunities in the drug markets in every part
of the UK is a strong disincentive to large numbers of young people
to work in the mainstream economy. Add to this the perceived glamour
and wealth associated with "successful" drug dealers
in these communities, and I would argue that this presents a significant
barrier to the wider government objective of a more inclusive
society. This phenomenon has received little policy or research
attention so far, but needs to be better understood and quantified.
In summary:
— assessment of the current drug strategy
has been focused too heavily on the overall prevalence of drug
use in society;
— the activities design to bring down
prevalence (ie Primary Prevention and Supply Reduction), while
of value for other reasons, are unlikely to achieve the key objective;
— policy should therefore be based
on an acceptance of a continued level of overall prevalence, but
concentrate on reducing the consequential harms associated with
certain patterns of use;
— some programmes within the current
strategy are working well in reducing health damage and crime,
but further attention is needed to reducing drug-related deaths
and social exclusion; and
— the way in which we police recreational
use (ie cannabis) has very little impact on these harms, so investment
in (and inconvenience of) these activities should be minimised.
Postscript: the current events in Afghanistan
raise the prospect that, for the first time since heroin use became
widespread in Europe, a significant drought could occur in Western
Europe. These unique circumstances present an opportunity to measure
the impact on local rates and patterns of use. The impact could,
of course, be positive or negative, but if such a reduction of
supply can be maintained, it is possible for a supply led approach
to deliver on the availability target.
September 2001
|
