Home Affairs Committee - Drugs: Breaking the CycleWritten evidence from Neil McKeganey (DP054)

1. Introduction

In 1994 I set up the Centre for Drug Misuse Research at the University of Glasgow which conducted research on various aspects of the UK and international drug problem since that date. In 2011 the Centre moved out of the University of Glasgow to form an independent research centre undertaking studies in a number of key areas related to drugs misuse. These include research into the effectiveness of drug abuse treatment services, the impact of drugs within the prison environment, the growth of the drugs problem and its impact on society both at the present time and in the future. Recently completed research by colleagues within the Centre include an assessment of the impact of major drug seizures on the local availability of drugs and the use of drug treatment services, work on the impact of parental drug use on children, and work on the developments of inner city areas where the drugs problem has attained considerable local momentum and is leading to a degree of separation on the part of those local areas from the wider society. This latter work has been undertaken for the United Nations as part of the forthcoming (2011) report of the International Narcotics Control Board. I am the author of over 150 academic papers related to drugs misuse research and in 2011 authored the book “Controversies in Drugs Policy and Practice” (Palgrave Macmillan). I should like to respond to a number of areas related to the Committees enquiry.

2. Fiscal Responsibility

My judgement is that we have largely skirted around the issue of fiscal responsibility in relation to implementing the various drug strategies and as a result we have relatively poor information on the cost benefit of many of the decisions taken with regard to the various areas of treatment, prevention, and enforcement. The tendency instead of subjecting current and recent past interventions in each of these areas to robust assessment has rather been to assume that any interventions within these areas are beneficial to some degree and are worthy of support on that basis.

3. Evidence Based

I think that it would be fair to say that we have utilised the evidence base in relations to tackling the UK drugs problem to only a limited extent. Presently we lack a robust connection between the gathering and analysis of evidence in relation to drug misuse matters and the policy making process. Rarely for example is consideration given as to whether how and to what extent have research findings been implemented in practice. The tendency instead has been to assumed that the process of implementation of research findings occurs by a slow process of osmosis rather than through a clear implementation mechanism. An example would be the research finding from work which I carried out with colleagues in Scotland which identified that the quantity of heroin seized within Scotland amounted to only one percent of the quantity of heroin consumed within Scotland. A similar analysis was undertaken for England with only a modest increase in the percentage of seized to consumed heroin. Those findings should ideally have led to a vigorous debate and critical consideration as to why the percentage of seized to consumed heroin was so low and to a determined examination of what strategies needed to be implemented in order to increase the proportion of seized to consumed heroin. What happened instead is that enforcement organisations rather regarded the findings as something of an embarrassment which it would be preferable to speedily move on from. Equally the finding in research which I and colleagues undertook which identified that the those drug users who were luck enough to be provided with access to residential rehabilitation services were significantly more likely to be drug free on follow up assessment than those provided with community based (methadone) provision has also had very little impact. Indeed in the period following the provision of those results there has been a diminution in the number of residential rehabilitation services available within the UK. The National Treatment Agency in the past and to a degree in the present has provided very weak leadership in relationship to developing the residential rehabilitation sector and have instead presided over a mushrooming national methadone programme that has delivered only modest results in terms of drug users abstinence and recovery.

4. Independence of Expert Advice

I think that this is an important issue but my sense is that there has been too great a tendency to rely on advice which is congruent with the current views of civil servants. Within this field there is definitely a tendency towards an “inside the tent outside the tent” divide within which discordant or more critical voices tend to be excluded and ignored. There may be a degree to which this occurs in all or most areas of public and private policy making although I think the operation of this divide in relation to drugs misuse where our achievements are very modest is particularly regrettable. We are very weak within the UK on developing a sustained profile in drugs related research. Most of the funding that is available is on a project by project basis with shortcomings in the quantity of the funding for that work and in its sustainability long term. It has been previously identified that the level of funding for drug misuse related research within the UK amounts to little more than a quarter of 1% of the monies spent on tackling the drugs problem. That observation was made in the Royal College of Physicians Report “Drugs Dilemmas and Choices” published in 2000. In all probability the percentage presently being allocated to drugs misuse research has changed to only a very modest degree.

5. Public Health Playing a Leading Role in Developing Drugs Policy

I think that it would be hugely regrettable to elevate the public health perspective above all else in shaping drugs policies within the UK. My reasons for this view are as follows. First I am not at all convinced that the public health approach gives due weight to the importance of individual recovery. The tendency instead is to adopt a more population wide approach in recommending and implementing interventions rather than an approach which enhances the capacity of individuals to improve their circumstances—including tackling the level of their drug dependency. Second, I think that effective drug policies require an equal contribution across the sphere of treatment prevention and enforcement. To the extent that any one of these assumed a preeminent position in shaping policy there is a real danger than an important contribution on the part of the other areas is being diluted.

6. Transfer of the NTA into Public Health

I think that it is very hard to judge what impact this transfer will have. To the extent that senior staff within the NTA migrate into equally senior positions within Public Health England then I think there must be some skepticism as to whether a demonstrably different approach to tackling illegal drugs will be implemented. Again I think there is a degree to which the current senior staff within the NTA seek the advice and expert input only from favoured experts and tend to ignore and exclude those who they see has having been critical of past approaches to tackle the drugs problem. I think that the harm reduction approach favoured by a number of the senior NTA staff remains very much a key driver of who and where they seek external advice from. Inevitably in my mind this reduces the likelihood of developing effective interventions to tackle our drugs problem.

7. The Link between Drugs Organised Crime and Terrorism

This is a very important area although not one well explored within the UK. My own research centre has undertaken work in the area of the link between drugs and organised crime although this work has largely been funded on the basis of EU rather than UK support. Indeed we seriously lack research expertise in exploring these links. To the extent that the research which has been undertaken in this area has been largely funded on a piece meal basis we have lacked the capacity to build incrementally upon the expertise acquired and have seen expert researchers move out of this area where their own funding has ceased. We should have a sustained research capacity addressing these topics and the relationships therein.

8. Support of Global Partners

The principle of shared responsibility is crucial to effective national and international action to tackle the problem of illegal drugs. Whilst there are very positive examples of shared responsibility I think that there is a need to do much more in this area. The international drug conventions are the clearest example of the principle of shared responsibility as it relates to the drugs issue although I suspect that we make much less use of these international efforts than we should do and need to do. In relation to enforcement there is a clear need to pool expertise as to effective means for tackling drug markets—whilst there are examples where this is occurring my belief is that we need to expand this considerably. However the principle of shared responsibility needs to be explored with equal vigor in relation to treatment and prevention—here too there is considerable scope for improvements in our efforts and contribution.

This submission has been prepared within the context of existing commitments in managing and developing the research programme for the Centre for Drug Misuse Research. As a result the submission is less detailed that I would have wished. I apologise for that. However, if the committee feels that their enquiry would be usefully contributed to by an oral presentation on any of the themes that I have outlined in my submission I should be more than happy to make that contribution.

January 2012

Prepared 8th December 2012