Home Affairs Committee - Drugs: Breaking the CycleWritten evidence submitted by University of Kent (DP 077)

1. Executive Summary

1.1 In this submission we argue that the current drug policy, based on the criminalisation of drug users, is ineffective, wasteful of resources and damaging to public well being.

1.2 We note that countries (eg Portugal and the Netherlands) that have moved towards depenalised and decriminalised systems for the regulation of illicit drugs have not seen the predicted increase in drug-related harms, and that they have achieved significant public health benefits.

1.3 We also note the association between social inequality, welfare support and drug-related harms. Countries which have lower inequality and higher welfare support (eg Sweden and the Netherlands) have lower rates of drug use and related harms than countries with higher inequality and lower levels of welfare support (eg the UK and USA).

1.4 We argue that the effectiveness of the current emphasis on “recovery” is hampered by the government’s failure to provide adequate support to the housing and employment needs of people who are recovering from drug dependence.

1.5 We acknowledge the copious evidence on the positive effects of harm reduction measures, such as opiate substitution treatment, in reducing illicit drug use and crime and in limiting the spread of blood borne viruses, such as HIV and Hepatitis B and C. We refute the non-evidenced based claim that these services prolong illicit drug use.

1.6 We recognise the existence of several alternative methods of regulating the production, distribution and use of psychoactive substances, some of which have been assessed as more cost-effective than current methods. Many of them are already in place for the regulation of other psychoactive substances (eg alcohol and tobacco).

1.7 However, we also recognise that the evidence base on which to base decisions in the field of drug policy is currently under-developed.

1.8 We acknowledge that some of these alternative methods would contravene obligations under existing UN conventions.

1.9 We therefore recommend:

1.9.1Investment in research to enable the generation of better evidence to inform the public debate on drug policy.

1.9.2Progressive movement through carefully evaluated steps to reduce the criminalisation of, firstly, drug possession and, secondly, drug production and sale.

1.9.3Diplomatic efforts to reform the UN conventions in line with respect for human rights and the need to create more effective drug policies.

1.9.4Redistribution of resources from private consumption, avoided tax and unearned wealth of people at the top of the income distribution towards universal welfare services (eg housing and disability benefits) and specifically targeted services to support recovering drug users into stable housing and employment.

2. The Submitters

2.1 This submission is made by members of the Crime, Culture and Control research group at the University of Kent. We are based in the University’s School of Social Policy, Sociology and Social Research. Collectively, we have significant expertise in the field of drug policy analysis, international drug policies, drug use, drug markets and drug trafficking. The individuals involved in the writing of this submission have been:

Professor Alex Stevens;

Dr Caroline Chatwin;

Dr Axel Klein; and

Dr Jennifer Fleetwood.

3. Current Drug Policy: Costs and Effects

3.1 Current British drug policy relies on the criminal law as its principal instrument and the criminal justice system as its most expensive component.

3.2 This is despite the repeated finding that drug use is a public health problem that is not amenable to eradication through the criminal law.1–2

3.3 Controlling drugs through prohibition is primarily intended to protect public health, but it also damages public well-being. Both property crime committed by users to pay the artificially inflated price of drugs and the activities of organised crime groups involved in drug trafficking and sale are unintended but predictable consequences of prohibition.3

3.4 Repeated analyses of British drug policy have shown that it has failed to achieve the goal of eradicating, or even significantly reducing, the use of substances whose possession is criminalised by the Misuse of Drugs Act 1971.4–9

3.5 There have been recent reductions in the overall use of drugs (driven by reductions in cannabis use)10 and in the estimated prevalence of problematic drug use (opiates and crack) in England and Wales.11

3.6 The fall in cannabis use occurred despite the downward reclassification of cannabis to class C from class B and the simultaneous introduction of the cannabis warning in 2004.

3.7 The reduction in use of opiate and crack cocaine may be associated with the significant expansion of treatment services, but may also be associated with a natural “epidemic” downturn in heroin and crack use.12

3.8 There has been a significant increase in the use of imprisonment for drug offences. The population in prison for drug offences rose by 91% between 1995 and 2007 (compared to 53% for other offences).13

3.9 This rise has most greatly affected black and minority ethnic groups. The increase amongst people classified as black was 117% and for those classified as Asian it was 345%, compared to 58% for those classified as white.13

3.10 The pains of imprisonment for drug offences fall especially hard on women. In 2010, 23% of the sentenced female prison population was made up of drug law offenders, compared to 15% of the male population.14

3.11 Despite the introduction of the cannabis warning, many young people continue to receive a criminal record for low level drug offences. In 2010, 25,661 people were convicted of drug possession.15 Over 40,000 received a caution for a drugs offence.16

3.12 The negative effect of a criminal record on future life chances is well known.17 Less well known is that being arrested for an offence makes young people more—not less—likely to reoffend.1 8

3.13 The total cost to the taxpayer of criminalisation through drug laws has never been properly counted. It is most likely to be above £2 billion per annum.4, 19 This is well in excess of current spending on drug treatment and prevention.

3.14 These calculations do not include the opportunity cost of the potential tax income from the substantial trade in substances which currently takes place in an unregulated and untaxed market. Nor do they include the cost of health harms associated with the lack of regulation of the contents of these products.

3.15 Previous reviews of drug policy have not found convincing evidence that drug law enforcement is cost-effective in reducing drug problems [2, 20]. They have found that drug treatment and, with a lower degree of certainty, some forms of drug prevention are cost-effective.20–21

3.16 Opiate substitution treatments, including methadone and buprenorphine maintenance as well as heroin assisted treatment, are among the best-researched interventions in the field of drug policy. They have been found to be effective in reducing the transmission of blood-borne viruses, reducing illicit heroin use and reducing offending by heroin users.20–28

3.17 A recent suggestion that methadone maintenance is too expensive and prolongs drug use29 is based on misinterpretation of the evidence. It conflates the cost of methadone prescribing with the cost of all treatments funded by the NHS (including abstinence-based treatment)30 and it misrepresents the BMJ article on the link between length of methadone treatment and length of injecting career.3 1 Specifically, it ignores that people with more severe drug problems are more likely to have both long methadone and long injecting careers. One need not cause the other.

4. Alternative Policies

4.1 A range of alternative policies are already in place internationally or have been proposed for the regulation of currently illicit psychoactive substances.

4.2 The three UN conventions restrict, but do not eliminate, possibilities for policy innovation.2 Specifically, the 1988 Convention against Illicit Traffic in Narcotic Drugs and Psychotic Substances obliges signatories to criminalise the possession, production and distribution of scheduled drugs. This makes it very difficult to move towards less damaging ways of regulating drug markets while staying within international law.

4.3 Existing international experiences with less harmful drug policies have focused on decriminalising use. Several US states have decriminalised the possession of cannabis.32 Many European countries, including France, Germany, Belgium, Finland, Greece, Romania, Slovakia, Estonia, Bulgaria and the Czech Republic have reduced penalties for drug possession since 2000,33 without any evident effect in changing the prevalence of drug use. Portugal decriminalised the possession of small quantities all drugs in 2001. Since 1976, the Netherlands has formally depenalised both the possession and small scale supply of cannabis.34

4.4 There are developing models for decriminalising the production of cannabis at home or in clubs for personal consumption.35

4.5 Several proposals have been made on how the wholesale production and distribution of drugs could be brought within legal regulation.36–38 Most envisage using models of regulation that are already in existence for food, alcohol, tobacco or pharmaceutical products. Due to the restrictions imposed by the UN conventions, no country has been able to try these out in practice and to develop evidence on their effects.

4.6 Any alternative model of production and sale should retain controls on price and advertising, as the limited research available suggests that the scale of use is responsive to both price and advertising.20, 39

4.7 There is recent research on models for the legal regulation of wholesale cannabis distribution which consistently suggests that this would be more cost-beneficial than the current criminalisation of the cannabis market.40–42

4.8 Evaluations of the Dutch and Portuguese policies of depenalisation and decriminalisation have suggested that they have not had significant effects in increasing drug use.39, 43–46 Significant public health benefits, including reductions in heroin use, in injecting drug use, in the incidence of HIV and AIDS and in drug-related deaths have been achieved in both countries.

4.9 It should be noted that these two countries have also invested in expansion of services for the treatment of drug dependence. In Portugal, there has been a major expansion in low threshold methadone maintenance treatment.43 In the Netherlands, a wide range of integrated services has been developed, including heroin assisted treatment and safe drug consumption rooms.45 Both countries have also succeeded in reducing their prison populations in recent years.47 It is likely that these developments have had significant impacts in improving public health.

5. Drugs, Inequality, Welfare and Recovery

5.1 Drug use and related harms are issues of public health. Like all such issues, they are closely associated with social inequality. Drug use tends to be more prevalent in countries with higher levels of inequality.48 Within the UK, drugs are more likely to be used by people who have higher levels of income.13 But drug-related harms, including dependence, imprisonment, HIV infection, drug-related death and drug-related crime are more prevalent among people at the bottom of the income distribution.13, 49–50

5.2 Drug-related harms are also associated with low levels of welfare support. For example, countries with more generous levels of sick pay, pension and unemployment benefits tend to have lower rates of adolescent drug use and injecting drug use (see figures 1 and 2 below).

5.3 These links are correlational and have not yet been proved to be causal. However, there are sociological and bio-psycho-social models that can explain why higher levels of inequality and lower levels of welfare support would cause increased rates of drug use and related harms.13, 48

5.4 Welfare services—such as income support, social housing and employment services—are especially important in enabling people to recover from dependent drug use. Without a decent minimum legal income, dependent drug users are reluctant to move away from participation in illicit drug markets and into treatment. Without stable housing, they are less likely to stay in treatment.51 Without support to get into employment, they are less likely to sustain abstinence and avoid relapse.52–53

5.5 Current government policies are limiting access to stable housing through cuts to the Supporting People programme, by limiting housing benefits in metropolitan areas where rents are high (and where many drug users live and are in treatment), and especially by lifting the minimum age for single accommodation to be paid from housing benefit from 25 to 35. Many recovering drug users need single accommodation to stay away from co-residents who may offer them drugs and alcohol, or stigmatise them for their former drug use or current treatment.

5.6 Current policies are making it harder for recovering drug users to find employment by cutting hundreds of thousands of jobs in the public sector (which the private sector is not replacing). There is a danger that the organisations contracted to deliver the Work Programme lack specific expertise in the needs of people recovering from drug dependence, and lack the incentives to take on difficult-to-place cases. British research has found that specific employment support services are vital to help recovering drug users into work.54

5.7 Current government policies are making it more likely that drug problems will become entrenched in future by increasing income inequality55–56 and by restricting sustainable funding for recovery-oriented services that work with people who are furthest from the drug market.

5.8 The current policy of payment-by-results for drug treatment is innovative, but is untested and risky.57 It may lead to uncertainty and unsustainability for many drug treatment agencies, including the residential abstinence based providers who currently have the highest costs but have little evidence of providing better outcomes than less expensive services.58 It is likely to create perverse incentives, including the “cherry picking” of less problematic patients who are most likely to show good outcomes.59

5.9 By focusing on the problem of addiction rather than on the social barriers to the inclusion of drug users, current policies reinforce exclusionary stigma and inhibit individual autonomy, which is an important precondition for overcoming drug misuse.60

Figure 1

SCATTERPLOT OF THE ASSOCIATION BETWEEN THE PREVALENCE OF PAST YEAR CANNABIS USE BY 15 YEAR OLDS AND LEVELS OF WELFARE SUPPORT, 2002 OR NEAREST AVAILABLE YEAR. DATA SOURCES: 61–62

Figure 2

SCATTERPLOT OF THE ASSOCIATION BETWEEN PAST YEAR PREVALENCE OF INJECTING DRUG USE AND LEVELS OF WELFARE SUPPORT, 2002 OR NEAREST AVAILABLE YEAR. DATA SOURCES: 62–63

6. Recommendations

6.1 That the government develops policies which plan for a progressive movement through carefully evaluated steps to reduce the criminalisation of, firstly, drug possession and, secondly, drug production and sale. This would involve a fundamental review of the Misuse of Drugs Act 1971.

6.1.1The first step would be to extend the cannabis warning system to all offences of cannabis possession (including those by young people and repeat offences) and to remove the power of arrest from these offences.

6.1.2A subsequent step would be to decriminalise the domestic production of small amounts of cannabis (eg the growing of up to six plants at a time at residential addresses).

6.1.3Another subsequent step would be to decriminalise the possession of all drugs, and to institute instead a system of administrative diversion to education and/or treatment, using the experience of the Portuguese Committees for the Dissuasion of Addiction, or the Australian cannabis diversion schemes.43, 64

6.1.4A further step would be to test systems for the regulated production and distribution of safer forms of popular psychoactive substances through licensed premises, clinics or prescription services, with retention of controls on price and advertising, in order to substantially reduce the scale of the unregulated, criminal market.

6.2 That the government extend its diplomatic efforts to reform the UN conventions in line with respect for human rights and the need to create more effective drug policies. The options include (in descending order of difficulty):

6.2.1Developing a new global convention to replace the existing three conventions. This new convention should clarify existing contradictions and tensions between the regime for international drug control and the need to guarantee fundamental human rights, should enable access to opiate analgesics for medical use in all countries and should allow countries to develop and test alternative methods for the regulation of drug markets.

6.2.2Negotiating a new convention with a smaller group of like-minded countries, without changing the existing conventions. This new convention would take precedence over existing conventions.

6.2.3Withdrawing from the existing conventions and re-acceding with a note of reservation on the clauses of the conventions that prevent development and trial of more effective domestic policies.

6.2.4Allowing the existing conventions to fall into desuetude by developing domestic policies with less regard to obligations imposed by the conventions, or at least to the interpretations that the International Narcotics Control Board makes of them.

6.3 Drug problems are associated with poverty and inequality. We therefore recommend redistribution of resources from private consumption, unearned wealth and avoided tax of people at the top of the income distribution to universal welfare services and specifically targeted services to support recovering drug users into stable housing and employment.

6.3.1Greater income inequality could be achieved through reforms of the labour market, eg by increasing the minimum wage and reducing excessive pay inflation for people in the highest centiles of the income distribution. It could also be achieved through more progressive taxation and tax credits.

6.3.2Universal welfare services, including housing benefit, should be protected from cuts in order to reduce the concentration of poverty that is associated with the development of drug dependency.

6.3.3The provision of more affordable housing is necessary both to bring down the housing benefit bill and to provide access to stable housing for all, including recovering drug users.

6.3.4For those drug users in recovery who cannot work, a flexible system of personalised assessment which takes into account the social barriers to the employment of recovering drug users should be created in order to provide disability benefits that support their recovery.

6.3.5Specialised support to the housing and employment needs of recovering drug users should be protected from the threats to their funding that have arisen from ring fencing being taken away from Supporting People and specific employment services. The funding structure for employment support, including the Work Programme and payment by results, must not ignore the specific needs (and associated costs) of those recovering drug users who are furthest from the labour market.

6.4 The evidence base on alternative methods for drug policy is currently too thin to provide definitive answers to important policy questions.2, 65–66 We therefore recommend:

6.4.1That development and renegotiation of international drug policies should take into account the need to enable testing of alternative drug policy regimes.

6.4.2That the UK government diverts money from law enforcement efforts (such as imprisonment) which are probably not cost-effective in reducing drug problems towards research that will improve the evidence base for drug policy and its cost-effectiveness.

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January 2012

Prepared 8th December 2012