House of Commons - Drugs: Breaking the Cycle

Drugs: Breaking the Cycle - Home Affairs Committee Contents

1 Introduction

Recommendations from the last Home Affairs Committee report on drugs policy

1. The last time the Home Affairs Committee looked at drug policy as a whole was in 2002, though more recent inquiries have touched on specific aspects of drug policy.[1] We decided it would be appropriate to look again at this whole matter, and see what significant changes, if any, have taken place here and in other countries since then. As part of this inquiry, we asked the House of Commons Library to produce a note, which is appended to this Report, examining the implementation of the recommendations from the 2002 report.

DRUG DRIVING

We recommend that techniques to test drivers for drug-related impairment are improved, and that all police officers responsible for testing receive the necessary training. (Para 99)

2. We welcome clause 27 of the Crime and Courts Bill, currently before the House of Lords, which introduces a new offence of driving, or being in a charge of a motor vehicle, with concentrations of specified controlled substances in excess of specified levels. It will sit alongside the offence of being unfit to drive while under the influence of drugs in the Road Traffic Act 1988. However, concerns have been expressed about the impact the Clause would have on those taking drugs which had been legitimately prescribed, especially in the case of opiate painkillers, where long-term users who suffer chronic pain might in the fullness of time end up on quite high doses to offset the body's habituation to the drug.[2] There were also concerns that the length of time that traces of a drug remain in the body may adversely affect some people. The Department for Transport has set up a panel of experts to advise on those drugs which should be covered by the new offence driving with concentrations of drugs in excess of specified levels and, for each drug, the appropriate maximum permissible level of concentration in a person's blood or urine. We believe that this maximum should be set to have the equivalent effect on safety as the legal alcohol limit, currently 0.08 mg/ml.

INCREASE IN TREATMENT PLACES

We recommend that the number of treatment places for cocaine users is substantially increased. We recommend that resources are channelled into researching and piloting innovative treatment interventions for cocaine users. (Para 140)

As with cocaine, we recommend that more treatment places are created for crack users and that resources are channelled into researching and piloting more effective treatments. We further recommend that in the meantime efforts are redoubled to extinguish supply of crack cocaine. (Para 147)

We recommend that the Government substantially increases the funding for treatment for heroin addicts and ensure that methadone treatments and complementary therapies are universally available to those who need them. We recommend that the guidance on the correct dosage of methadone to be used is strengthened. (Para 161)

We recommend that the broadest possible range of treatments is made available to opiate users, and that all treatments and therapies should have abstinence as their goal. (Para 164)

3. There are currently 197,110 people in treatment for drug addiction.[3] Roughly 165,000 of those will be addicted to heroin or crack cocaine (or both). The rest are being treated for addiction to cocaine, cannabis, ecstasy and other drugs.[4] Waiting times have also improved, according to the National Treatment Agency. In 2011-12:

97% [of patients] waited no more than three weeks from referral to first appointment, up from 96% in 2010-11. In 2005 the average wait for the first appointment was nine weeks; in 2012 it is just five days.[5]

There are estimated to be 306,000 heroin and/or crack dependent users[6] so at least half of those are in treatment at present. By contrast, it is estimated that only a fifth of heroin or crack dependent users are in treatment in countries such as the United States and Sweden.[7] Of those in treatment in the UK, 81% are either dependent on heroin alone or a combination of heroin and crack cocaine. Cannabis and cocaine accounted for just 8% and 5% of those in treatment.[8]

Changing patterns of demand for treatment

4. Illicit drug use is, in fact, falling—according to the crime survey of England and Wales, it is at almost its lowest level since measurements began in 1996[9]—but the types of drugs that people are seeking treatment for has changed. This is especially true of the 18-24 age group, among whom heroin use has fallen sharply to about a third of the level it was at six or seven years ago. However, in the same time-period, the significantly smaller number of young people seeking treatment for problem cannabis use has risen by around a third, from 3,328 in 2005-06 to 4,741 in 2011-12.[10] Cannabis was downgraded from a Class B drug to a Class C drug in 2004 and re-classified as a Class B drug in 2009. The 2012 Global Drug Survey which measured the prevalence of drug use from a self-selecting, and therefore probably unrepresentative, sample of 7,700 UK drug users found that a third of respondents had taken prescription drugs in conjunction with illicit drugs[11] and that 19% of 18-25 year olds had taken a 'mystery white powder' without being sure of what it contained.[12]

5. The Royal College of Psychiatrists also notes the growth in the use of "club drugs"[13], abuse of over-the-counter medications and prescription medications, and internet sourcing, arguing that these trends should inform the future development of drugs policy.[14] The Club Drug Clinic at the Chelsea and Westminster Hospital was opened in September 2011, and is the country's only open-access clinic for the users of club drugs. By March 2012, it was treating more than 200 patients.[15] The Angelus Foundation highlighted the importance of such a clinic

One of the difficulties is that a lot of these new substances are addictive and they have awful side effects, and the kids have nowhere to go to get help, absolutely nowhere. That is something else that we need to look at. The parents are just bemused and bewildered [...] one of the toxicologists said there has been an increase in the incidence of hanging. There have been a lot of young deaths associated with that, and they suspect that it may be attributable to some of these substances. The fact is we don't know what the long-term harms are because there is no research, but there is a whole generation of kids waiting to go down the drug route and cost the taxpayers a fortune.[16]

The criminal justice benefits of treating those dependent upon heroin or crack cocaine as a priority are obvious. Dr Bowden-Jones, who runs the club drug clinic, told us that club drugs have very low rates of associated criminality, and that the majority of people who came into the Club Drug Clinic were working and had family networks and social networks.[17] However, the priorities for the provision of drug treatment must include the health of the dependent user, as well as the reduction of local crime rates. The introduction of Health and Wellbeing Boards, which we discuss below, will provide for treatment places to be allocated at a local level.

6. The Government is already aware that there is a change in need. Its 2010 Drug Strategy notes that groups of people "who would not fit the stereotype of a dependent drug user" are presenting for treatment in increasing numbers. These individuals are often younger and are more likely to be working and in stable housing.[18] The Government must ensure that provision for these individuals is appropriate and responsive to their needs.

7. The establishment of Health and Wellbeing Boards under the Health and Social Care Act 2012 provides an opportunity to tailor drug treatment services more closely to local needs. It is important that local provision should not develop into a "postcode lottery", where the availability of drug treatment is inadequate in those areas where drug use is not generally regarded as a significant problem. On the other hand, there is the risk that interventions by central Government which are intended to promote equality of access to services could stifle Boards' localised decision-making. We recommend that the Government continue to monitor the decisions of the Health and Wellbeing Boards as to allocation of treatment places, recording each request, monitoring waiting times to enter treatment and assessing the success rate of those dependent on different drugs. The Government should publish this information in an easily accessible and understandable format and consider developing a league table of Health & Wellbeing Boards' performance on local drugs provision while taking care in selecting assessment criteria not to introduce perverse incentives into the decision making process. This will allow Boards to benchmark their provision against each other, having due regard to local need.

TREATMENT IN PRISONS

We recommend that appropriate treatment forms a mandatory part of custodial sentences and that offenders have access to consistent treatment approaches within the prison estate as well as outside it. This should include strictly supervised methadone treatment in the first instance, as the most effective treatment available. (Para 169)

8. There are positive developments which we have identified in individual prisons but there are also still a number of issues with treatment for drug dependence within the prison service and we expand upon those in detail below. However, we use this opportunity to note the need for services which also address alcohol dependence. The annual report of Her Majesty's Inspectorate of Prisons recently found that the provision of alcohol treatment was variable: in one prison where 30% of the population had an alcohol problem directly related to their offending, prisoners were unable to access an accredited alcohol or drug programme.[19]

PRESCRIBING DIAMORPHINE (HEROIN)

We recommend that a proper evaluation is conducted of diamorphine prescribing for heroin addiction in the UK, with a view to discovering its effectiveness on a range of health and social indicators, and its cost effectiveness as compared with methadone prescribing regimes. (Para 178)

9. The Government's 2010 Drug Strategy stated that it would "continue to examine the potential role of diamorphine prescribing for the small number who may benefit, and in the light of this consider what further steps could be taken, particularly to help reduce their re-offending." A 2010 study found that treatment with supervised, injectable heroin leads to significantly lower use of street heroin than does methadone. It recommended that "UK Government proposals should be rolled out to support the positive response that can be achieved with heroin maintenance treatment for previously unresponsive chronic heroin addicts."[20] When medical heroin was prescribed regularly in Switzerland, half of those who received treatment were also in regular employment.[21] There have been six studies in the UK over the past 15 years, all showing the benefits of prescribing diamorphine in the small number of cases where chronic heroin users do not respond to traditional treatment.[22] Diamorphine prescribing is still rare despite evidence of its effectiveness.[23]

10. New evidence which has emerged in the decade since our predecessor Committee's Report on drugs suggests that diamorphine is, for a small number of heroin addicts, more effective than methadone in reducing the use of street heroin. It is disappointing therefore that more progress has not been made in establishing national guidelines for the prescription of diamorphine as a heroin substitute. We recommend that the Government publish, by the end of July 2013, clear guidance on when and how diamorphine should be used in substitution therapy.

EDUCATION AND PREVENTION

We acknowledge the importance of educating all young people about the harmful effects of all drugs, legal and illegal. Nonetheless, we recommend that the Government conducts rigorous analysis of its drugs education and prevention work and only spends money on what works, focussing in particular on long term and problem drug use and the consequent harm. (Para 211)

11. We highlight this recommendation as an issue which still requires attention - this is the strand which seems to have the lowest priority in the Government's 2010 Drug Strategy. The Strategy, which aims to reduce demand, restrict supply and support and achieve recovery, announces that the Government will establish a whole-life approach to preventing and reducing the demand for drugs that will:

break inter-generational paths to dependency by supporting vulnerable families;

provide good quality education and advice so that young people and their parents are provided with credible information to actively resist substance misuse;

use the creation of Public Health England (PHE) to encourage individuals to take responsibility for their own health;

intervene early with young people and young adults;

consistently enforce effective criminal sanctions to deter drug use; and

support people to recover.[24]

12. Despite this, the UK annual reports to the European Monitoring Centre for Drugs and Drug Addiction reveal that public expenditure on drugs education decreased from £5.4 million in 2006-07 to £0.5 million in 2010-11.[25] In addition, central government support for the national Continual Professional Development training for drug education has been cut, and the Tellus Survey, which collected school-level data on young people's drug use amongst other health and well-being measures has been stopped.[26] We consider this issue in more detail below (see paragraphs 62 to 81).

The aims of drugs policy

13. There are a number of harms associated with the recreational use of drugs, whether legal or illegal:[27]

a) Direct damage to the health of drug users, the nature and severity of which varies enormously from drug to drug, depending also on dose and purity. Ketamine, for example, can cause severe and irreversible damage to the bladder; cocaine use accelerates the development of coronary artery disease and can precipitate acute cardiovascular events; and ecstasy (MDMA) can in some cases lead to severe hyperthermia or sudden death.

b) Health risks associated indirectly with drug use, particularly intravenous drug use, including the spread of blood-borne viruses such as HIV and hepatitis C and the impact of drug-related violence, which is a particular problem with alcohol. Some drug addicts turn to sex work to fund their habit, thereby exposing themselves to additional risks to their health and personal safety.

c) Acquisitive crime—mostly robbery and burglary—committed by addicts to fund their habit.

d) Crime associated with the production, importation, distribution and supply of illegal drugs, much of which is serious and organised. International drug trafficking is also associated with people trafficking, terrorism, the clandestine trade in firearms, political corruption and a wide range of other major, global, criminal threats.

e) Social exclusion: not all drug users are addicted and not all addicts are unable to function as a productive member of society but, at its worst, addiction (or other forms of problem drug-use) can result in behaviour which can be destructive to the individual and others. This can include criminal behaviour, excessive risk-taking and an inability to care for children, maintain employment, or participate fully in society.

f) Issues with the environment: the destruction of the rainforest through the clearing of areas to plant coca leaf, the introduction of the harsh chemicals used in the making of different drugs into the local eco-system and the impact of aerial fumigation on soil and ground water.

14. Drug use can lead to harm in a variety of ways: to the individual who is consuming the drug; to other people who are close to the user; through acquisitive and organised crime, and wider harm to society at large. The drugs trade is the most lucrative form of crime, affecting most countries, if not every country in the world. The principal aim of Government drugs policy should be first and foremost to minimise the damage caused to the victims of drug-related crime, drug users and others.