Drugs: Breaking the Cycle - Home Affairs Committee Contents

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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Prepared 10 December 2012