Drugs policy Contents

1The scale of the problem

1.Every drug death is avoidable. However, the United Kingdom, and in particular Scotland, have amongst the highest drug death rates in Europe. The evidence we have heard leads us to conclude that UK drugs policy is failing.

2.This year drug related deaths in the UK rose to their highest ever levels, placing the UK near the top of all European countries, and more than three times the European average.1 In England in 2018 there were 2,670 deaths directly attributed to drug misuse, an increase of 16% since 2017. This figure underestimates the true harm caused by illicit drug use (e.g. overdose): if other causes of premature death amongst people who use drugs were included, it is likely that this figure would approximately double.2 Our view of the evidence we have seen is that this issue has now escalated to the proportions of a public health emergency, and the scale of the problem the UK faces requires similarly large-scale solutions.

3.The vast majority of drug-related deaths involve opiates. While nearly half of these deaths are caused by overdose, people who use drugs are far more vulnerable to other illnesses and other causes of death as well–cancer, cardiovascular disease, respiratory disease, liver disease, suicide and homicide–and opiate users are 12 times more likely to be the victim of homicide than the general population.3

4.While statistics on the health harms associated with drug use are stark and compelling, an even bleaker picture of the wider impact is painted by those who have suffered from drug addition, as we heard from Kerrie Hudson, a recovered drug user and operational lead at the Well:

It is the damage to self-esteem, the damage to self-respect, the unresolved trauma, the lack of ambition, the stigmatisation, the going to places for help and getting the wrong kind of help and the wrong kind of support. That then perpetuates the feeling of uselessness and hopelessness because you cannot do what people are asking you to do or what people are expecting of you. There is the damage to your family members. It is knowing: people are fully aware of the damage that they cause when they are in addiction but they are just incapable of stopping it. You go against your conscience; you go against what you know to be right and wrong.4

5.Drug use has profound impacts beyond the individual user, on families, carers, as catalogued for us by ADFAM, a charity that supports the families of drug users:

Relationship difficulties; family breakdown; issues with communication; severe mental ill health, and isolation from friends and family, financial impacts, physical violence and abuse, missing work on a regular basis because of caring responsibilities; and physical health impacts.5

6.And there are wider social impacts. The Modern Crime Prevention Strategy states that offenders who regularly use heroin, cocaine and crack cocaine commit an estimated 45% of acquisitive crime,6 and we heard that the illegal drugs trade involves exploitation of young or very vulnerable people, from production all the way through to transportation and delivery in the UK.7 The cartels and dealers leave a worldwide trail of misery, death and corruption.

7.Statistics from the last ten years paint a varied and complex picture of drug use–there have been decreases in drug use overall, particularly amongst young adults, with a fall in cannabis use, but increasing use of cocaine. Whilst heroin use amongst young people is notably lower than ten years ago, the UK still has much higher rates of illicit opiate use than elsewhere in Europe.8 Our inquiry has focused on the harms caused by illicit drug use, but we have also heard about the growing health threat caused by addiction to prescription medicines. This threat is discussed further in the next chapter.

8.Problematic drug use is concentrated in areas that suffer from poverty and multiple deprivation, so the pressure is on areas that have the least capacity to respond to them.9 And whilst poverty and lack of opportunity do not inevitably lead to drug use, they are factors that can drive experimental use onto a higher risk of dependency.10

9.The overall cost of illicit drug use is estimated to be about £10.7 billion per year.11 There is a considerable cost benefit to investing in drug treatment–with every £1 spent on treatment estimated to save £4. Yet despite this, spending on drug treatment has fallen by nearly 30%.12

10.We write this report only half way through what was planned as a longer and more detailed inquiry. We are indebted to all those who contributed to this inquiry, including those who provided us with their views through written and oral evidence; our specialist advisers Rosalie Weetman and Alex Stevens;13 the FCO in Frankfurt and Lisbon; and all those who generously gave us their time on our visits. We have regrettably had to cancel a fact-finding visit to Teesside, the area with England’s highest rates of drug deaths, and have not yet heard from many important groups, or had the opportunity to question Government ministers. However, we have been so concerned by the evidence we have received to date that we feel compelled to publish a short report with recommendations so that the evidence we have heard is brought to the Government’s attention as soon as possible. It is clear to us and to many others who have examined the international evidence that this is a problem that requires swift, bold action on a number of fronts. There is a clear need for evidence-led policy on drugs. We urge the Government and other policy makers not to shy away from the lessons from Portugal and Frankfurt, but to take a harm reduction approach and implement the recommendations set out in this report without delay.

1 EMCDDA, European Drug Report - trends and developments, 2019; England rate of 73.5 sourced from ONS drug poisoning dataset; differences between countries in investigating and recording drug related deaths mean comparisons should be treated with caution.

2 ONS, 2019; Lewer et al, Causes of hospital admission and mortality among 6683 people who use heroin: A cohort study comparing relative and absolute risks, Drug and Alcohol Dependence, 2019

3 Q2, Professor Tim Millar

4 Q284, Kerrie Hudson - the Well is an addiction recovery support service

5 Q287, Emily Giles, ADFAM

6 Department of Health and Social Care (DRP0065) written evidence

7 Q253, Q241, Jason Harwin

8 Q23, Q29, Professor Tim Millar

9 Q8, Professor Suzanne MacGregor

10 Q44, Professor Tim Millar

12 Q186, Danny Hames

13 Professor Alex Stevens declared the following interests:

  • In addition to my employment at the University of Kent, I am paid as Senior Editor of the International Journal of Drug Policy. The University is paid for my time as a consultant, currently with RAND Europe.
  • I am an unpaid member of Advisory Council on the Misuse of Drugs, the Advisory Boards of the Global Drug Policy Observatory (Swansea University) and of the Swiss Institute for Addiction and Health Research (University of Zurich), the International Society for the Study of Drug Policy (as President and trustee), the European Society of Criminology, the Society for the Study of Addiction, and the Green Party.

    Rosalie Weetman declared the following interests:

  • Derbyshire County Council Public Health Lead for alcohol, drugs and tobacco (remunerated role).
  • Member of Advisory Council on the Misuse of Drugs (unremunerated role).
  • Portman Group Independent Complaints Panel (remunerated role) and Company Director.

Published: 23 October 2019