Appendix 1: Recommendations from the 2002
Home Affairs Committee report on drug policy: Paper by the House
of Commons Library
We believe it is self-evident that by focussing
on the relatively small group of problematic drug users, the Government
could have a significant impact on the harm caused by drug use.
(Para 24)
We believe that drugs policy should primarily
be addressed to dealing with the 250,000 problematic drug users
rather than towards the large numbers whose drug use poses no
serious threat either to their own well-being or to that of others.
(Para 38)
The Government accepted these in its 2002 response
to the Report, adding that "there are strong arguments for
focusing on problematic drug users". These recommendations
would be "central to the Government's updated Drugs Strategy".
The Updated Drug Strategy 2002 included "a stronger focus
on education, prevention, enforcement and treatment to prevent
and tackle problematic drug use".
The current Government's 2010 Drugs Strategy does
not appear to focus specifically on problematic drug users.
We believe it is unwise, not to say self-defeating,
to set targets which have no earthly chance of success. We recommend
(1) that the Government distinguishes explicitly between aspirational
and measurable targets; (2) that it focuses on outcomes rather
than processes as indicators of success and that where a process
is intended to lead to a particular outcome, the basis for expecting
this be explained, with evidence; and (3) that baselines are established
as soon as possible for all targets. (Para 42)
The Government's 2002 response to the Report did
not address this recommendation fully. The current Government's
2010 Drugs Strategy states that "Drug use in the UK remains
too high" but does not set targets for reduction.
While acknowledging that there may come a day
when the balance may tip in favour of legalising and regulating
some types of presently illegal drugs, we decline to recommend
this drastic step. (Para 66)
We accept that to decriminalise the possession
of drugs for personal use would send the wrong message to the
majority of young people who do not take drugs and that it would
inevitably lead to an increase in drug abuse. We, therefore, reject
decriminalisation. (Para 74)
The Government's 2002 response to the Report made
clear that the Government did not plan to legalise any currently
illegal drugs (with limited exceptions for medical purposes)
The current Government's 2010 Drugs Strategy states
that "this Government does not believe that liberalisation
and legalisation are the answer".
No controlled drugs have been decriminalised since
2002, although one manufactured preparation of cannabis extract,
Sativex oral spray, was licensed under medicines legislation in
June 2010 as a treatment for muscle spasm associated with Multiple
Sclerosis (MS).
We are not persuaded that an intent to supply
should be presumed on the basis of amounts of drugs found; we
therefore recommend that the offences of simple possession and
possession with intent to supply should be retained without alteration.
(Para 77)
The then Government's accepted the recommendation
in para 77 in its response to the Report. Its response to the
recommendations in paragraphs 82 and 83 was:
The Government's view is that, with the exception
of the new offence discussed below, the existing laws allow the
courts to take account of all the circumstances in cases of supply
of drugs. Cases of commercial supply should lead to a higher penalty
than supply within a social circle. The maximum penalties for
supply are set at a sufficiently high level to allow for the full
range of circumstances of any case to be taken into account.
Young people need to be protected from the influence
of drug dealers, and it is important to send a message that targeting
young people will not be tolerated.
The Government therefore proposes to introduce a
separate criminal offence of supplying drugs to young people.
The new offence will attract higher maximum sentences than are
currently available to the courts for supply cases. It is proposed
that this new offence would cover the supply of drugs to young
people of 16 years of age or under.
Despite accepting the Committee's recommendation
that intent to supply should not be presumed on the basis of the
quantity of drugs found, in 2005 the Government legislated to
introduce just such a provision. This was set out in section 2
of the Drugs Act 2005 (see also the related Explanatory Notes
and pages 27 to 28 of Library Research Paper 05/07 The Drugs Bill
for background information). However, section 2 was repealed without
ever being brought into force: see section 12 and Schedule 7,
Part 13, paragraph 122 of the Policing and Crime Act 2009.
The offences of simple possession and possession
with intent to supply in section 5 of the Misuse of Drugs Act
1971 as currently in force do not therefore include any statutory
presumption of an intent to supply based on the quantity of drugs
found.
However, quantity is one of the factors (among others)
that the Crown Prosecution Service (CPS) will consider when deciding
whether to charge someone with possession or the more serious
offence of possession with intent to supply. If an offender is
convicted of a supply offence, the quantity of drug involved will
play a key role when the court is determining his sentence. This
is because sentencing guidelines use the quantity and class of
drug involved as the main indicator for determining the level
of harm caused by the offence in question: see the Sentencing
Council's Drug Offences: Definitive Guideline, 2012, pp10-15.
We do not agree with the Police Foundation. Those
guilty of "social supply" should not escape prosecution
for this offence on the basis that their act of supply was to
their friends for their personal consumption. We believe that
this act of "social supply", while on a different scale
from commercial supply, is nonetheless a crime which must be punished.
(Para 82)
In relation to the recommendation in paragraph 82,
CPS guidance makes it clear that in cases involving the sharing
of small quantities of class B or C drugs between friends it may
not always be in the public interest to prosecute.[305]
We believe that while there are two different
crimes of supply, the law only formally recognises one. We recommend
that a new offence is created of "supply for gain",
which would be used to prosecute large scale commercial suppliers.
So-called "social suppliers" who share drugs between
their friends on a not-for-profit basis should continue to be
prosecuted for supply. (Para 83)
In relation to the recommendation in paragraph 83,
no new offence of "supply for commercial gain" has been
created since the Committee's report was published. A person convicted
of supply on a commercial scale would be convicted of the same
basic offence - i.e. supply of a controlled drug contrary to section
4(3) of the 1971 Act - as a person convicted of supply on a lesser
scale. However, an offender who was involved in supply on a commercial
scale will obviously be subject to a harsher sentence than an
offender involved in social supply between friends: again, see
the Sentencing Council's Drug Offences: Definitive Guideline,
2012, pp10-15.
In the Government's response to the recommendation
in paragraph 83, it set out its plans to introduce a new criminal
offence of supplying drugs to young people. It did this by way
of section 1 of the Drugs Act 2005, which introduced a section
4A into the 1971 Act setting out an aggravated form of the supply
offence in section 4 of the 1971 Act. Section 4A, which came into
force on 1 January 2006, applies where an offender aged 18 or
over commits the supply offence in section 4 of the 1971 Act and
either of the following conditions is met:
- the offence was committed in
the vicinity of school premises in use by under 18s during school
hours or one either before or after school hours; or
- the offender used a courier aged under 18 in
connection with the commission of the offence.
If either of these conditions is met, section 4A
requires the court to treat this as an aggravating factor when
sentencing the offender.
Please see the related Explanatory Notes and pages
26 to 27 of Library Research Paper 05/07 The Drugs Bill for background
information.
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)
The Government's response to the Report accepted
this recommendation. For a detailed overview of developments in
this area, including research into testing techniques and proposals
for a new drug driving offence, please see Library Standard Note
2884 Driving: drugs, which was last updated on 8 June 2012.
In the event of the successful completion of clinical
trials and a positive evaluation by the Medicines Control Agency,
we recommend that the law is changed to permit the use of cannabis-based
medicines. (Para 109)
The Government's response to the Report accepted
this recommendation.
One manufactured preparation of cannabis extract,
Sativex oral spray, was licensed under medicines legislation in
June 2010 as a treatment for muscle spasm associated with Multiple
Sclerosis (MS). This has not altered its classification as a form
of cannabis under the Misuse of Drugs Act 1971. However, it can
be legally prescribed, dispensed, possessed and used under provisions
of a specific licence issued for Sativex by the Home Office in
December 2005. The Government is currently considering legislative
amendments to remove the need for this license following advice
from the ACMD that this would be an appropriate step.
Any registered medical practitioner can legally prescribe
Sativex but its Summary of Product Characteristics (a statutory
document registered as part of the medicines approval process)
states "Treatment must be initiated and supervised by a physician
with specialist expertise in treating this patient population."
Doctors prescribing Sativex for problems other than
muscle spasm in MS would be doing so outside its current UK license.
While such "off-label" prescribing is relatively common
in many areas of medicine, it places clear responsibility on the
doctors for assuring themselves that the drug is safe and appropriate
for the intended use. The General Medical Council (GMC) provides
guidance to doctors in this area.
We accept that cannabis can be harmful and that
its use should be discouraged. We accept that in some cases the
taking of cannabis can be a gateway to the taking of more damaging
drugs. However, whether or not cannabis is a gateway drug, we
do not believe there is anything to be gained by exaggerating
its harmfulness. On the contrary, exaggeration undermines the
credibility of messages that we wish to send regarding more harmful
drugs.(Para 120)
We support, therefore, the Home Secretary's proposal
to reclassify cannabis from Class B to Class C. (Para 121)
The Government's response to the Report took this
recommendation into consideration and noted its intention to reclassify
cannabis from Class B to Class C, on the advice of the ACMD. Cannabis
was reclassified from Class B to Class C in January 2004.
Cannabis was the reclassified from Class C to Class
B in January 2009. However, this contravened the advice of the
ACMD, which had stated in a 2008 review that:
after a most careful scrutiny of the totality of
the available evidence, the majority of the Council's members
consider - based on its harmfulness to individuals and society
- that cannabis should remain a Class C substance. It is judged
that the harmfulness of cannabis more closely equates with other
Class C substances than with those currently classified as Class
B.[306]
We believe that nothing should be done to imply
that the taking of ecstasy is harmless, legal or socially desirable.
Ecstasy is a dangerous drug. We recognise, however, that some
young people will take ecstasy, and we want to reduce the numbers
of deaths which result. We recommend that advice on the dangers
of ecstasy and the ways to reduce the risks of death should be
made available in nightclubs, and we welcome the recent publication
by the Home Office of the guidance under the title Safer Clubbing.
Police, club owners and licensing authorities should continue
to aim for drug-free clubs and should work together to achieve
this. (Para 129)
The Government's response to the Report accepted
this recommendation. Ecstasy remains a Class A drug. However,
the current Government's 2010 Drugs Strategy does not mention
drugs information in nightclubs
We agree with the Police Foundation and therefore
recommend that ecstasy is reclassified as a Class B drug. (Para
135)
See above (response to paragraphs 120 and 121)
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)
Details of policy up on drug treatment up to 2009
can be found in the POST Note Treatments for heroin and cocaine
dependency published in 2009.
The Department responsible for drug treatment is
the Department of Health. Currently funding and treatment for
drug addiction is split between local and central Government.
Figures for the level of funding and successful treatments for
2009-10 can be found in written answer from 27 June 2011 c529W
when 63.8% of the total £597.6 million budget for 2010/11
coming from central sources.
The Government is moving towards a system, to be
implemented in April 2013, where full responsibility for drug
treatment commissioning is passed onto local bodies:
In April 2013 upper tier and unitary local authorities
will take on responsibility for commissioning the full range of
drug and alcohol prevention, treatment and recovery services.
Also, from 22 November 2012, newly elected Police and Crime Commissioners
will be responsible for cutting crime and improving community
safety. This note highlights the new opportunities for joint working
to improve outcomes and use resources more efficiently. It outlines
the support that will be available to help you meet the needs
of your community.
The 2010 Drug Strategy highlighted the importance
of tackling dependence on drugs and alcohol which are key causes
of crime, family breakdown and poverty1. Promoting recovery is
central to addressing drug use. A key element of government reforms
is to give local areas the freedoms and powers necessary to develop
a holistic, joined-up recovery system that goes beyond drug treatment
and addresses the wider needs of those with dependence on drugs
and/or alcohol.[307]
As part of its approach the Government is piloting
treatment contracts that are based on Payment by Results:
Government is working with eight areas over two years
to pilot Payment by Results as an approach to contracting. These
pilots are being formally evaluated. In addition, a number of
other drug partnerships are incorporating a PbR element into their
contracts with providers, and there is increasing use of PbR for
other public services. The skill of local authorities and their
partner agencies in developing new forms of contracts and in managing
the interface between PbR schemes for different services will
be crucial to the success of this approach.[308]
Further details on the progress of the pilots can
be found on the Department of Health website.
From a medical aspect NICE has published two sets
of guidelines on treatment of drug misuse - 'Drug misuse: psychosocial
interventions' (NICE clinical guideline 51) and 'Drug misuse:
opioid detoxification' (NICE clinical guideline 52). They cover:
the support and treatment people can expect to be offered if
they have a problem with or are dependent on opioids, stimulants
or cannabis; and how families and carers may be able to support
a person with a drug problem and get help for themselves.
We consider that the risks posed by cocaine to
the user and to other people merit it remaining a Class A drug.
(Para 141)
The Government agreed and cocaine remains a Class
A drug in the UK.
Where crack is concerned we see no prospect for
compromise. We note that few of our witnesses argued outright
for legalisation. We leave it to those who do argue for general
legalisation to explain how this could be justified given that,
unlike other illegal drugs, crack can trigger violent and unpredictable
behaviour. (Para 148)
The Government "wholeheartedly" accepted
this recommendation in its response to the Report.
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)
In the interests of consistency, we recommend
that the National Treatment Agency should have responsibility
for auditing drug treatment services in prisons, as it does for
services outside prisons. (Para 171)
The then Government's official response to the recommendation
in paragraph 169 was:
The Government will give careful further consideration
to this recommendation. Issues to be considered include the principle
that valid consent must be obtained before starting treatment
or physical investigation, or providing personal care for a patient
and the possibility that coerced participants may disrupt programmes
and reduce their overall effectiveness for others. Above all
the Government would with to ensure that treatment capacity is
available before introducing mandatory treatment in Prisons.
Drug assessment and treatment services have been
introduced in every prison in England and Wales to meet the needs
of prisoners with low, moderate and severe drug misuse problems.
All prisoners identified as having drug-related problems are
referred to Counselling, Assessment, Referral, Advice and Throughcare
Services.
The Government recognises the importance of continuity
of treatment and aftercare provision for ex-offenders. There
are two reasons for this: to ensure there successful reintegration
into the community, and to prevent treatment services from becoming
over-burdened by ex-offenders relapsing into drug use.
A new Prison Service Standard for Health Services
to Prisoners (January 2000) requires all establishment to have
in place a written and observed statement of their substance misuse
service.
The Government's current objective is to focus on
increasing the uptake, standard and quality of the drug detoxification
services offered to prisoners. There is currently provision for
methadone maintenance treatment in appropriate cases.[309]
And its response to the recommendation in paragraph
171 was:
The NTA has a wide-ranging agenda to improve the
capacity, quality and staffing arrangements of treatment services.
This has a positive impact where prisons make use of treatment
options provided by community services.
How best to audit treatment services in prison will
be kept under review. Our goal is to ensure we set the highest
standards possible. The Prison Service will work closely with
the NTA to make sure that high quality treatment and support is
available to prisoners.[310]
In 2006, the Department of Health and HM Prison Service
introduced an "Integrated Drug Treatment System" for
prisons. Guidance from the Department of Health acknowledged
the potential role of methadone treatment:
In its review of drug policy and treatment, the Home
Affairs Select Committee (2002) recommended that methadone maintenance
should be available across the prison estate. It is acknowledged
that there has been considerable unease around this practice within
the Prison Service, but through careful evaluation and study,
it has become apparent that this intervention within a prison
setting can lead to important harm reduction benefits (Dolan 2003).[311]
Section 5 of the guidance provides a detailed overview
of when prisons should "stabilise" new opiate-dependent
prisoners by subscribing methadone during the very early days
of their time in custody. Section 7 deals with opiate agonist
maintenance, and section 8 with the continuation of methadone
treatment for patients arriving in prison who are currently receiving
a community methadone prescription. See also the Department of
Health, Updated guidance for prison based opioid maintenance prescribing,
March 2010.
The consultation paper Breaking the Cycle: Effective
Punishment, Rehabilitation and Sentencing of Offenders set out
(amongst many other things) how the Government intended to help
prisoners get off drugs for good:
We must ensure that more drug misusing offenders
fully recover from their addiction and that they do not take drugs
while they are in prison. To achieve this we are proposing to:
- reduce the availability of
illicit drugs in prison and increase the number of drug free environments;
- introduce pilots for drug recovery wings in prisons;
- work with the Department of Health and other
government departments to support the design and running of pilots
to pay providers by the results they deliver in getting offenders
to recover from their drug dependency;
- test options for intensive community based treatment;
and
- learning the lessons from the approach to managing
women offenders and apply them more broadly.[312]
Use of new technologies would be one part of that
and prisons would work in closer partnership with other agencies:
91. While the proportion of samples testing positive
under the prisons random mandatory drug testing programme has
declined, nearly one in thirteen drug tests are still positive.
Prisons and their law enforcement partners must work together
closely to share intelligence and tackle staff corruption. We
will investigate new technologies to tackle drugs and mobile phones
in prisons. We are committed to creating drug free environments
in prison and we will therefore increase the number of drug free
wings, where increased security measures prevent access to drugs.
92. Doing more to tackle the supply of drugs is one
half of the equation. The other is to reshape drug treatment in
prisons so that there is an increased emphasis on recovery and
becoming drug free. This means working in partnership with health
services which are now responsible for funding and commissioning
drug treatment in prisons. In doing so we will look at the evidence
collected by the Prison Drug Treatment Strategy Review Group,
chaired by Professor Lord Patel of Bradford, on how to raise the
ambition for drug treatment and interventions in prisons.[313]
Within six months, though, it was reported that plans
had been modified and the approach based on abstinence had been
replaced with one based on recovery:
The plans for "drug-free wings" in prisons
have been renamed as "drug-recovery wings", although
they would need to be "abstinence-focused". The justice
secretary, Kenneth Clarke, underlined that point last week when
he told Tory critics demanding a "drug-free" approach
in prisons that simply making problem drug users go "cold
turkey" was clinically dangerous. Mr Clarke said he didn't
oppose the use of methadone as long as the objective was to get
the user off drugs completely.
James Brokenshire, the Home Office minister responsible
for drugs policy, said the new strategy was a major policy shift,
putting more responsibility on individuals to seek help and overcome
their dependency.
The document marks a step away from the language
of "harm reduction" that has dominated the past 10 years,
but it stops far short of the abstinence-based policy demanded
by some rightwing Tory thinktanks.
(...)
Six pilot schemes will explore how a payments-by-results
system could work. The precise benchmark as to what constitutes
recovery - either reducing drug use or total abstinence - has
yet to be spelled out. Former addicts would also be promoted as
"drug recovery champions", to act as mentors to problem
drug users.[314]
Drug recovery wings in five prisons -
Bristol, Brixton, High Down, Holme House and Manchester -
were launched in June 2011. According to the Ministry of Justice,
these would "place a strong emphasis on connecting offenders
with a wide range of community services to help them to live drug-free
lives on release - such as finding a home, a job and rebuilding
relationships with their families."[315]
For guidance on the different roles and responsibilities
of the various bodies involved in drug treatment in prisons, please
see Integrated Drug Treatment System (IDTS): Guidance On Roles
& Responsibilities and Governance Arrangements, Dept of Health/Ministry
of Justice, 2009 (in particular section 11.3, which deals with
the role of the National Treatment Agency).
We conclude that the licencing system of providing
a limited number of heroin addicts with diamorphine on prescription
is badly monitored and evaluated, provides practitioners with
inadequate training and guidance, and patients with a variable
standard of care. (Para 177)
We do not think that it is enough for the Government
simply to expand the number of doctors licensed to prescribe diamorphine
to heroin addicts. (Para 183)
A response to a Freedom of Information request to
the Home Office date March 2012 sets out the current level of
monitoring of diamorphine licences:
1. The Home Office holds records of 250 - 300 licences
issued to individual doctors for the treatment of addiction; a
significant proportion of these would enable the prescription
of diamorphine. a doctor holding a licence should be in a position
to provide, upon request of a legitimate and reasoned request,
a copy of his or her licence.
2. Since April 2011, the Home Office has issued 11
licences under The Misuse of Drugs (Supply to Addicts) Regulations
1997 to doctors to prescribe diamorphine.
These licences are open-ended and we do not have
a record of any being withdrawn during this time. A licence remains
active until an individual moves premises or seeks to amend their
licence at which time we would revoke the previously issued licence.
It is possible that we, or the Department of Health (or equivalent
body) may be notified of a change to an individual's registration
status with the General Medical Council (GMC). Should relevant
information be received we may review a previously issued licence
in consultation with relevant parties to determine whether a person
should continue to hold a licence.
3. The Home Office does not collect or store any
data regarding prescriptions. The Department for Health has responsibility
for health matters, including prescriptions.
4. As outlined above, licences remain active until
such time as they are withdrawn. Licences are open-ended and not
issued with an expiry date.
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)
We recommend that an evaluated pilot programme
of safe injecting houses for heroin users is established without
delay and that if, as we expect, this is successful, the programme
is extended across the country. (Para 186)
We conclude that the Dutch and Swiss evidence
provides a strong basis on which to conduct a pilot here in Britain
of highly structured heroin prescribing to addicts. We recommend
that a pilot along the lines of the Swiss or Dutch model is conducted
in the UK. Should such a pilot generate the positive results which
one would expect from the Dutch and Swiss experience, we recommend
that such a system should supersede the little-used "British
system" of licensing. (Para 190)
We recommend that a pilot offering prescribed
diamorphine to heroin addicts is targeted, in the first instance,
at chronic addicts who are prolific offenders. (Para 191)
We recommend that the Government commissions a
further trial to look at the prescription of diamorphine to addicts
who have not yet, or are not currently accessing any treatment,
despite having a long history of heroin addiction. (Para 194)
We recommend that the Government reviews Section
9A of the Misuse of Drugs Act 1971, with a view to repealing it,
to allow for the provision of drugs paraphernalia which reduces
the harm caused by drugs. (Para 252)
We recommend that Section 8 of the Misuse of Drugs
Act 1971 is amended to ensure that drugs agencies can conduct
harm reduction work and provide safe injecting areas for users
without fear of being prosecuted. (Para 257)
Supervised Injectable Opioid Treatment is now a recognised
approach to dealing with diamorphine addiction in hard to treat
cases. The Department of Health website provides the following
information:
Supervised Injectable Opioid Treatment (IOT) is the
prescription of injectable diamorphine (pharmaceutical heroin)
in a supervised setting for the treatment of opiate misusers who
have not responded to other types of treatment.
Funded by the Department of Health (DH) and supported
by the National Treatment Agency (NTA), the Randomised Injectable
Opioid Treatment Trial (RIOTT) in England established a small
number of new supervised injecting clinics, following the recommendations
of the 2002 UK Drug Strategy. Results published in the Lancet
(Strang et al, 2010) showed that treatment with supervised injectable
diamorphine leads to significantly lower use of street heroin
than does supervised injectable methadone or optimised oral methadone.
As a result of the studies in the UK and overseas,
IOT is now evidenced as a clinically effective second line treatment
for a small group of people who have repeatedly failed to respond
either to standard methadone treatment or to residential rehabilitation.
The distinctive feature of this treatment is the complete supervision
of all injectable doses, usually twice daily, every day of the
year.
It is also currently in the process of setting up
various pilots to determine how best to deliver this form of treatment.
We believe that all drugs education material should
be based on the premise that any drug use can be harmful and should
be discouraged. (Para 201)
We acknowledge the need to provide realistic drugs
education, but we believe that examples such as the Lifeline leaflet
cross the line between providing accurate information and encouraging
young people to experiment with illegal drugs. We believe that
publicly funded organisations involved in educating impressionable
young people about drugs should take care not to stray across
this line. (Para 207)
The Government accepted these two recommendations
in its response to the Report.
The FRANK website, launched in 2003, offers factual
information about drugs including the "highs and lows"
of drug use. However, it has been criticised for example in 2003,
the UKCIA complained about FRANK's advice on cannabis and the
Transform Drug Policy Foundation stated that "though vastly
superior to US counterparts, FRANK leaves much to be desired in
terms of drugs included, harm reduction advice offered and level
of detail".
The FRANK service is a key lever to deliver the 2010
drug strategy. The current Government relaunched the FRANK service
in 2011 as a resource for young people seeking advice and information
about drugs: it states that all drugs are potentially dangerous.
We do not share the view that confronting young
people with shocking images of the harm caused by some drug use
is counter productive. (Para 208)
The Government accepted this recommendation in its
response to the Report
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)
The Government accepted this recommendation in its
response to the Report and added that it would "be considering
how its guidance to schools can be revised". It stated that
the Government would invest £7.5 million over the next five
years "to determine the most effective approach to delivering
drug education in English schools".
The 2010 Drug Strategy states:
Schools have a clear role to play in preventing drug
and alcohol misuse as part of their pastoral responsibilities
to pupils. We will make sure school staff have the information,
advice and the power to:
- Provide accurate information on drugs and alcohol
through drug education and targeted information via the FRANK
service;
- Tackle problem behaviour in schools, with wider
powers of search and confiscation. We will make it easier for
head teachers to take action against pupils who are found to be
dealing drugs in school; and
- Work with local voluntary organisations, the
police and others to prevent drug or alcohol misuse.
We will strengthen the quality of alternative provision,
including drawing on the expertise of the voluntary and community
groups and enabling schools to develop and fund their own local
approaches to best meet the needs of excluded pupils. We will
also share teaching materials and lesson plans from successful
schools and organisations online and promote effective practice.
This will all be supported by revised, simplified
guidance for schools on preventing drug and alcohol misuse.
Currently the Department for Education is the Government
lead for young people and substance misuse.
We recommend that drugs prevention and education
programmes are targeted towards particularly vulnerable groups
of young people, such as truants, those excluded from school and
children in care. (Para 213)
The Government accepted this recommendation in its
response to the Report.
The 2010 Drug Strategy recognises that:
Some young people face increased risks of developing
problems with drugs or alcohol. Vulnerable groups - such as those
who are truanting or excluded from school, looked after children,
young offenders and those at risk of involvement in crime and
anti-social behaviour, those with mental ill health, or those
whose parents misuse drugs or alcohol - need targeted support
to prevent drug or alcohol misuse or early intervention when problems
first arise.
The Government's approach is described in the drug
strategy:
Developing responses to these needs is best done
at the local level, supported by consistent national evidence
and advice on effective approaches. We will simplify funding to
local authorities, including the creation of a single Early Intervention
Grant, worth around £2 billion by 2014-15. This will draw
together a range of funding streams for prevention and early intervention
services, allowing local government the flexibility to plan an
approach to reach vulnerable groups most effectively. Sitting
alongside the Public Health Grant, this will allow local areas
to take a strategic approach to tackling drug and alcohol misuse
as part of wider support to vulnerable young people and families.
Some family-focused interventions have the best evidence
of preventing substance misuse amongst young people. Local areas
are already using a range of family-based approaches. These have
led to significant reductions in risks associated with substance
misuse, mental ill health and child protection and have led to
reductions in anti-social behaviour, crime, truanting and domestic
violence.
Leaders in a number of local areas are redesigning
their services so that they are better equipped to respond to
the demands that families with multiple problems make on services,
and to use evidence based family support to prevent further problems
from developing. Intensive family interventions are highly cost
effective with every £1 million invested achieving £2.5
million in savings to local authorities and the state.
Young people's substance misuse and offending are
often related and share some of the same causes, with 41% of the
young people seeking support for drug or alcohol misuse also being
within the youth justice system. New funding arrangements for
youth justice services will incentivise local government to find
innovative ways to reduce the number of young people who commit
crime, including tackling drug or alcohol misuse where this is
part of the reason for their offending.
Directors of Public Health and Directors of Children's
Services will be empowered to take an integrated and co-ordinated
approach to determine how best to use their resources to prevent
and tackle drug and alcohol misuse. They will be supported by
evidence, advice and by sharing the most effective approaches
from those areas that are already succeeding. They will also have
access to simplified, flexible budgets both through the Early
Intervention Grant and Public Health Grant.
We recommend that the guidance and training provided
to practitioners prescribing diamorphine to heroin addicts is
strengthened, with a view to spreading best practice. (Para 179)
We conclude that General Practitioners are, for
the most part, inadequately trained to deal with drug misuse.
We recommend that training in substance misuse is embedded in
the undergraduate medical curriculum and postgraduate General
Practice curriculum, as a problem which will arise with increasing
frequency over the careers of all prospective doctors training
today. We recommend that the Department of Health funds more training
courses in substance misuse for existing General Practitioners.
(Para 218)
We would also expect the British Medical Association
and the Royal College of General Practice to take a rather greater
interest in this area than is evident so far. In particular we
would expect these organisations to use their considerable influence
to ensure that treatment of drug misuse is included in the medical
curricula. We would also expect the professional bodies to encourage
more of their members to take an interest in treating drug abusers
so that a handful of dedicated General Practitioners are not left
to shoulder the burden alone. (Para 219)
We recommend that training for healthcare professionals
in addiction is improved, and we believe that it ought to be possible
to provide treatment for those urgently in need within a week.
(Para 235)
The Government accepted that training for GPs and
other medical staff was "of central importance in its response
to the Report and that it would work with the BMA and RCGP. It
added that:
The Government has funded the Royal Colleges of General
Practitioners to develop a Certificate in Drug Misuse for Primary
Care Practitioners and a Diploma in Primary Care Substance Misuse.
The Royal Colleges of General Practitioners (RCGP)
provides training courses on substance misuse for existing GPs
(e.g. Certificate in the Management of Drug Misuse in Primary
Care in Scotland and the RCGP Certificate in the Management of
Drug Misuse in England).
In 2007 the International Centre for Drug Policy
published guidance on Substance Misuse in the Undergraduate Medical
Curriculum. It was funded by the Department of Health and welcomed
by the then Chief Medical Officer, Sir Liam Donaldson. The guidance
states:
Substance misuse as a topic in the medical curriculum
does not have a high profile, and it is timely that this project
seeks to address this. If our health service is to succeed in
combating the problem of growing substance misuse, our new doctors
must have a better understanding of the nature of the problem
and the interventions which are available. In addition to focusing
on the needs of patients, the curriculum must not omit the task
of educating students about the risks to their own health and
professional practice through their misuse of drugs and alcohol.
If attitudes are to change a sustained, consistent and high-impact
message is required.
It cannot be said too strongly that, given the
damage to the community that the chaotic drug user can cause,
investment in effective treatment is in the wider public interest.
(Para 229)
We welcome the setting up of the National Treatment
Agency, with its aim to provide "more treatment, better treatment
and more inclusive treatment". (Para 234)
The Government concurred with this and welcomed these
conclusions in its response to the Report
We also believe that the quality of the service
needs to be improved. Drug Action Teams need to make more effort
to involve the families and carers of drug abusers and listen
to what they have to say rather than simply tell them what is
good for them. (Para 236)
The Government agreed that the families and carers
of drug abusers have an important part to play in designing services.
In its response to the Report the Government stated that "the
NTA is working to establish national and regional user and carer
forums and to encourage commissioners and providers to include
users and carers in contributing to a range of aspects of drug
treatment."
The NTA website (accessed August 2012) states that
"having drug users and their families and friends involved
in the treatment system is crucial for effective treatment".
It outlines how a user or carer can be involved in the treatment
system, including contacting their nearest drug action team (DAT)
or one of the NTA's regional teams.
We recommend that a target is added to the National
Strategy explicitly aimed at harm reduction and public health,
in addition to the Treatment objective. This target should be
measured through two indicators: to reduce the number of overdoses
(measureable through Accident and Emergency records) and to reduce
the number of new infections through injecting of HIV and Hepatitis
(measureable through medical records of drug users). (Para 245)
The Government's response to the Report stated that:
The Government accepts the need for a target aimed
at minimising drug-related harm and protecting public health.
The development of harm minimisation programmes, including work
to reduce drug related deaths by 20% by 31 March 2004 from a baseline
set in March 2002, will address the Committee's underlying concerns
to protect individual and public health.
The 2010 drug strategy "has recovery at its
heart" although neither of those two targets is explicitly
stated:
- puts more responsibility on individuals to seek
help and overcome dependency
- places emphasis on providing a more holistic
approach, by addressing other issues in addition to treatment
to support people dependent on drugs or alcohol, such as offending,
employment and housing
- aims to reduce demand
- takes an uncompromising approach to crack down
on those involved in the drug supply both at home and abroad
- puts power and accountability in the hands of
local communities to tackle drugs and the harms they cause.
The first Annual Review of the strategy published
in May 2012 provides further details on progress.
We recommend that the Government reviews existing
guidelines on the treatment of injecting drug users for Hepatitis
C and amends the guidelines if necessary to ensure that users
are not excluded from treatment. (Para 248)
Current NICE guidelines on the treatment of Hepatitis
C do not exclude drug users.
We recommend that the Home Office and the Department
of Health urgently review the current legal framework on the dispensation
of controlled drugs by community pharmacists in consultation with
the Royal Pharmaceutical Society. (Para 260)
The Government accepted this recommendation in its
response to the Report.
We consider it highly undesirable that it should
be easier for a drug addict to access treatment through the criminal
justice system than in the community. This is a further reason,
if any were needed, for the Government to provide more treatment
in the community. (Para 262)
As mentioned previously the Government is intending
to devolve all commissioning of drug treatment to local bodies
by April 2013.
We recommend that Drug Abstinence Orders are amended
to carry the requirement of access to treatment. (Para 264)
The then Government's official response to this recommendation
was:
The Government does not accept this recommendation.
Effective and more quickly available treatment that fills gaps
in provision is central to delivering overall. That is why we
are employing a number of initiatives within the criminal justice
system that are designed to deliver treatment to those who need
it. A Drug Abstinence Order (DAO) is a stand-alone order targeted
at low level offenders who are not assessed as requiring drug
treatment but where there is sufficient concern about their risk
of drug misuse to justify ongoing monitoring. DAOs are being
piloted in nine areas across England and Wales and may be amended
following a comprehensive evaluation of their impact. DAOs, and
Drug Abstinence Requirements, a voluntary treatment option, complement
Drug Treatment and Testing Orders by providing the courts with
new community sentence options, providing a range of sentencing
options which the courts can use as they deem appropriate to 'fit'
the offender.
Drug abstinence orders were introduced in July 2001
by the Criminal Justice and Court Services Act 2000, which inserted
a new section 58A into the Powers of Criminal Courts (Sentencing)
Act 2000. However, they were abolished with effect from April
2005, when section 58A was repealed by the Criminal Justice Act
2003. The recommendation is paragraph 264 is therefore obsolete.
The 2003 Act replaced the various community-based
orders that previously existed - including drug abstinence orders
and various other orders, such as community rehabilitation orders
and community punishment orders - with a generic community order.
When sentencing an offender to a community order, the court must
impose at least one of the requirements listed in section 177
of the Criminal Justice Act 2003. One of the requirements that
can be imposed is a "drug rehabilitation requirement":
see sections 209 to 211 of the 2003 Act.
Details of what a drug rehabilitation requirement
involves are summarised in Dr David Thomas QC's Sentencing Referencer:
A drug rehabilitation requirement may be made only
if the court is satisfied that the offender is dependent on or
has a propensity to misuse drugs; and that his dependency or propensity
is such as requires and may be susceptible to treatment. The
treatment and testing period must be at least six months.
A drug rehabilitation requirement requires the offender
to submit, during the treatment and testing period, to treatment
by a specified person with a view to the reduction or elimination
of the offender's dependency on or propensity to misuse drugs.
The treatment may be treatment as a resident in a specified institution
or place, or treatment as a non-resident in a specified institution
or place. The nature of the treatment is not specified in the
order.
The requirement must also require the offender to
provide samples during the treatment and testing period at times
and in circumstances determined by a responsible officer or person
providing treatment, for the purpose of ascertaining whether he
has any drug in his body during the treatment and testing period.
A court must not make a drug rehabilitation requirement
unless it is satisfied that arrangements have been or can be made
for the treatment intended to be specified in the order, and the
requirement has been recommended by an officer of a local probation
board.
A requirement may not be included in an order unless
the offender expresses his willingness to comply with the requirement.
A drug rehabilitation requirement may (and must if
the treatment and testing period is more than 12 months) provide
for the order to be reviewed periodically at intervals of not
less than one month at a hearing held for the purpose by the court
responsible for the order. The offender may be required to attend
each review hearing (and must if the period is more than 12 months).
At a review hearing the court, after considering
the responsible officer's report, may amend any requirement or
provision of the order. The court may not amend the treatment
or testing requirement unless the offender expresses his willingness
to comply with the amended requirement, and must not reduce the
treatment and testing period below the minimum of six months.
If the offender fails to express his willingness to comply with
the amended order, the court may revoke the order, and deal with
him, for the offence in respect of which the order was made, in
any manner in which it could deal with him if he had just been
convicted by the court of the offence.
If at a review hearing the court is of the opinion
that the offender's progress under the order is satisfactory,
the court may so amen the order as to provide for each subsequent
review to be made by the court without a hearing, but this may
be reversed.[316]
Section 74 of the Legal Aid, Sentencing and Punishment
of Offenders Act 2012 will remove the current requirement for
the treatment and testing period of a drug rehabilitation requirement
to last at least six months. This means that there will be no
minimum treatment and testing period. Section 74 has not yet
been commenced so is not yet in force.
Drug rehabilitation requirements under the 2003 Act
are more akin to the old drug treatment and testing orders that
existed under section 52 of the Powers of Criminal Courts (Sentencing)
Act 2000 (also repealed by the 2003 Act), rather than drug abstinence
orders.
The current community sentencing regime under the
2003 Act does not currently include any requirement that is directly
equivalent to the old drug abstinence orders (although the Government
has recently legislated to introduce a new alcohol abstinence
and monitoring requirement: see section 76 of the Legal Aid, Sentencing
and Punishment of Offenders Act 2012 and the related Explanatory
Notes).
We recommend that the Government initiates a discussion
within the Commission on Narcotic Drugs of alternative ways—including
the possibility of legalisation and regulation—to tackle
the global drugs dilemma. (Para 267).
The Government did not accept this recommendation.
305 CPS website, Legal Guidance - Drug Offences, incorporating
the Charging Standard: Public Interest Considerations: Supply/Possession
with intent to supply/Offering to supply (accessed 23 August 2012) Back
306
Advisory Council on Misuse of Drugs, Cannabis: classification
and public health (2008) Back
307
Letter from the Department of Health to Local Authorities Chief
Executives (April 2012) Back
308
Ibid Back
309
The Government Reply to the Third Report from the Home Affairs
Committee Session 2001-2002, HC 318, Cm 5573 (July 2002),
p18 Back
310
Ibid Back
311
Department of Health, Clinical Management of Drug Dependence
in the Adult Prison Setting (2006), para 1.4 Back
312
Cm 7972, December 2010: page 27 Back
313
Cm 7972, December 2010: page 28 Back
314
Alan Travis , "Coalition shelves plans for 'abstinence-based'
drug strategy" Guardian , 8 December 2010 Back
315
Ministry of Justice Government launches drug recovery wings to
help cut reoffending 22 June 2011 Back
316
Dr David Thomas QC, Sentencing Referencer (2012) , p 47-48 Back
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