Conclusions and recommendations
Recommendations from the last Home Affairs Committee
report on drugs policy
1. The
Department for Transport has set up a panel of experts to advise
on those drugs which should be covered by the new offence driving
with concentrations of drugs in excess of specified levels and,
for each drug, the appropriate maximum permissible level of concentration
in a person's blood or urine. We believe that this maximum should
be set to have the equivalent effect on safety as the legal alcohol
limit, currently 0.08 mg/ml. (Paragraph 2)
2. We recommend that
the Government continue to monitor the decisions of the Health
and Wellbeing Boards as to allocation of treatment places, recording
each request, monitoring waiting times to enter treatment and
assessing the success rate of those dependent on different drugs.
The Government should publish this information in an easily accessible
and understandable format and consider developing a league table
of Health & Wellbeing Boards' performance on local drugs provision
while taking care in selecting assessment criteria not to introduce
perverse incentives into the decision making process. This will
allow Boards to benchmark their provision against each other,
having due regard to local need. (Paragraph 7)
3. New evidence which
has emerged in the decade since our predecessor Committee's Report
on drugs suggests that diamorphine is, for a small number of heroin
addicts, more effective than methadone in reducing the use of
street heroin. It is disappointing therefore that more progress
has not been made in establishing national guidelines for the
prescription of diamorphine as a heroin substitute. We recommend
that the Government publish, by the end of July 2013, clear guidance
on when and how diamorphine should be used in substitution therapy.
(Paragraph 10)
The aims of drugs policy
4. Drug
use can lead to harm in a variety of ways: to the individual who
is consuming the drug; to other people who are close to the user;
through acquisitive and organised crime, and wider harm to society
at large. The drugs trade is the most lucrative form of crime,
affecting most countries, if not every country in the world. The
principal aim of Government drugs policy should be first and foremost
to minimise the damage caused to the victims of drug-related crime,
drug users and others. (Paragraph 14)
Current international drugs policy
5. The
Committee saw for itself during its visit to Colombia the effect
of the drugs trade on producer and transit countriesthe
lives lost, the destruction of the environment and the significant
damage caused to governance structures by corruption and conflicts.
We recognise and sympathise with the immense suffering and slaying
of innocent people which tragically has taken place over the years
in Colombia and other Latin American countries, as a result of
the murderous rivalry between drug gangs. (Paragraph 25)
6. We believe it is
important that countries remain inside the Single Convention on
Narcotic Drugs of 1961, rather than entirely outside it. We therefore
believe that Bolivia should be allowed to re-accede to the Convention,
with the reservation they require for traditional practices. We
recommend that the UK Government support this position and encourage
other countries to do likewise. (Paragraph 27)
The impact of globalisation on the drugs trade
7. We
were concerned to discover that the Maritime Analysis and Operations
Centre (Narcotics) has seen a sharp fall in its rate of drug interdiction
and now faces an uncertain future over its funding, 95% of which
is currently provided by the European Commission. Gathering reliable
intelligence about the maritime trafficking of illegal drugs is
a crucial part of the international fight against the drugs trade.
While recognising that this is not a matter for the UK Government
alone, we urge the Government to work with both EU countries and
other key international partners to ensure more effective drug
interdiction in the future. (Paragraph 35)
The balloon effect
8. Targeting
supply at an early stage is the most effective way of reducing
supply, as larger amounts can be intercepted higher up the supply
chain. Even so, we do not believe that it will be possible to
reduce the overall volume of the international drugs trade dramatically
only by tackling supply it is too easy for narco-criminals
to respond by diversifying their supply routes. (Paragraph 41)
9. The global nature
of the drugs trade, and the potential for displacement of drug
cultivation and supply routes in response to law enforcement measures,
means that the international drug trade can only ever be tackled
effectively by co-operative, co-ordinated international efforts.
We must recognise that no one nation can do this on its own.
(Paragraph 42)
10. The potential
for "substance displacement", where users switch from
one drug to another in response to changes in supply, has clear
implications for public policy. In particular, the Government
must be mindful of the fact that tougher measures against one
drug can lead to increased consumption of another. Where the drug
that is being targeted is less harmful than its substitutesand
all recreational drugs are harmful to a greater or lesser extentthere
is the clear potential for measures which are intended to tackle
the supply and consumption of drugs to result in an overall increase
in the harm they cause. We recommend that, where decisions about
the classification of drugs are concerned, the opinion of the
Advisory Council on the Misuse of Drugs should be sought on the
potential for substance displacement, and the comparative risk
associated with the likely substitutes. (Paragraph 44)
Links between drugs, organised crime and terrorism
11. We
are concerned that despite significant international efforts to
disrupt supply of illegal drugs and bear down on demand, the illegal
drugs trade remains a hugely profitable enterprise for organised
criminals and narco-terrorists. In part this is due to the highly
inflated prices of the drugs in question, inevitable in a high
demand underground market, and in part due to very low production
costs, arising from cheap labour costs where many workers are
exploited and the fact that most illicit drugs are very simple
and inexpensive to make. This ultimately causes massive harm and
deaths around the world. We urge the Government to continue to
factor this unintended consequence into considerations on drugs
policy. (Paragraph 55)
Human rights abuses
12. The
Government should not turn a blind eye to capital punishment and
other human rights abuses affecting those involved in the drugs
trade. In particular, we recommend that the Government ensure
that no British or European funding is used to support practices
that could lead to capital punishment, torture, or other violations.
(Paragraph 61)
Drug education in schools
13.
The evidence suggests that early intervention should be an integral
part of any policy which is to be effective in breaking the cycle
of drug dependency. We recommend that the next version of the
Drugs Strategy contain a clear commitment to an effective drugs
education and prevention programme, including behaviour-based
interventions. (Paragraph 75)
14. We recommend
that Public Health England commit centralised funding for preventative
interventions when pilots are proven to be effective. (Paragraph
76)
The Inter-Ministerial Group on Drugs
15. We
believe that the current, inter-departmental approach to drugs
policy could be strengthened by identifying a Home Office Minister
and a Department of Health Minister, supported by a single, named
official, with overall responsibility for co-ordinating drug policy
across Government. We recommend that the Home Secretary and the
Secretary of State for Health should be given joint overall responsibility
for co-ordinating drug policy. By giving joint lead responsibility
to the Home Office and Department for Health, the Government would
acknowledge that the misuse of drugs is a public health problem
at least as much as a criminal justice issue. (Paragraph 83)
16. We recommend that
the agenda, a list of attendees and minutes of each meeting of
the inter-ministerial group on drugs be published on a government
website. We would also welcome work addressing the harmful effects
of drug consumption. (Paragraph 84)
Current treatment options
17. Different
treatment regimes will work for different patients. It is clear
that, for some people, residential rehabilitation is the most
effective treatment, backed by proper aftercare in the community.
Although it is expensive when compared to treatment entirely in
the community, it is cost-effective when compared to the cost
of ongoing drug addiction. While we welcome the Government's focus
on recovery in the Drugs Strategy 2010, we have consistently been
told that there is a shortage of provision, and in particular
provision for specific groups such as teenagers. We recommend
that the Government expand the provision of residential rehabilitation
places. In addition, we recommend the Government review the guidance
for referrals to residential rehabilitation so that inappropriate
referrals are minimised and amend the National Drug Treatment
Monitoring System form so that where incidents of inappropriate
referral do occur they can be captured and an accurate picture
of the effectiveness of residential rehabilitation as a treatment
option can still be obtained. (Paragraph 94)
18. Outcomes which
range from 60% of patients overcoming their dependence to just
20% suggest that the quality of provision is very variable. We
recommend that, in line with the publication of certain outcome
statistics for National Health Service providers, publicly-funded
residential rehabilitation providers should be required to publish
detailed outcome statistics so that patients and clinicians can
make better-informed choices of provider. (Paragraph 96)
19. We make no comment
on the relative merits of methadone and buprenorphine. It is for
the individual prescriber to decide which drug is clinically indicated
for each patient. However, we note that recent pharmacological
advances in opioid substitution therapy mean that there are other
options to patients being "parked" on methadone are
notably treatment using buprenorphine which was less widespread
when our predecessor committee published its report in 2002 and
that it is possible that OST could in the future become a more
effective route to abstinence than it has been in the past.
Policy makers should understand the potential for more effective
OST treatments and, rather than ignoring reports of the negative
side effects of current OST drugs because they are available,
familiar and cost-effective, should continue to keep sight of
a greater emphasis on buprenorphine relative to methadone prescription
to lead to better patient and societal outcomes.
(Paragraph 100)
Implementation of the Government's goal of recovery
20. Drug
treatment in prisons is a point of critical interventionif
a drug-dependent offender is treated effectively then it greatly
improves their chance of rehabilitation on release. Given that
drug and alcohol dependence treatment in prisons has been so heavily
criticised for the lack of co-ordination with treatment in the
community, we are concerned that new structural changes may reverse
the gradual improvement we have seen in treatment for drug-dependent
offenders. We recommend the Government closely monitor the transition
of treatment funding responsibilities to the Health and Wellbeing
Boards and the NHS Commissioning Boards respectively. (Paragraph
106)
21. The Government
goal of recovery will require the co-ordination of several government
departments: the Department of Health to ensure that effective
treatment is being funded, the Department for Work and Pensions
to support patients to re-enter the workforce and local authorities
which must take responsibility for ensuring that they have appropriate
accommodation. We believe that giving the Home Secretary and the
Secretary of State for Health joint overall responsibility for
coordinating drug policy (see paragraph 83) will help to improve
the focus on the goal of recovery. We recommend that the Inter-Ministerial
Group works with the Recovery Committee of the Advisory Council
on the Misuse of Drugs to carry out an assessment of how the situation
is working once the changes have been fully implemented, and to
publish its findings by July 2013. (Paragraph 109)
22. Payment by results
potentially produces a very cost-effective system in which the
taxpayer pays only for successful outcomes. However, past experience
in other areas such as employment has shown that it is easy for
the market to become dominated by a small number of large providers,
leading to the marginalisation of smaller, innovative voluntary
sector organisations. Another risk is that the most difficult
to treat patients may be denied access to services. We recommend
that the Government establish ways to create provider diversity
to ensure that smaller providers and civil society are not excluded
and that a wide range of services are available. This could be
achieved by ring-fencing a certain proportion of expenditure for
such providers. The model will also need to ensure that providers
are rewarded appropriately for taking on the most difficult patients,
so that those who are harder to help will not be denied services.
(Paragraph 114)
23. Prescription drug
dependence and the use of prescription drugs for non-medicinal
purposes is widely and erroneously viewed as being less harmful
and certainly more acceptable than drugs which are part of the
classification system. Prescription drugs are becoming more widely
available, through diversion of prescriptions and unregulated
sales via the internet. This was not an issue which our predecessor
committee looked at in 2002 but we are alarmed by the increase
in availability of and addiction to prescription drugs. Having
seen first-hand the scale and impact of prescription drug use
in Florida, we recommend that the Government publish an action
plan of how it intends to deal with this particular issue as part
of the next version of the drug strategy to prevent the situation
here in the UK deteriorating further. (Paragraph 122)
24. It is unacceptable
that no government agency can give us information on the prevalence
of dependence on prescription drugs. We welcome the proposed review
of prescription medicine diversion by the ACMD. The issue is one
which has been highlighted as a growing problem and as the overall
trends of drug use change, the Government must ensure that it
has access to suitable treatment for dependence on all drugs rather
than just focussing on a narrow sub-set. It is ultimately the
responsibility of the medical profession to ensure that their
prescribing decisions do not lead patients into drug dependency.
However, the police and public should be aware of this deeply
concerning trend, so they too can be vigilant in seeking to prevent
it. (Paragraph 123)
Misuse of Drugs Act 1971
25. Our
predecessor Committee's recommendation for an independent assessment
of the Misuse of Drugs Act 1971 was rejected on the basis that
it gives effect to the UK's international obligations in this
area. That is not, in our view, a compelling reason for refusing
to review our own domestic legislative framework, particularly
given the growing concern about the current international regime
in many producer nations. The message from Colombia and other
supplier and transit states is clearwhat the international
community is currently doing is not working. We are not suggesting
that the UK should act unilaterally in these matters, but our
Government's position must be informed by a thorough understanding
of the global situation and possible alternative policies. (Paragraph
131)
26. This inquiry has
heard views from all sides of the argument and we believe that
there is now, more than ever, a case for a fundamental review
of all UK drugs policy in the international context, to establish
a package of measures that will be effective in combating the
harm caused by drugs, both at home and abroad. We recommend the
establishment of a Royal Commission to consider the best ways
of reducing the harm caused by drugs in an increasingly globalised
world. In order to avoid an overly long, overly expensive review
process, we recommend that such a commission be set up immediately
and be required to report in 2015. (Paragraph 132)
27. We endorse the
praise from President Santos and others for the work of the Serious
and Organised Crime Agency. In the countries we visited, it was
clear that they did an excellent job and were well respected.
We encourage the Government to find a way to retain the SOCA brand
overseas, in the move to the National Crime Agency, perhaps as
a Serious Overseas Crime Arm of the NCA. However, despite their
best efforts and considerable success, we agree with President
Santos and others that it is impossible for them to prevent drug
trafficking completely. (Paragraph 138)
28. Like any business,
the international drug trade thrives on profit. Identifying and
seizing the profits of the drug trade, wherever they are in the
world, must be a central part of the global fight against drugs.
In that context, the UK's approach to money-laundering has been
far too weak. Whilst we recognise that the financial crisis has
occupied the attention of the FSA since 2008, there is little
evidence that it treated the issue of money laundering sufficiently
seriously prior to that time. We welcome the creation of the Financial
Conduct Agency and we recommend that it produce annual reports
which show the prevalence of money laundering within the UK financial
sector. (Paragraph 151)
29. Being fined by
a regulatory body is an inadequate a sanction for complicityhowever
peripheral, and whether it is wilful or negligentin an
international criminal network which causes many thousands of
deaths each year. We recommend that the Government bring forward
new legislation to extend the personal, criminal liability of
those who hold the most senior posts in the banks involved where
they are found to have been involved in money laundering. (Paragraph
152)
The impact of austerity on drug-related policing
30. Drug-related
policing is a vital component of reducing supply and the intelligence
aspect, whether it be data on supply routes, the trend in available
products or the location of markets, assists not just local police
forces but other law enforcement agencies. Following the election
of Police and Crime Commissioners, the use of police budgets will
be decided with increased community input and local accountability.
There is a risk that significant variations in the local approach
to drugs could lead to geographical displacement of the drugs
trade within the UK. Commissioners will therefore need to be fully
briefed on the wider impact of decisions which they might take
locally. We recommend that the National Crime Agency submit to
every Police and Crime Commissioner and Chief Constable an annual,
confidential briefing setting out the measures they could take
to contribute to disrupting the drugs trade nationally and internationally.
(Paragraph 157)
31. Police time is
always limited and needs to be carefully prioritised to have the
most impact. As budgets get tighter going forward this situation
will intensify. It is important that Police Commissioners carefully
consider how best to target drugs crime in their local area. In
particular, we encourage Police Commissioners to ensure they are
fully informed about the relative effectiveness of different forms
of drug-related policing, including cannabis warnings and other
forms of diversion work, and to carefully consider the issue of
how police time is best prioritised between different kinds of
drug-related offences, whether simple possession, acquisitive
crime, supply or trafficking. (Paragraph 158)
32. Identifying drug-related
crime is vital in order to ensure that the right approaches to
reduce re-offending are targeted and effective. Drug-dependent
offenders are often prolific re-offendersby identifying
their prevalence, the Government and local authorities can make
targeted interventions in the community. (Paragraph 163)
New psychoactive substances
33. The
market in new psychoactive substances is changing quickly, too
quickly for the current system of temporary banning orders to
keep up. Forty-nine new substances were found in Europe last year,
a rate of development which makes additional measures critical.
At the moment, businesses are legally able to sell these products
until such time as they are banned with apparently no legal consequences
when they lead to death or long-term illness. We recommend that
the Government issue guidance to Local Authority trading standards
departments, citizens advice bureaux and other interested parties
on the action which might be taken under existing trading standards
and consumer protection legislation to tackle the sale of these
untested substances. A restaurant which gave its diners food poisoning,
a garage which left cars in a dangerous state, or a shop which
sold dangerously defective goods could all be prosecuted for their
negligence. Retailers who sell untested psychoactive substances
must be liable for any harm the products they have sold cause.
It is unacceptable that retailers should be able to use false
descriptions and disclaimers such as "plant food" and
"not for human consumption" as a defence where it is
clear to all concerned that the substance is being sold for its
psychoactive properties and the law should be amended. (Paragraph
170)
The effect of having a drugs conviction
34. We
believe that former drug users should be encouraged to play an
active part in society, and that making it harder for them to
find employment is likely to hinder that process, and make it
more likely they will be unemployed and supported by the state.
We therefore recommend that the Government review the inclusion
of convictions for offences of simple possession of a controlled
substance (as opposed to offences relating to supply, or any other
drug-related crime such as burglary) in CRB checks after they
become spent, or after three years, whichever is shorter. The
review should, in particular, take account of those areas of employment
to which drugs convictions are directly relevant. We also recommend
that cannabis warnings be treated as spent immediately. (Paragraph
178)
Cross-Departmental strategy
35. Tackling
drug use touches on issues of criminal justice, social justice,
education, health and local authorities, which is why the formation
of an Inter-Ministerial Group to coordinate Government policy
on the subject makes sense. However, as with any other cross-departmental
challenge, driving through reform requires clear, senior leadership.
Our recommendation for the Home Secretary and the Secretary of
State for Health to take joint overall responsibility for drugs
policy will help to strengthen inter-departmental co-operation,
with a focus on prevention and public health. (Paragraph 183)
Availability of drugs in Prisons
36. We
accept that prisons cannot be hermetically sealed and that it
will never be possible to eradicate completely the availability
of drugs within prisons. However, the fact that almost a quarter
of prisoners surveyed found it easy to get drugs in prison is
deeply disturbing. The methods of reducing supply are only effective
if they are implemented as intended. We recommend that the National
Offender Management Service ensure that measures such as the installation
of netting to stop 'throw-over' packages, regular cell searches
and regular drug tests based on suspicion are put into operation.
(Paragraph 188)
37. We commend the
work taking place on the drug recovery wings and the drug free
wings in certain prisons. The examples that we saw of both were
inspiring. If the evaluation of the pilots shows them to be successful,
we recommend that they be rolled out nationwide as a matter of
priority. We also recommend that the Government ensure that they
remain fully funded. The matter of the lack of funding for voluntary
drug testing in HMP Brixton's drug recovery wing is worrying and
we ask that the Justice Secretary reassure us that such a vital
strand of the recovery programme remains funded. (Paragraph 201)
38. There is some
very impressive work happening in some prisons at present with
innovative approaches being formulated in regards to treatment
and managing the transition of release but this is not the standard
and there is considerable scope to spread best practice (Paragraph
202)
39. Treatment in prisons,
just like treatment outside prisons, should be tailored to the
individual. Some people will be able to enter abstinence programs,
and should be encouraged to do so. For others, such as those who
are already being maintained on methadone, prescription alternatives
may be the best option, and should be made available. (Paragraph
205)
Lack of reliable data
40. Producing
an evidence base of effective interventions is one of the most
vital building blocks of drugs policy. We recommend that the Ministry
of Justice introduce mandatory drug-testing for all prisoners
arriving at and leaving prison whether on conviction, transfer
or release. Tests should be carried out for both illegal and prescription
drugs. This should be in addition to the existing random testing
regime, the principal purpose of which is deterrence. The information
obtained from such a test would be very valuable in evaluating
the effectiveness of the current systems in place and identifying
those prisons which have a serious problem. Prisons are a key
point in the cycle of drug addiction and if addicted offenders
can be got off drugs, the monetary and societal benefits would
be huge. (Paragraph 211)
41. Release from prison
is a critical intervention point in the cycle of addiction and
re-offending. We welcome the Justice Secretary's recent announcement
that prisoners will be "met at the prison gate" by mentors
who can help them to settle back into the community. Successful
rehabilitation is a challenging outcome to achieve, but it is
worth investing the resources necessary to ensure that those leaving
prison have the care and support they need in the community, including
suitable and stable housing, to provide them with the best possible
chance of a long-term recovery. Under the our recommended regime
of universal drug testing on release, those who test positivehowever
long they have servedshould be automatically referred to
the appropriate community drug rehabilitation service. Given the
importance of this point of critical intervention, we intend to
return to this issue in the near future to assess whether there
has been an improvement following the implementation of the Justice
Secretary's policy. (Paragraph 212)
Decriminalisation and Legalisation
42. We
were impressed by what we saw of the Portuguese depenalised system.
It had clearly reduced public concern about drug use in that country,
and was supported by all political parties and the police. The
current political debate in Portugal is about how treatment is
funded and its governance structures, not about depenalisation
itself. Although it is not certain that the Portuguese experience
could be replicated in the UK, given societal differences, we
believe this is a model that merits significantly closer consideration.
(Paragraph 243)
43. Following the
legalisation of marijuana in the states of Washington and Colorado
and the proposed state monopoly of cannabis production and sale
in Uruguay, we recommend that the Government fund a detailed research
project to monitor the effects of each legalisation system to
measure the effectiveness of each and the overall costs and benefits
of cannabis legalisation. (Paragraph 248)
Implications of discussing drugs policy - politics
and the media
44. Drugs
policy ought to be evidence-based as much as possible but we acknowledge
that there is an absence of reliable data in some areas. We therefore
recommend the Government allocated ring fenced funding to drugs
policy research going forward. Such a funding stream would most
appropriately sit with the Medical Health and Research Council
so that the evidence base for prevention and recovery aims of
the Drugs Strategy can be strengthened, although cross disciplinary
applications in this area will be vital. (Paragraph 257)
45. We recommend that
the responsible minister from the Department of Health and the
responsible minister from the Home Office together visit Portugal
in order to examine its system of depenalisation and emphasis
on treatment. (Paragraph 258)
46. As our predecessor
Committee supported in their 2002 report, we recommend that the
Government initiate a discussion within the Commission on Narcotic
Drugs of alternative waysincluding the possibility of legalisation
and regulationto tackle the global drugs dilemma. (Paragraph
259)
47. We welcome the
Government's efforts to make clear its commitment to reducing
drug misuse and tackling the consequences of drug misuse. We also
recommend that the Government instigate a public debate on all
of the alternatives to the current drugs policy, as part of the
Royal Commission (see paragraph 132). (Paragraph 260)
48. We have made a
number of recommendations regarding the need for further evidence
gathering. We believe that this would be most effective if it
were co-ordinated through one body. The appropriate body to do
this would, in our view, be the Advisory Council on the Misuse
of Drugs, which is already tasked with advising the Home Secretary
on classification decisions. It is logical that the body which
is responsible for formulating scientific advice to ministers
should also have a role to play in coordinating the gathering
of scientific evidence on the subject. (Paragraph 261)
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