TUESDAY 12 FEBRUARY 2002
Mr Chris Mullin, in the Chair
MR BOB AINSWORTH, a Member of the House, Parliamentary Under-Secretary for Anti-drugs Co-ordination and Organised Crime, Home Office, examined.
Chairman: Good morning, Minister, and welcome. This is probably the final session we are going to have on our drugs inquiry, although there is a possibility we will take a witness from Sweden whom we have had some difficulty tracking down; otherwise it is our final session and we hope to complete our report by April. Thank you very much for coming. We are going to start, if we may, with some general questions.
(Mr Ainsworth) Can I just say, I have followed some of the evidence that has been given to the Home Affairs Select Committee over the period of your inquiry now and I know this question was asked of officials right at the very start. There have been some attempts to scope the issues but it would be very difficult to actually pin down the whole costs of such a move of policy. That is really a matter for ministers rather than for officials and I thought that at the time - to pin officials to the wall on what they should or should not have been doing in this regard. That is another area we are actively looking at and, therefore, it is not an area we have asked officials to spend great amounts of resource exploring. There is a lobby for legalisation; and there is a lobby for criminalisation. I am not sure people always understand what they are arguing for within those two definitions. I think it is often the case that those who advocate legalisation advocate it as a potential panacea for many of the costs that are imposed upon the criminal justice system, without necessarily looking at the downside in terms of the fact that I think it is proven beyond all doubt that illegality discourages use; that legalisation would lead, to some degree, to an increase in use. That is proven by surveys that come back that say directly people are discouraged from using some of these substances by the fact that they are illegal. It is also self-evident from the fact that, to some extent, availability has got to be suppressed by the very fact that they are not legally available. When you look at the public health consequences and the individual health consequences of what could be a very substantial increase in use, it is not something we are contemplating; and, therefore, it is not something that we are giving large amounts of money on.
(Mr Ainsworth) You have had witnesses coming in front of you who have said everything from one extreme of the spectrum to the other extreme.
(Mr Ainsworth) It is against what measures you want to say that. The overwhelming majority of people in this country do not use illegal drugs. The cost of legalisation is, what, in terms of blue sky thinking? These are largely refined agricultural products. What is the difference at the end of the day between the cost of heroin or cocaine and a bag of sugar? To what degree does legalisation get us out of some of the difficulties we have got? Unless we are prepared to contemplate a situation where drugs, including hard drugs, are widely and cheaply available to everybody, including children, you cannot get the legal system out of this area in its entirety. Surely, cigarettes and cigarette smuggling and the rest go to prove that that is the case.
(Mr Ainsworth) I would contend that that is not necessarily the case. There is evidence that the wholesale price of drugs is higher than it has been for some time now. The Drug Strategy has only been in since 1998, and that has given us the ability to work across government departments in a joined up way and to focus on the gaps that have been there in the past. I think that if we tried to suggest to people that there is an easy answer, that we can solve problems of illegal drug use either by the present methodology or by legalisation, then we clearly are deceiving them.
(Mr Ainsworth) Very simply, as the Home Secretary I think tried to say to the Committee at the start of its deliberations, there is a desire, which we have been pressing for some considerable time now, for the main effort to be directed at drugs that present us with the main problems. Those are the Class A drugs; those are the drugs that are responsible for acquisitive crime; those are the drugs which do massive damage to people's personal health. Yet the evidence of police intervention is, first of all, there are different methods of dealing with cannabis possession in different police forces the length and breadth of the country; and that actions against the possession of cannabis were actually rising, and rising year on year. A disproportionate amount of police time is being spent on cannabis by comparison with where we are trying to push the enforcement effort, and that is in the direction of Class A drugs. There is also an issue, as I think the Home Secretary tried to say as well, of how we get the message across to young people. They are not stupid; they do know the basic facts in this area, or many of them do; and unless we have a credible message they switch off altogether to everything that we say. If we are trying to say to young people that cannabis is just as bad and just as dangerous as heroin or crack cocaine they hear nothing that we say at all.
Mr Cameron: Do you think that reclassification is a satisfactory situation? Some of our witnesses have put it to us that it is a halfway house - that you need to supply cannabis into the hands of dangerous, armed criminals and gangs -------
Chairman: Mr Cameron, you wandering into someone else's neck of the woods!
(Mr Ainsworth) I think for the reasons I have given for other drugs, that we risk an increase with regard to use and availability if we do that. There are consequences of that as there are consequences to everything. There is no easy solution to this. People advocate decriminalisation, but decriminalisation of what? Decriminalisation in Holland, for instance, leaves the supply in the hands of criminals. So there is no easy place to draw the line, other than total legality. If you make the supply of cannabis as well as its use and possession legal, then you do risk a very substantial increase in use.
(Mr Ainsworth) We do attempt to differentiate on that. The very fact that we have a Drug Strategy in the first place with targets attached has encouraged us to do a lot of work on exactly where the costs arise. Overwhelmingly, both economic costs and social costs to society arise from dramatic drug use. The Committee is aware, I think, that we are in the middle of a stock-taking review at the moment with regard to targets, and one of the issues we want to pick up in the review is whether or not we have sufficient emphasis on problematic drug use, and whether or not the targets on strategies are leading us to attack the worst of the problem.
(Mr Ainsworth) I think it is overstated. I think that the overwhelming majority of drugs are delivered in small quantities by people who are known to the end users at the end of the day. I think, yes, the same people are involved in the supply of different drugs. The Committee needs to reflect on this if it thinks there is some way to take cannabis out and treat it differently, How exactly are we suggesting we supply it - through tobacconists?
(Mr Ainsworth) I think you are twisting very slightly what I have said. We are concerned about recreational drug use and all drug use, but we do see the need for additional resources, additional emphasis and additional focus on dealing with problematic drug use.
(Mr Ainsworth) I do not know exactly what people mean by "decriminalisation". There are different experiments in different countries.
(Mr Ainsworth) What I think people mean is that we replace for possession only or small quantities some kind of civil penalty, a fining regime with the potential for arrest and court action. Where people have experimented in that, I would ask the Committee to look at what happened in South Australia recently - they actually found against a fairly rigid system. I think people found there was a substantial increase in the numbers of offenders on possession of cannabis. You may well find if you move to some kind of system like that you do apply a rigidity to the law enforcement system that does not necessarily apply at the moment. There would also be massive problems, I would suggest, in the quality of the fines that may well be appropriate to some kind of decriminalised regime.
(Mr Ainsworth) I gave you my definition of decriminalisation. I would say to you, that I have difficulty understanding exactly what people were advocating when they said "decriminalisation". If you would like to tell me what you mean by decriminalisation I will comment on it.
(Mr Ainsworth) It is not decriminalisation; it is reclassification. There are other drugs that have been in the B and C Class for some time. If the Advisory Council go along with the idea of reclassifying cannabis, cannabis will remain illegal, with potential for caution by the police on the suppliers, and possession with intent to supply will still be there. We are in one part bringing the law into line with what is being practised by many police forces in any case. As I have said, we are trying to direct police resources where we feel they ought to be, targeted at Class A drugs.
(Mr Ainsworth) At the moment there are three offences which are available. If we were to suggest that dealing should be replaced with possession and replace possession with intent to supply, we would have to define "dealing". If we were to define dealing by possession of a particular amount, then we would find systematically people were on the streets with just under that amount. People are not stupid, and that is exactly what they would do. We would, in effect, be depriving the police of that middle option, where they feel that they have enough evidence to show that the person is in possession with intent. At the moment we enable them, where they think it is appropriate to take that case to court, not to accept it as simple possession, and to attempt to prosecute somebody who is effectively dealing. The alternative is you put some physical measure above or below a particular number of grammes. That would certainly simplify the process. There would be, in effect, only two charges to be brought, dealing, trafficking or supply and, the other one, possession for personal use. We would see systematically people riding that threshold and getting them to think again.
(Mr Ainsworth) I am aware of the evidence you have received and I have tried to check on whether or not that is actually going on. I do not believe, from what has been fed back to me since then, that possession with intent to supply is being used inappropriately or in a massive amount of cases.
Mr Cameron: It might be useful for you get back to us because that is something we have been asked to look at.
(Mr Ainsworth) Yes, there are advantages and disadvantages, as I have said. I think that to some degree depends not only on the court time with the individual cases, but the numbers of cases that are being brought. I have been told at the moment those cases are only being brought where police officers have a high degree of suspicion that trafficking is effectively going on. There is not the evidence to bring a case of trafficking itself, but they do believe they can prove a case of possession with intent to supply, and they do so. If that offence was being used widely and inappropriately at the expense of massive amounts of court time I think you would be absolutely right, there might be a case to review and to look carefully at the benefits of putting set amounts. I am told that it is not.
(Mr Ainsworth) I think that kind of market exists for all the drugs we are dealing with - that kind of small scale dealing by friends, acquaintances and the rest. Yes, there is a line of judgment to be drawn as to where you want to use the law. I think there needs to be discretion by the prosecuting authorities as to when they seek to use possession with intent. I do not think there is any easy way around it though. It is not only would you find friends who are buying and selling on at cost, but you would find quite systematically people putting stashes in safe places and going out with just under the amount, and effectively being immune from any action taken against them for trafficking.
(Mr Ainsworth) You are absolutely right. At the moment we have the potential of this third offence, this middle offence, that can be brought. What we would effectively be doing, we would be removing that potential, I think.
(Mr Ainsworth) At least now we have defined the situation, and what is being said is why do you not consider legalisation of possession and not decriminalisation.
(Mr Ainsworth) I do not accept that that is so. For a start off, you will be aware that this was a police initiative from within the Metropolitan Police Authority. From their point of view it was about redirecting resources and using police resources effectively. We have not had the final evaluation of that yet. Obviously that will be taken into account with any policy change there may well be. The initial feedback I have had on the experiment is that there is still a lot of effective action being taken against possession of cannabis. As a matter of fact, there are more confiscations of cannabis than there were prosecutions for the offence. We must wait for the final analysis and evaluation of what has gone on in Lambeth. It may well be that the police have achieved what they wanted to achieve, and they are effectively able to deprive people of cannabis where they are smoking it without disproportionately wasting police time. Let us wait and see what the evaluation is.
(Mr Ainsworth) You know that the Home Secretary has asked for an evaluation of the provision of heroin on prescription to be looked at again. An expert group has looked at that and there is going to be something put forward about that situation. Heroin is a highly addictive substance, as you know. There is no known top threshold for the amount people can take to make themselves compliant with. I think that would be a recipe for increasing the harm done to people quite substantially, and effectively providing the ability for suppliers to go on and for there to be less effective controls on the supply of heroin.
(Mr Ainsworth) How would we do that, because the supply would remain a criminal activity.
(Mr Ainsworth) You are suggesting the legalisation of heroin?
(Mr Ainsworth) You presuppose that the impurities are the main cause of death with heroin.
(Mr Ainsworth) There have been some quite spectacular individual cases where supplies of heroin have led to a number of deaths. Heroin itself is a highly dangerous substance, massively addictive, and people take it, wind up becoming completely dependent upon it and wind up taking it with other substances as well and deaths are caused, in fairly large numbers, other than through impurities. I do not believe we would have the ability, without massive input from the law enforcement criminal justice system, to be able to control the supply in the way you suggest we might be able to. Warnings on the packets, available only through particular suppliers. How would we keep it out of the hands of children? How would we be able to evaluate the costs of potentially a very large increase in the use of heroin that might flow?
(Mr Ainsworth) Do we do it successfully with cigarettes?
(Mr Ainsworth) I do not believe that heroin is as freely available to young people as it would be in the kind of regime you describe. I think it would be a lot more available. That people would not be discouraged from using it; but there would be a line which would be peddled that if it is legal it must be okay. We would see a substantial increase in the use of heroin and heroin addiction, and not only among addicts but young people as well.
(Mr Ainsworth) That certainly is not true of the recent past. There is no evidence of a substantial increase of heroin addiction in this country at the moment.
(Mr Ainsworth) I am talking about over the last ten years or so. The use of drugs is broadly stable. Ecstasy use went up, and there is some evidence it has now tailed off. LSD and amphetamine use has gone down. There is a rather worrying increase in the use of cocaine. There is absolutely no evidence of an increase in the use of heroin.
(Mr Ainsworth) You are absolutely right. If you were prepared to sell it at a low price to almost anybody there would be no opportunity for a secondary market to grow around the primary market. If you attempted to tax it, regulate the price, or prevented it getting into the hands of people whose hands you did not want it to get into then a secondary market would grow up around the legal market, and we would have some of the same problems of enforcement that we have now.
(Mr Ainsworth) There are a couple of things going on with regard to cannabis. The Lambeth experiment was not a government project, it was a Metropolitan Police Service project. You know that the Home Secretary has told you at the start of your inquiry, rather than halfway through, he was minded to ask the Drug Advisory Council to consider the reclassification of cannabis. We obviously, in taking a view on that, will want to look at the outcome of your report, the outcome of the Lambeth report and what the Drug Advisory Council themselves say. The motives, as I have tried to say, were not simple and singular; they were about trying to bring the law into line with that which was being practised in some police authorities in any case, and provide some consistency within police authorities; direct police resources a little more towards Class A drugs where the most damage was being done; and get a more credible message to send out to young people in order to get through to them about the damage that drugs do.
(Mr Ainsworth) If the Advisory Council recommended reclassification -------
(Mr Ainsworth) I will be surprised if they do not.
(Mr Ainsworth) I have admitted that before. If they do that then the consequences of reclassification to C will be that possession of small amounts would not be an arrestable offence. Some of what is going on in terms of the police experiment in Lambeth will become the law of the land.
(Mr Ainsworth) We did not provoke it, but we did not condemn it either. We were happy to watch it, and very interested in seeing the evaluation because, you are absolutely right, there are, effectively, these post code lotteries with regard to how the police deal with the possession of small amounts of cannabis.
(Mr Ainsworth) I have not met the officers on the beat in Lambeth since the early days of the experiment. It would be fair to say there were mixed views among those officers when I did met them, but there was not hostility to it. There was not general hostility to it. Their main worry is about the drugs that we are worried about - about heroin and cocaine. Their own concerns were that they were able to take effective action and this would assist them in doing so, and not present them with difficulties in doing so. That was right at the very early days. I have not spoken to them since back in October.
(Mr Ainsworth) The evaluation of the Lambeth experiment should be available this month.
(Mr Ainsworth) As I tried to say earlier on, the initial reports I am getting are that what is going on in Lambeth has been quite positive. I have not seen the leak you are talking about, but it is not out of line with those interim evaluations I have. It is important we get the proper full evaluation.
(Mr Ainsworth) As I think I have explained, the effects of reclassification would be very similar in terms of policing to what is going on in Lambeth at the moment. It is not right, I do not think, that the Home Secretary effectively does things by diktat and without appropriate consultation. Therefore, he made the announcement he did to this Committee at the start of your inquiry. We are consulting the Drug Advisory Council before any decision will be taken. I do not disagree with what you are saying. I get pretty tired of answering parliamentary questions that show trends of offences and arrests for possession of cannabis going up and up when, in theory, everybody is supposed to be focussed a little more on the drugs doing the real damage.
(Mr Ainsworth) I think you will find the Police Foundation did a report, I cannot remember how long ago, but at the outcome of that it was said that the classification of all drugs will be kept under review; and this Home Secretary, picking up what the Police Foundation said, took the decision he did and reported to this Committee.
(Mr Ainsworth) Yes.
(Mr Ainsworth) One is not in a position where one can possess and use small amounts of cannabis. Cannabis is being reclassified to Class C; it will still be illegal. There is no intention of legalising it or decriminalising it under the different models people have for decriminalisation; so the possession of cannabis will remain illegal, albeit there will be a redirection and potentially a saving of police time.
(Mr Ainsworth) It still will lead to confiscation and caution; and if we are effectively saving police time (and that is why I say the final evaluation does need to be looked at, and we should not jump to any conclusion) then it will improve effective policing; not only effective policing to be used against other drugs but potentially more effective policing against cannabis possession. If we can confiscate an amount of cannabis that is worth a substantial amount often to the person who has possession of it, and do that efficiently and effectively without tying up a police officer for three, four or five hours in order to drag them in front of a magistrate in order for a magistrate to present them with a £30 or £40 fine, there is not a massive difference in terms of penalty at the end of the day. It is just that we have enabled the police to move on, and we have encouraged the police to refocus their activity in the areas where we see the most damage being done. There is no intention to legalise the possession of cannabis.
(Mr Ainsworth) I can only assure you, when we were considering this policy over the recess between the General Election and the start of the parliamentary session, when the Home Secretary came in front of this Committee we did not consider it as part of an ongoing process towards something else. We considered it as a practical measure to be taken in itself.
David Winnick: We shall see, Minister.
(Mr Ainsworth) There is no classification for recreational drug. There is a definition that is used about the way in which people use drugs and whether or not they are in control to any extent of their use of drugs in terms of problematic drug users, on the one hand, and recreational drug users on the other; but those can apply to almost any kind of drug irrespective of classification.
(Mr Ainsworth) As nobody, as far as I am aware, uses the phrase a "recreational drug", I do not know that that is an issue, is it? Who uses the words "recreational drug"? To what substance?
(Mr Ainsworth) What I have said is that there are people who manage, over fairly long periods of time (when they can slip into problematic drug use) to use drugs in a recreational fashion without becoming problematic drug users. That can apply to any substance, as far as I am aware. I see no particular substance as being a recreational drug. If I have given that impression I did not intend to.
(Mr Ainsworth) Let us check the record first. I do not think I did.
Chairman: If it is of any help to you, Mr Russell, I think I introduced the word into the proceedings.
(Mr Ainsworth) Not in every case; but there are some forms of cannabis which are a lot stronger than the norm. There are some cannabis products that are highly hallucinogenic and far faster.
(Mr Ainsworth) The number of people who are taking all drugs?
(Mr Ainsworth) 4 million people admit to using listed drugs in each year. 1.8 million of those are Class A drugs. We then, as best we can, size the number of people whom we class as problematic drug users as anything between 160,000 to 280,000. It is very hard to become specific about this.
(Mr Ainsworth) 200,00 to a quarter of a million problematic drug users in this country, yes.
(Mr Ainsworth) I do not think it will make any difference to the reporting mechanisms.
(Mr Ainsworth) You are absolutely right. In providing incentives we need to make sure they are properly directed. That is exactly what we are trying to do through encouragement to tackle the issue of Class A drugs.
(Mr Ainsworth) It is about how we structure the targets we apply to the police. It will also be about how we structure the targets following this October review of the Drug Strategy. I think you are absolutely right, we need to try to make sure there are many changes to the Drug Strategy, that we are maximising the focus and the efficiency of the resources we are applying to the areas we want to apply to.
(Mr Ainsworth) That is precisely our motivation to do exactly that. Yes, we will look at those issues.
(Mr Ainsworth) You can remember the 1960s, can you?
(Mr Ainsworth) You know what they say about that - if you can remember you were not there! There are available cannabis strains which are a lot stronger, and there are health problems taking cannabis both in the short-term as well as potential long-term health problems. There is not enough research done on that as of yet. That is the reason for us continuing to believe that cannabis should remain an illegal substance. With the skunk cannabis, as they call it, the THC-bearing cannabis, there is no evidence as far as we are aware that it has carcinogenic contents greater or significantly greater than long-term regular use of ordinary cannabis.
Chairman: Let us turn to the subject of ecstasy.
(Mr Ainsworth) There have been a lot of reports around and some conclusions that have been jumped to off the back of Home Office reports that need to be used with care. The best measure of use for ecstasy is the British Crime Survey, which suggests that 5 per cent of young people have used ecstasy at least once in the last year.
(Mr Ainsworth) Over the recent past there was a rise in the level of ecstasy use which appears, in the last couple of years, to have tailed off. We have no evidence that it is going down.
(Mr Ainsworth) There have been a number of reports out and some of them have carried their own riders in terms of people being asked to consider them with caution, because the methodology was something that needed proper evaluation over a period of time. We still believe that the best measure of the level of ecstasy use is that it is not going up but, equally, it is not going down.
(Mr Ainsworth) It is a different drug, with different effects. It does not carry the kind of physical addictions that heroin does - there is no doubt about that. There is no safe dose of ecstasy. There is a popular myth that some of the ecstasy-related deaths have been caused by impurities. That is a myth. There is no evidence that ecstasy has been cut in this country by any substance that is any more dangerous than ecstasy itself. Ecstasy is a dangerous drug to take.
(Mr Ainsworth) Its harms are different in that it is used for recreational enjoyment. The level of dose that people take in order to get the enjoyment they get from it are potentially dangerous and life threatening.
(Mr Ainsworth) It is not. The two drugs that have a proven link to acquisitive crime are heroin and cocaine.
(Mr Ainsworth) That does not mean we cannot target resources at areas of need. Knowing what we know about ecstasy in terms of the immediate risk of, at worst, death; and not knowing (because while it has been around for quite some time as a drug) the misuse of ecstasy in any quantity, for the moment; not knowing the long-term health consequences of ecstasy; and in the absence of any specific recommendation from the Advisory Council, it would be wholly wrong in my opinion for us to reclassify ecstasy.
(Mr Ainsworth) As I say, we think that ecstasy is a dangerous drug. It is a dangerous drug in its immediacy. We do not know about the long term consequences of regular use and we see no reason or justification for reclassification of ecstasy. I do not think we should exaggerate the amount of police time that has been thrown up by the reclassification of cannabis, as if we are going to be able to move hordes of man hours into tackling other areas. I think potentially it can be of benefit, but it is not going to be of a massive order.
(Mr Ainsworth) We do not think there is an increase in the use of cannabis as inevitable from reclassification at all. If we did our reaction would be different to that which it was. I do not know, is the obvious answer, what the consequences of the reclassification of ecstasy might be. It could be we send a message to people that it is a safe drug to use; and that would be a very damaging message to send.
(Mr Ainsworth) I think we have to look at how we get the message across to people; whether or not we have any credibility in the message we are getting across to people. I know there are arguments repeatedly made for the reclassification of ecstasy. It is not my belief the fact that ecstasy is in Class A is massively detracting from the message to young people. I think there is quite a fear where people are aware of the potential consequences of ecstasy of taking it and that is discouraging ecstasy use. I think that is part of the reason why the increase in the use of ecstasy has actually tailed off in the last few years.
(Mr Ainsworth) I do not know to what extent it is believed, but just because all of these drugs are classed as A does not mean that we are equally concerned about every aspect of every single one of them. For instance, I think we have got a particular problem with crack cocaine and if you start looking at overall harm done by any given substance, given the kind of culture that surrounds the supply of crack cocaine and the massive damage that it is doing to certain communities and inner-city areas, you could argue that that warrants some higher classification, but there is not necessarily a need to make crack cocaine Super A in order to try to zoom in on and apply the necessary resources to start to try to tackle those problems.
(Mr Ainsworth) No, we are not looking at that. One of the things we are looking at which the Home Secretary tried to indicate to the Committee, I think, is that we are looking at introducing to a greater extent in the Drug Strategy the concept of harm minimisation. I cannot say, because the review has not finished yet, exactly where we have got to with regard to that evaluation, but if we are looking at harm minimisation, then it is only right that we should look at the harm that is done by particular substances and the way that they are used and the impact that they have on particular communities. I do not think that we need a reclassification in order to be able to do that. I think we need to look carefully at the structure of the strategy, the targets, the SDAs that underpin, the service delivery that underpins the targets as well, and I think that we can do that within a harm minimisation direction, but we do not need to have a separate classification for every single substance that exists and put them in ranking order.
(Mr Ainsworth) We have not accepted it, otherwise we would do what they effectively suggest. We know that there are arguments for both reclassification with regard to cannabis and reclassification with regard to ecstasy. On the cannabis ones we thought there were good grounds underpinning the arguments, that we were effectively detracting from the message that we were sending across to people about drugs overall by being seen, and it was not necessarily true, but by being seen as counting cannabis as as important or as dangerous or as threatening as Class A drugs and we needed to try to differentiate a little bit the message that we sent across in order to make it credible. The same argument is presented by the people you suggest with regard to ecstasy, but we do not think that it is true to anything like the extent that it is with cannabis. As I have said, it is a life-threatening drug and there is no safe dose. The Advisory Council looked at ecstasy as recently as 1997 and decided to keep it as Class A. Now, in the absence of knowledge about the long-term health effects or any feeling that this was a safe drug to take in any way, it would be irresponsible, in our opinion, to reclassify ecstasy.
(Mr Ainsworth) The source is overwhelmingly the British Crime Survey.
(Mr Ainsworth) Yes.
(Mr Ainsworth) Yes.
(Mr Ainsworth) The team of experts met for the first time last month in order to look at treatment. You are absolutely right, that treatment in terms of stimulants, particularly cocaine and crack cocaine, is a long way back from that which has developed surrounding opiates where there is a lot of knowledge which has been built up over a period of time, but there is some good practice and some effective practice which is taking place in parts of the country. There was a high degree of consensus for these at that meeting about a way forward and the way forward is, first of all, that in trying to make sure that treatment is available wherever it is needed, and it is not yet, it is very patchy, so we need that capacity, and we need also to be able to spread best practice which is actually working in terms of stimulants. Cocaine addiction, I am told, is very different from heroin addiction in that it is not physical addiction where people need to be maintained and withdrawn over a long period of time, but it is more of a psychological addiction. In treating it, people need at the beginning just to be able steady people down in order to be able to talk to them and communicate with them at all, heavy, problematic users, and then they need to address the underlying problems which will enable them break the addiction themselves. As I say, there is some expertise that is growing and we need, following the consensus meeting, to take forward what was agreed there, to use the NTA which we have just set up, to make sure that that capacity is spread throughout the country where it is needed.
(Mr Ainsworth) By the end of the year.
(Mr Ainsworth) As I have said to you, we have substantially increased the amount of resources for the Drug Strategy overall and one of the myths, I think, that is sometimes peddled by those who advocate a substantive change to the legal framework that we have in this country is that we over-concentrate on prohibition and criminal justice and the enforcement measures as against treatment measures, but over the last few years we have moved substantial amounts of money in terms of the proportion of spend towards treatment. We have not cut back on the amount of money that we are spending on availability, but as the amount of money has grown, the amount of money that we spend on treatment has grown substantially. For instance, in 2000/01 the amount of money already allocated only represented a third, 33 per cent, of the money within the Drug Strategy just for treatment, and by 2003/04 it is estimated that it will grow to 40 per cent, so that is 40 per cent of a growing amount of money as against 33 per cent of the amount of money in the year 2000/01, so there are substantial resources going in now to providing treatment facilities.
(Mr Ainsworth) Your whole remit as a committee has been, "The Drug Strategy: is it working?". Perhaps I may make a couple of general comments, and then come specifically to the point you raise. I think that if you make that judgment, and this is something you will be deciding in the near future with regards to drawing up your report, if you make that judgment in terms of, "Has the Drug Strategy already now had a massive impact on use here in this country, or are we going to be able to hit every single one of our targets?", then I think that your report may well find in the negative, but if you judge the Drug Strategy on, "Has it managed to allow us to focus the effort that is needed into the most efficient and into the areas that actually work?", then you will see that there is a massive amount of work which has been done which is having a very real effect on the problem of drugs in this country. Now, the communities target within the Drug Strategy, which is really at the moment defined as a re-offenders target, has led to the kind of initiatives that are now being piloted in Staffordshire, Nottingham and Hackney where we are testing people, whether they are being charged for acquisitive crimes or drug-related crimes, for the two Class A drugs that are known to be associated with those acquisitive crimes, that is cocaine and heroin, and a very high proportion of those who are being charged are being shown to have tested positive. Something like, across the three, 50 per cent of those who were being tested were shown to be positive for either or both of those substances, and that has enabled us either to get them into treatment by a DTTO, a drug treatment and testing order, or if their problem is not perceived to be of a level where a DTTO is necessary, then we are able to apply a drug abstinence order or drug abstinence requirements. So the criminal justice system is giving us the opportunity to get people into treatment and we would not be developing the kind of initiatives that we have piloted in Staffordshire and I do not think we would have pushed out arrest referrals to now where we have got it in practically every police force in the country without the focus that the Drug Strategy has given us.
(Mr Ainsworth) I gave you the figures for all Class A which was 160,000 to 240,000 problematic drug users. I am just trying to put my hands on heroin on its own. We have got about 118,000 people in treatment at the moment and that is growing at a rate of 8 per cent a year which is just above the target that we set in the Drug Strategy which will require at least 7 per cent annual growth in order to reach the levels of treatment that we are attempting to reach. Those are not just heroin figures, I am sorry.
(Mr Ainsworth) Explain the difference? I think there are people who have managed, and I think they are relatively few with regard to heroin, but there are people who have managed to use heroin for a period of time and yet maintain a stable lifestyle and not fall into addiction to the extent where it begins to be a massive problem with their lives, they lose their jobs and they turn to crime or prostitution or whatever in order to fund their habit. There are probably more people who fall into those categories with other drugs than there are with heroin which is a highly addictive substance, as you know.
(Mr Ainsworth) Forty-six thousand?
Chairman: That is in treatment, is it not?
Mr Cameron: No, that was users. It was my written question.
(Mr Ainsworth) Yes, but this is an area where it is extremely difficult to pin down exact figures, for a start. I said "problematic users" and you can see the range that there is there. From 160,000 to 280,000, there is an enormous variance between the top and the bottom of that. The overwhelming majority of those problematic drug users are heroin addicts.
(Mr Ainsworth) Again, as I say, there are 118,000 places of treatment in the country and that is overwhelmingly opiate users.
(Mr Ainsworth) You will know, and I have sought the evidence that was given to the Committee, about the problems that we have got with regard to GPs becoming involved with drug treatment overall, not just heroin treatment. As we are attempting to grow the treatment facilities and all these other measures, like DTTOS, the interventions that there are within the Prison Service, drug abstinence orders, they are not going to work unless there is the treatment there to back them up. They are not going to be successful unless we manage to increase the preparedness to be involved in treatment. That is the whole purpose of the setting up of the NTA and we are looking to the NTA to provide training, quality assurance and to do a proper evaluation of where the gaps are, to see to it that treatment is widely available where it is needed, so yes, with the money that is going in and with the input of the NTA, we think that we can substantially grow the treatment facilities that there are in the country at the moment. It is, as I say, on target with regard to the growth that was anticipated within the Drug Strategy.
(Mr Ainsworth) Well, in order to hit the targets, we need to grow treatment at about 7 per cent per year. We have managed to grow it at about 8 per cent per year, so we are really ahead of target at the moment.
(Mr Ainsworth) This is a major problem and this is one of the biggest problems that we need to confront and I would suggest to you that it is caused by the fact that we have managed to grow in triplicate capacity within prisons at a much faster rate than we have managed within the community. If you go back just a few years then prison involvement in effective treatment was practically non-existent. It is not true to say that detoxification is the only thing that is available to people in prisons. Where people are on remand or where they are on very short-term sentences, an evaluation is done when they enter prison as to whether or not detoxification is appropriate or whether or not they need some kind of maintenance because they are just not going to be there for long enough to be able to control that situation. One of our main needs with regard to where the Drug Strategy goes now is effectively to pick people up on release and that is not easy and it is not cheap. We run the prison estate in as efficient a manner as we can and in order to do that, to get effective follow-through so that we are not losing people as they come out of prison, is a massive difficulty, but a lot of effort is being made in terms of advice to prisoners on pre-release, and there is a video which has just been made available warning people of the risks of overdose because their susceptibility to these substances has been massively reduced, or they may have been using when they first went in or in the earlier parts of their sentence, in order to try to avoid the level of deaths, which I am afraid has risen in recent years, the level of deaths amongst recently-released prisoners, so this is one of the main areas that the NTA needs to look at in terms of the growth of community treatment to make absolutely sure that it is available to prisoners on release, that they are able to pick them up and we do not immediately throw them back on the market at great risk to themselves and at great risk that they will return to the life of crime which put them in prison in the first place, and that is not cheap and that is not easy. This is where we hold our hands up and say, "This is a big job that needs to be done. We are aware of it and this is one of the main tasks of the NTA over the next period of time".
(Mr Ainsworth) There has been a big growth in treatment provision within prison. Since the mandatory drug-testing regime has been introduced within prisons, we have seen a substantial drop in the positives resulting from those tests, almost halving in percentage terms from 26 to 14 per cent, or something like that. I am not sure of those figures ----
(Mr Ainsworth) ---- but there has been a substantial drop in the positives on the mandatory drug treatment. We have got to remember that whatever is wrong or deficient within the prison regime, they have come a very long way in a relatively short period of time and, as I have said, part of the problem that we have got is that they have outstripped the provision in the community and we have now got this very real gap on joining people up when they get released from prison.
(Mr Ainsworth) Well, let me just give you the figures. Since the mandatory drug-testing procedures were brought in, the positives which have come back have fallen from 24.4 per cent in 1996/97 to 12.4 per cent in 2000/01, so it has halved over that four-year period. As I have said, there is often a misrepresentation put around that the only thing that is offered to people in prison is detoxification. That is not the case. Where there are people who are going to be in prison for a prolonged period of time, their sentence is such that people effectively believe that they can go through a detox programme, then yes, detoxification is seen to be an answer. They then need a lot of advice on leaving because if they return to their old lifestyle and their old habits, they will potentially kill themselves and they will certainly wind up with a major problem, but where there are short-term prison sentences or remand prison sentences, there is a proper Department of Health assessment that now applies to all prisoners which is done to see whether or not a treatment programme is offered to them is effective and appropriate to their needs in those circumstances, so it could be, if they are already on a methadone maintenance programme before they go into prison and that has been shown to be beneficial, they will be maintained on methadone within the prison environment.
(Mr Ainsworth) I am not sure.
(Mr Ainsworth) Yes.
(Mr Ainsworth) The cocaine group is not the same as the heroin group.
(Mr Ainsworth) Yes, in part, if not in whole. Can I just say that on cocaine there is a need, as I said, to drag up the level of involvement, the level of availability and expertise that exists from a far lower level that exists with heroin. On cocaine, because certainly with crack cocaine there is a very real problem at the moment, we know that, for instance, Operation Trident who are looking at trying to deal with the gun crime, black-on-black violence which is taking place in London and has very real cocaine motives in almost every incident, they know that they cannot solve that by just policing alone, so they are looking at community input with regard to how they spread that methodology, so maybe we are going to look at joining together the work that is looking at the treatment side of crack cocaine with the policing side of crack cocaine because there is no need while we ought to be looking at spreading best practice on two separate parallel lines, and there are so many cross-sections between the two, so we may approach the Trident group to see whether or not there is work to be done across the piece. On heroin, this is specifically looking at prescription advice. The consensus group met only last week and they are due to have another meeting in the spring and again before the end of the year we think that we can get to a situation where we have agreement and we need, if we are going to carry GPs with us, we need to try to build confidence around whatever is provided as to what the guidance should be on heroin prescription.
(Mr Ainsworth) There were involved in the consensus group some of the experts in both Switzerland and Holland, so we are not ruling out some of the things which are being looked at in those countries with regard to prescription here. We do not necessarily see the Swiss experiment as being the answer to the situation or necessarily better able to reach the people whom we need to reach than community provision. We equally do not see, and I think we need to make this clear, heroin prescription as becoming the main treatment that is offered to heroin addicts. We still believe in the overwhelming majority that it is the ability that is provided by the drug, and because it gets people away from the injecting habit, that methadone will be the most appropriate form of treatment for the majority of people.
(Mr Ainsworth) What we are worried about is that the current guidance has led us to be a little too restrictive as to where we are prepared to offer heroin as a form of treatment and that there are situations where people are not being allowed access to that treatment where it may well be appropriate and that is in part because, or we believe it is in part because, of the guidance that we have given and the effective restriction of the guidance which has been given, so what the group is looking at is changes to that guidance, trying to reach the maximum consensus about that change so that everybody can buy into it and feel comfortable with it and we will not get a reaction from health professionals to say, "This isn't working as anything that we have confidence in or that we are prepared to operate within that new guidance", so that we can more appropriately use heroin prescription, and there are people who are in such a chaotic state and are so dependent on the drug that are currently not being accessed to heroin prescription because of the nature of the treatments that are being provided where maybe it is appropriate, but we are not seeing it taking over from methadone as the main form of treatment being offered. Heroin has a much shorter effect on people. There is a requirement to go back repeatedly within hours of a particular episode of treatment in order to get some kind of a boost. Methadone, first of all, it is taken orally so you get people out of the injecting syndrome and also it has a much longer-lasting effect, so they only need to go back on a daily basis and on occasions on a wider than daily basis.
(Mr Ainsworth) I do not think so. I do not think that is true at all. The consensus event was run by the Department of Health and not the Home Office. We totally buy into the way in which they are trying to examine the appropriateness of heroin injection as a treatment. I cannot perceive a difference between the two departments at all. We have no intention or desire, and I am sure the Home Secretary did not give you the impression that we wanted, just to change the regime with regard to heroin use and to do it without the necessary safeguards and going through the necessary procedures in order to do that. I cannot perceive any reluctance from the Department of Health to examine this issue, to facilitate what is necessary in order to have it properly evaluated, and to change the guidance if that is what is appropriate and if they can get consensus. As it seems from the reports back that I am getting from the meeting which took place last week, there was a high degree of consensus around some new potential guidance.
(Mr Ainsworth) People are not put on maintenance automatically or because they want to be when they enter prison. The Prison Service does an evaluation and, as I say, they have to do that within guidance set by the Department of Health and that applies to this decision-making process, but where they feel that they have the opportunity or where it is beneficial to the prisoner that they go through the detoxification, then detoxification is what is applied. It is more where they are not going to be able to hang on to that person for the length of time to be able to go satisfactorily through that process and where they are already on some form of treatment before they get in there that is clearly beneficial to them, then it is open to the Prison Service to decide to continue that treatment within the prison environment if they feel that it is appropriate.
(Mr Ainsworth) Overwhelmingly, if they are going in and the length of sentence is such that detoxification can be completed, then whether or not they have been on treatment before they go in, detoxification is the road that people start to look at, but if they are short-term prisoners or if they are prisoners on remand and there is going to be no ability of the Prison Service to complete that situation, then they can look at some kind of maintenance programme in order to stabilise the individual concerned within the prison if that is what is felt to be appropriate given the circumstances that apply to that particular prison in terms of his state of health, his state of addiction and length of sentence or the length of incarceration that he potentially faces.
(Mr Ainsworth) Yes, you are absolutely right and I acknowledge that that is a potential problem. What we need to do is to pick people up and carry them through that release period and to try to carry them through in a seamless way. It is more than just drug treatment in terms of the medical side of drug treatment; it is more to prevent them from going back to the market, back to the crime that fed the market in the first place, and then there are a lot of other things that need to be joined up as well. Not a million miles from your constituency, in Solihull, we funded a pilot whereby the local police followed the arrestees into prison and back through and out and back into the community again. Now, in order to do that, you are potentially building inefficiencies into the Prison Service because you cannot use the estate and maximise the capacity within the estate if you are going to keep prisoners local to the area in order that you can monitor their progress as they go into prison and come back out of prison as well. The police in the Solihull area were very keen on that kind of programme. At the very worst it enabled them to pick people up for re-offending quicker than they otherwise would do, but potentially there was the ability to help them as well to avoid re-offending in the first place, so these things do need to be looked at, but there are maybe substantial costs attached to them as well.
(Mr Ainsworth) Well, I think it would be true and I hope that we are not doing that. 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. Then we are implementing drug abstinence orders in the three pilot areas and we are looking to expand the three pilot areas. I think we have designated another six areas for this kind of work, and 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. That is why we are absolutely dependent upon the funding and the good work that we are hoping is going to come from the NTA in terms of assessing the quality of treatment and the availability of treatment across the country. 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.
Chairman: Now we are coming to the bigger picture which is the National Strategy.
(Mr Ainsworth) Yes. When we were discussing this potential question before I came here, the officials from the Department said, "We are monitoring it to high heaven, repeatedly and continually", and I think that there is some truth in that. You have interviewed Keith Hellawell as part of the official team that came to a meeting. When we drew up the Drug Strategy, I do not think anybody felt or claimed that every single piece of it was pinned down, that we had evidence to back up targets in every case, that some of the targets, it was openly acknowledged at that point, were aspirational and I do not criticise that because there was a necessity to get people focused and to force them to work together. Now, the very fact that we have that Strategy and that we have those targets has forced people to look at what works, what does not work, what is measurable and what is not measurable and some of those targets are extremely difficult to apply a baseline and a form of measurability to be able to say in a critical way that we are or we are not on target. There is little doubt that the one that is most measurable is treatment and, as I have said, we are on target to deliver that and in regard to the other targets, there is a lot of good work that is flowing from the focus that has been given, but in some cases, and this is part of the stocktaking review that we are going through now, we need to develop credible baselines, we need to make certain that what we are reaching for is in some way achievable, although we do need people to be stretched in this area and the last thing we want is for complacency to set in.
(Mr Ainsworth) This is part of what we are looking at in the stocktaking review. It would be rather foolish of me, I think, at this stage while we are still going through that process to try to say at exactly what stage we have reached. Let me share with the Committee one of the problematic targets where I do not think anybody needs to be a genius or where I do not think it requires rocket science to see that there are potential problems with it, which is if we look at availability. Now, how do we measure availability? This is the one that first jumped at me in the face as soon as I saw it. One is availability. Now, how do you measure it? What is easily measurable is seizures. Now, we are doing very well on seizures and the very fact that we have got people working together and we have got them working together as a result of the Strategy being put into place has meant a substantial increase in discussion, particularly on cocaine where there is a very big increase and some evidence that is beginning maybe to show through in terms of the wholesale price and the purity of the product that is coming through. However, if we retreated to seizures, where we have got an easily recognised and an easily measurable target, I think we would be far too narrow in terms of the problem that we are trying to tackle. What is the problem that we are trying to tackle? We are trying to dismantle to the extent that we can the illegal drug supply in the country, so we need to focus on seizures of the supply, we need to focus on disruption of the criminal elements that are involved within that, a lot less measurable than seizures, we need to focus on, and we have done this to a large degree, the Proceeds of Crime Bill, which Tom is painfully aware of, going through the House of Commons, we need to focus on seizing the assets and depriving those criminal elements of the profitability to the maximum extent that we can and then we need to use the other targets to try to whatever extent we can to deprive them of a market in terms of the people whom they are supplying in the first place. To what degree do we narrow the target and to what degree do we give up the breadth of it in order to get measurability is something we are wrestling with in the stock-taking review.
(Mr Ainsworth) By the summer, it has to be, to feed it into the 2002 budget round.
(Mr Ainsworth) Yes.
(Mr Ainsworth) The timing of your report is fortuitous in that we can use your report to feed into our thinking, along with things like reclassification, the Lambeth experiment and other issues, as we check on whether or not we have the focus right, we have the gaps right, we have measurability where it is available. A lot of work is being done on trying to establish some of the baselines which are necessary in order to measure the targets in the first place.
(Mr Ainsworth) When the strategy was pulled together and the targets were applied - and I cannot remember to what degree they were explicit with the Committee when they came here - they used the situation in America, the situation in Australia, to pull some figures down to get people going in a particular direction. I think it was widely acknowledged at that time they were aspirational or inspirational. What is availability? How do we measure it? I go back to that. How can we say definitely it is achievable? These are the issues we are trying to deal with in the stock-taking review in trying to make sure we have credible measures which lead people to do some of the good work which is already being done and yet get the maximum focus and the maximum efficiency for the money we are expending.
(Mr Ainsworth) There is no doubt Customs & Excise have upped their game quite considerably and that also we have a very good working relationship with other agencies, like the National Crime Squad and NCIS in terms of disrupting supply. What we have not seen yet at the retail end of availability in this country is an increase in price. There is some evidence it is beginning to come through at the wholesale level. As I say, there has been a lot of good work in terms of getting people to work together and getting them to focus, there has been a massive increase in seizures, and we have also been able to identify gaps in terms of availability. One which has become pretty apparent is what is called the middle market. We have been obliging local police forces to look down into their own local communities, so at the PCU level it has been focused on the streets and what is going on in the neighbourhoods; at National Crime Squad and NCIS level, we have been saying, "Disrupt the supply and if necessary go back up the supply chain towards the countries of source", and what has grown up to some extent is a potential gap in the middle. We have a pilot going on in the West Midlands with four local police forces being resourced from seized assets to look at how they disrupt that middle market supply. Those kind of issues have been highlighted by the strategy and that has been a success of the availability target. There is a lot of good work which is flowing from it.
(Mr Ainsworth) We have been using the young people's target in order to try to widen the availability of education within schools, and have had quite a success at doing that. Almost 93 per cent of secondary schools now have drug education available to them and 75 per cent of secondary schools (sic). It is not education that is given to them in isolation, and I am not sure it would be effective if it was. It is part of presenting people with life skills leading them in the direction of a healthy lifestyle, and issues like smoking, alcohol and the consequences of using illegal substances are brought in to try and help them, to give them the knowledge to take appropriate decisions when they are confronted with the availability of those substances. That has been the main thrust of the education side of the young people's target.
(Mr Ainsworth) Let me tell you what we are trying to do. We are trying to be effective and the judgment that we have come to in deciding how we could be effective is that preaching at young people is not going to work. I know there are people who advocate that, and there was the "Just Say No" campaign and everything else, but if we thought that would work, we would certainly be looking to go down that road. Our evaluation is that it is not going to and what we are effectively going to do, if we attempt to preach to young people, is switch them off and they will not listen at all. So what we are trying to do is equip them with credible information, so they do not wind up getting themselves into situations without a degree of knowledge. We are trying to equip not only the young people themselves, but their parents and their carers as well. One of the main reasons why parents do not engage with young people on drugs is that they feel they simply have no knowledge whatsoever in depth of the issues they are getting involved in, so there is a need in our opinion to raise the awareness and to raise the level of knowledge among young people themselves. Peer group information is what they are effectively getting at the moment, some of it is accurate, some of it is totally off the wall. The whole of our recent communications campaign which we ran over the Christmas period was to try to advertise the availability of the National Drugs Helpline and to say to young people in language they would perceive, with messages coming from young people themselves, "If you really want to know what ecstasy will do to you or what cocaine will do to you, don't listen to your mate, ring the National Drugs Helpline, you will not be preached at, you will be given credible information about the effects of these substances." So that is the broad thrust of our message. It certainly is not to encourage experimentation, quite the reverse, it is in order to give people the information to draw them away from it. If we thought preaching would work, we would go there but we do not think it will. 1313. Drug taking is higher in absentees from school and young offenders, how do we target these particular vulnerable groups who are more likely to be taking drugs than pupils who are in school?
(Mr Ainsworth) This is one of the issues we have to try and take on board to a greater extent in the stocktaking review than we have up to now. We need to try and discourage all drug use, there is no doubt about that. It would be a very strange message, indeed, to problematic drug users if we were doing anything other than saying to the population at large, "These are dangerous substances and you should not be using them". We need that message to go out broadly to all young people. You are absolutely right, that it is absentees from schools, it is people with other problems, people in care, who have a far higher propensity to become problematic drug users. The degree to which we focus on those groups and the degree to which we are going outside the young people's area and the degree to which we link up with Neighbourhood Renewal and Social Exclusion Programmes - because that is where the main impact of drug misuse is being inflicted on communities - are issues that we are trying to pick up in the stocktaking review.
(Mr Ainsworth) I think that culture can be changed over a period of time. I think that the levers are difficult to identify and quick hits are not available. We have seen patterns of drug use change over periods of time. For instance, we have seen the increase in ecstasy has tailed off, sadly it is not going down but we see it tail off, and I think that is largely because of the message that has come through the media over a period of time of the acute danger of taking those drugs. LSD use has almost disappeared, not disappeared but gone down substantially. Culture changes over a period of time and we have to try influence it and push it in the right direction. Whether or not we should be investing in a substantial increase of work on enforcement - all of the money comes out of a finite pot at the end of the day - at the expense of education, at the expense of treatment is another thing. When we have tried to look at what actually works we think that we have evidence that treatment does work and that pound for pound we are getting more out of treatment than we are out of law enforcement activity. The evidence appears to suggest that every pound spent on treatment can effectively save three pounds in social economic costs and the criminal justice costs. That is why the balance of expenditure has been moving in that direction rather than in any other.
(Mr Ainsworth) In my opinion we have to keep up our efforts on enforcement and a failure to do that will lead to increased availability and it will send a message that the use of drugs is okay. We have to keep up our expenditure on information. There is evidence that comes back from polling, that I think I mentioned earlier, that suggests that a fair proportion of people are deterred from experimentation by the mere fact that the substances are illegal, not everyone, sadly, but a fair proportion of people are deterred, and they give in answer to questions to MORI polls, and the rest of it, "Why have you not experimented with cannabis or cocaine?", the fact that they are illegal. In my opinion we have to maintain our efforts on the enforcement side. Education, communication and building up the capacity of everyone concerned, whether it is carers, people who are in care, local authority homes, parents and young people themselves is going to have payback. It is not going to have immediate payback. If we manage to lift the level of knowledge among young people - we are currently measuring drug use in young people up to the age of 25 - it is going to be quite a time before it begins to feed through into the take-up and use figures up to the age of 25. I think it is a side of the tragedy that we cannot neglect.
Angela Watkinson: Thank you, Minister.
(Mr Ainsworth) There was a Home Office report that suggested that 26 million a year were being taken. There was a serious rider in that report, as I tried to say earlier, about the methodology that had been used and people were lead in the report itself to take this figure with great caution. It is not often that the media do not look at the headline figure and give the same prominence to the rider that is given in research like this.
(Mr Ainsworth) In my opinion, as I said before, the best and most reliable figure to use if you want to look at prevalence is the British Crime Survey. The British Crime Survey indicates that five per cent of young people have taken ecstasy at some time in the last year.
(Mr Ainsworth) If they contact the National Drugs Help Line there is detailed, solid, comprehensive advice on the consequences of taking any particular substance. We ran a programme over the Christmas and New Year period trying to ward people off excessives, that might involve drugs over the holiday period. It was almost exclusively focussed on people using the National Drugs Help Line and we saw as a result of that advertising campaign a 20 per cent increase in abuse. Most interestingly, a 10 per cent increase in use from young males, who are usually about the hardest I am told - I cannot remember when I was young male - to get through to. That was a specific decision we took. What do we do with regard to our communications, and we decided that the best way would be to lead people to credible information, because they do get this appalling advice from their friends, sometimes without any knowledge whatsoever. They are confronted with taking some substance but do not know what it is, do not know what potentially it will do to them. It does not lead to addiction in the case of ecstasy but it can put them in a life-threatening situation.
(Mr Ainsworth) I think the Home Secretary gave you an indication this is an area we wanted to look at and whether or not we should be upping the emphasis that is given to harm minimisation. There was a lot of work done on harm minimisation in this country around HIV and a degree of success was achieved by that work but there are other issues. Drug-related deaths are something which has given a greater emphasis to it, for instance, in the Scottish Strategy than it has currently in the English and Welsh Strategy. So while a lot of harm minimisation procedures are already in place, it is something we are looking at as to whether or not we should be lifting this up the agenda.
(Mr Ainsworth) Sorry, that was treatment, 3:1.
(Mr Ainsworth) It is hard to measure all of the money that is spent on drug-related issues. For instance, there is a lot of expenditure by the NHS which does not fall within the ring-fenced drug budget. There is a lot of activity by the police and courts which is almost immeasurable but which has a drug connection. The only thing I can measure is the pro-active funding we are providing through the Drug Strategy, and I can give you an indication of the movements of money over a period of time, and I will provide the Committee with this, if you like, afterwards. If you take the year 2000-2001 and then the last year of the current spending review, 2003-04 and the movements there have been within that, treatment will move from 33 per cent to 40 per cent over that period of time; young people, which is mostly education, will move from 9 per cent to 12 per cent; communities, which is as I have said currently targeted on re-offending, will move from 6.5 per cent to 9.5 per cent; and availability will move from 50 per cent to 38 per cent. We have not cut the money on availability, it is because the overall amount of money allocated has been growing quite considerably. For instance, in 2000-01 we were spending £353 million, and it will be £380 million in 2003-04, so the actual money has gone up although the percentage of the overall pot has declined quite a lot as we have pushed substantial growth on the treatment side.
(Mr Ainsworth) It has not been published in total yet but we have some headline findings of the study which are quite fascinating actually. The York Study estimates that the economic costs, mainly to the Health Service and the criminal justice system, of drug misuse in England and Wales are between £3.6 billion and £5.8 billion. Adding on the social costs, the overwhelming majority being crime and cost to victims, increases their estimate to between £10 and £18 billion. Problematic drug users, they say, are responsible for 99 per cent of that cost.
(Mr Ainsworth) Those are the headline results of the York Study.
(Mr Ainsworth) Yes.
(Mr Ainsworth) There are wide variations in scoping the size of the problem.
Chairman: Finally Mr Prosser has a few questions on harm minimisation.
(Mr Ainsworth) We have underlined treatment targets and SDA set a target of reducing drug related deaths by 20 per cent, and also the universal provision of needle exchanges and syringe exchanges in order to try to avoid sharing of equipment. I say a lot of money has already been put towards that off the back of HIV but there are other issues like Hepatitis B and Hepatitis C, and that concerns us as well.
(Mr Ainsworth) Can I let the Committee have a note on where we are with that?
(Mr Ainsworth) Safe injecting areas like the Swiss experiment?
Mr Prosser: Safe injection areas where a clean needle is provided, perhaps a safe-ish dose is provided and some level of supervision?
(Mr Ainsworth) We have provided needles to problematic drug users and syringes, and the rest of it, we are not requiring them to stay within a particular area in order to do so. I think we would be worried about them effectively walking away from that provision were we to do so.
(Mr Ainsworth) Excluded from having treatment, in what environment?
(Mr Ainsworth) Not that I am aware of. There is some guidance that has been issued by the Department of Health on how to deal with Hepatitis C infected drug users, so that does not match with the idea that we are excluding them from treatment. Obviously if people are not stable because of their drug habits then treatment is very difficult.
(Mr Ainsworth) Yes. 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. The provisions were brought in because of very real problems that exist with crack houses. We had a particular problem in North London round Camden and the Kings Cross area over a period of time. 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, and they arose in areas where advice was given and it was felt that despite that inappropriate practices were continuing. 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.
(Mr Ainsworth) 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. That has to be the main focus of harm minimisation
(Mr Ainsworth) We are aware of the evidence that was given and we will be receiving your report within a very short period of time. We have no intention of ignoring any of the recommendations without properly evaluating them.
(Mr Ainsworth) I am happy to do that, but I have to say that in the relatively short period of time I have been in this job, with the opportunities I have had to get out in the field, this is not an issue that has been raised with me. The issue which has been raised with me of most concern is the preparedness of GPs to become involved in providing treatment. In any given area there are a very small percentage of GPs who are prepared to offer cooperation with drug treatment therapies, that is something we are far more concerned about. No one has raised this issue, although I saw the evidence that was given to this select committee.
(Mr Ainsworth) They were arguing with each other.
(Mr Ainsworth) I have to admit that I have not talked directly with pharmacists, it has mostly been GPs and drug treatment centres. We will need to pick that up and find out whether or not there is an issue. Obviously we do need security and we do need to guard against leakage that is effectively going to feed inappropriate drug use. There has to be that security as well. If there are issues that pharmacists want to raise obviously we will look at them.
(Mr Ainsworth) I am told that she has a meeting with Hazel Blears arranged so that she can raise her concerns with the Department of Health. I do not know when that is.
Chairman: That is fine, thank you.
(Mr Ainsworth) I do not think I have said, Mr Cameron, that we are looking to provide shooting galleries. What the Home Secretary has repeatedly said in this regard, this is true about what he said about cannabis, and it is true of the whole of the debate around drugs, is that we badly need a sensible adult debate. We need to lift the level of awareness of the consequences of drug misuse in the country and as part of reducing the size of the problem, surely, I would have thought, that everyone would see that you have not only got to attack supply, the profitability of the criminal elements and disrupt the criminal gangs but you also have to try, where it is necessary to do so, depriving them of their market. Where there are people who are hopelessly addicted if you can get them into treatment, if you can stabilise the situation and pull them out of the grip of the peddlers and the traffickers that has to be a good thing in terms of the benefit to society, because they are not going to be paying for their habit through crime, and they are not going to be feeding the supply chain by providing the demand. Harm minimisation is essential from that point of view and treatment is essential from that point of view. It is, surely, also essential because of these very serious viral illnesses that there are round. As I said, the main drive in this country towards upping our gain on harm minimisation was HIV. I would hope that everyone would want us to stay focussed on the potential dangers of such diseases.
(Mr Ainsworth) I do not think there is a clash, I really do not think there is a clash. I think it is essential from the other point of view, in terms of infections, it is part of reducing demand. Obviously if it is done in an unacceptable way, an uncontrolled way and there is massive leakage into the illegal market then, yes, you are going to be acting against some of your other aims in the drug strategy. That is why we need effective controls to try to minimise, if we cannot eliminate, that kind of leakage.
Mr Cameron: Thank you.
(Mr Ainsworth) I will. The main issue that they have raised with me is protection for people in the prison environment against the spread of Hepatitis C, and that goes far wider than injection behaviour, it is from tattooing to sex, and whatever have you. Those are the main issues they were concerned about when they raised them with me. I will look at those issues, as I agreed. I can understand the benefits in terms of keeping the paraphernalia off the streets and in safe, disposable areas. The potential downside of that is that we drive people back on to the market if they are not prepared to use drug in those environments. Let me look at that and give you a note.
(Mr Ainsworth) Yes.
(Mr Ainsworth) There is no desire to leave people with a habit that leaves them vulnerable at any point that they cannot continue to use the treatment that is available to the illegal market and to drive them back to the harm and the traffickers and the dealers. Any treatment has to be tailored to reducing the harm and reducing the addiction of the particular individual. With regard to crack cocaine addicts one of the biggest problems is even getting them in the door. We had to undertake Out Reach to go out and try and persuade them to come into treatment centres in the first place, they feel very threatened and they feel there is nothing being offered to them, so non-threatening treatment, such as calming them with acupuncture, and things like that, is what is offered by some centres in order to get them in, establish contact with them, calm them down so they can start talking to them about some of these underlying issues. At certain phases in any treatment, the aim of which is to try and help the person to reduce the addiction, there may be a period of maintenance that is absolutely essential that is part of that.
(Mr Ainsworth) Where there is any alternative I do not think there is any desire from anybody to continue to maintain an addiction.
Angela Watkinson: That was my point.
Chairman: Going back to those guidelines I referred to, they are not Department of Health guidelines, Minister, they are National Institute for Clinical Excellence guidance on the use of ribavirin and interferon for Hepatitis C. I believe the other one was the British Society of Gastroenterology Clinical Guidelines for the management of Hepatitis C. Those are the ones referred to. Minister, thank you very much, you have been answering questions patiently for two and a half hours and we are extremely grateful to you. This session is closed.