The Home Affairs Committee published its Third Report of Session 2022–23, Drugs (HC 198) on 31 August 2023. The Government response was received on 2 November 2023 and is appended to this report.
The Government is grateful to the Home Affairs Select Committee for its consideration of this important issue and to witnesses who provided evidence to the Committee.
Dame Carol Black’s independent review of drugs1 in 2020 and 2021, exposed the chronic and entrenched nature of drug use in this country by highlighting the violence and exploitation prevalent in the drug supply chain, the high levels of demand for drugs across the population and the lack of capacity in the treatment system to meet the needs of drug users. In response to this, the Government published its landmark ten-year Drug Strategy, From Harm to Hope2, a whole of government approach focused on three key strategic priorities: breaking drug supply chains, delivering a world-class treatment and recovery system and achieving a generational shift in the demand for drugs.
This is underpinned by a record investment of over £3 billion over the first three years of delivery.
The Government published the first annual report on the Drug Strategy in July 2023.3 This set out the progress made in the first year of the delivery of the Drug Strategy and the Government’s priorities going forward. Key achievements in the first year, to March 2023, include:
Looking ahead, we will deepen our work across each of the three priorities set out in the Drug Strategy. To break drug supply chains we will increase drug seizures at the border, invest in the National Crime Agency to increase disruption of supply chains before they reach the UK, dismantle County Lines drug trafficking networks and target the operations of the key organised criminal groups involved in drug supply. To build a world-class treatment and recovery system, we will increase the number of high-quality treatment places available in a recovery-orientated system of care in every part of the country, continuing to build a high-quality workforce, improving the quality of psychosocial interventions and ensuring access to mental and physical healthcare and housing and employment support. To understand what works to reduce the generational demand for drugs, we will increase drug testing on arrest and pilot out of court disposals as one of the suite of tools the police have to address drug misuse. We will also work with law enforcement to target visible drug use such as cannabis through our zero-tolerance approach.
In March 2023, the Government launched a plan to crack down on anti-social behaviour, aimed at restoring people’s confidence that this behaviour will be quickly and visibly punished. This plan is backed by £160m of funding. This includes over £50m to fund an increased police and other uniformed presence to clamp down on anti-social behaviour, targeting hotspots. We are working with 10 police force areas who have started their patrols in July 2023. From 2024 we will support a hotspot approach across every police force area in England and Wales, which will see thousands of additional patrols taking place in places blighted by anti-social behaviour. In addition, we are providing up to £50m to establish new Immediate Justice pathways aimed at delivering swift, visible punishment for anti-social behaviour. This has started in 10 police force areas in July 2023 and will be rolled out across England and Wales in 2024.
Drugs have a devastating effect on individuals and their wider communities. As I have set out, the Government is committed to tackling the supply of illegal drugs through relentless police action, reducing the demand for illegal drugs through a zero-tolerance approach and building a world-class system of treatment and recovery to turn people’s lives around and prevent crime.
The Government’s response to each of the Committee’s recommendations is set out below. Paragraph numbers refer to paragraphs in the Committee’s report and text in bold is taken directly from that report.
There is increasing support for public health responses as a tool to respond to drugs, and the adoption of such responses are within the spirit of the Drug Control Conventions. We recommend that the Government balances its criminal justice response to drugs with an increased public health response that seeks to prevent and treat drug use and tackle the root causes of drug use through, for example, a broad range of harm reduction approaches. (Para 16)
The UK Government’s legislative framework and strategy are already delivering a balanced approach which combines a range of public health and criminal justice responses. The Drug Strategy sets out our commitment that the government and our public services will continue to work together and share responsibility for creating a safer, healthier and more productive society. It is backed by increased funding across the system, including nearly £900 million of additional investment over 2022–2025, of which the largest amount, £780 million, is dedicated additional funding for the treatment and recovery system.
Established in 2021, the cross-government Joint Combating Drugs Unit supports government departments in driving forward a range of coordinated activities across health, enforcement, criminal justice, education, employment and housing to support the three strategic priorities in the Drug Strategy. A Combating Drugs Minister oversees this and was introduced in 2021 in line with the 10-year strategy.
Delivering a world-class treatment and recovery system is one of the three key strategic priorities in the Drug Strategy. We have already made progress by increasing and improving the treatment workforce, implementing measures in the criminal justice system and increasing pathways into treatment in the criminal justice system. This has included increasing the drug and alcohol workforce by 1,670 additional staff and launching a ground-breaking addiction mission to enhance the development of new technologies to prevent deaths and combat addiction. We have doubled the number of Incentivised Substance Free Living units in prisons and increased the number of referrals to treatment from the criminal justice system by 8%.
The Government also continues to support a range of evidence-based approaches to reduce the health-related harms of drug misuse, such as maintaining the availability of needle and syringe programmes to prevent blood borne infections, widening the availability of naloxone to prevent overdose deaths and the rollout of the novel opioid treatment, depot buprenorphine.
Alongside national action, local partners have a critical role to play by creating the right conditions for local leaders to also develop multi-agency partnerships and deliver coordinated action on treatment, recovery, prevention and enforcement, and all areas in England have formed Combating Drugs Partnerships to manage this.
Each partnership has nominated a Senior Responsible Owner to represent and account for local delivery and performance to central government. These individuals are the key local point of contact for central government and these include Police and Crime Commissioners and Directors of Public Health.
We conclude the Misuse of Drugs Act 1971 and the Misuse of Drugs Regulations 2001 require reform. We recommend that the UK Government reform the 1971 Act and 2001 Regulations in a way that promotes a greater role for public health in our response to drugs, whilst maintaining our law enforcement to tackling the illicit production and supply of controlled drugs. (Para 20)
The Government does not accept this recommendation and has no plans for fundamental reform of the Misuse of Drugs Act 1971 or the Misuse of Drugs Regulations 2001. A balanced public health and law enforcement response to drugs is compatible with both the Misuse of Drugs Act 1971 and the Misuse of Drugs Regulations 2001, including the range of interventions detailed in this response.
The overall legislative framework on illicit drugs simultaneously allows for the control of harmful substances and enables appropriate access to those drugs for legitimate purposes, including medicinal, research and in exceptional cases industrial, which reflects the need to take a balanced, system-wide approach to tackling drug misuse in the UK.
There is a substantial body of scientific and medical evidence to show that controlled drugs are harmful and can damage people’s mental and physical health, and our wider communities. Current legislation remains instrumental in ensuring the public are safe from dangerous or otherwise harmful drugs.
The Government keeps drug legislation under review and will introduce new legislation where it is appropriate to do so, taking into account advice from the ACMD.
In 2016 the Government responded to the rise of new threats of emerging psychoactive substances by introducing the Psychoactive Substances Act. The Government has also implemented ACMD advice to introduce generic controls under the Misuse of Drugs Act to better safeguard public health against the criminal supply of synthetic drugs.
We welcome the ACMD’s work reviewing the status of drugs controlled under Schedule 1 to the 2001 Regulations. However, we conclude a wider review is required. We recommend that the Home Office commission the ACMD to review whether the most commonly used controlled drugs in the UK are correctly classified under the 1971 Act and correctly scheduled under the 2001 Regulations based on the scientific evidence available. The Home Office must reform the classification system and the scheduling system based on the findings of that review. We recommend the ACMD conduct updated assessments every 10 years, or in circumstances where a review is required, to take into account the emerging scientific evidence on controlled drugs. (Para 29)
The Government does not accept this recommendation and has no plans to commission a broad review of the classification and scheduling of controlled drugs under the Misuse of Drugs Act 1971 and the Misuse of Drugs Regulations 2001.
Apart from psychedelics, which are addressed below, the Committee’s report does not identify specific drugs, of which it has particular concern about the classification, nor does it share the evidence for those concerns. The most commonly used drugs in England and Wales are cannabis, powder cocaine, nitrous oxide, ketamine and ecstasy.4 The Government is satisfied that the current legislative controls for these drugs are appropriate, with the exception of nitrous oxide which we have introduced legislation to control as a Class C drug under the Misuse of Drugs Act 1971 and schedule as a Schedule 5 drug under the Misuse of Drugs Regulations 2001, due to an increase in health- related and social harms associated with the substance.
The Government keeps drugs controls under review, and frequently seeks and acts on advice from the ACMD on the appropriate classification and scheduling of substances. An example of recent reviews include:
The ACMD can also self-commission and choose to examine topic areas it believes to be of importance without a formal commission from government. In 2019 this included a workstream investigating young people’s drug use5 and currently includes a workstream investigating drug use in ethnic minority groups.6
We welcome the UK Government’s commitment to reducing barriers to researching psychedelic drugs under Schedule 1 to the 2001.
Regulations. Pending the outcomes of the ACMD’s ongoing review of Schedule 1 controlled drugs, we recommend the UK Government urgently moves psychedelic drugs to Schedule 2 in order to facilitate research on the medical or therapeutic value of these drugs. (Para 30)
The Government awaits the ACMD’s advice, which it will consider carefully before taking a decision. This process is a statutory requirement that must be met before amending the Misuse of Drugs Regulations 2001.
In December 2022, the Government responded to Part 1 of the ACMD’s advice on reducing barriers to research with controlled drugs, which focussed on one group of compounds, Synthetic Cannabinoids.7 In the response, the Government formally commissioned the ACMD on its “Part 2” review, which will consider research with Schedule 1 drugs more widely.
The Government has asked the ACMD to consider in particular the potential options available to extend Schedule 2 status for research purposes (but not prescribing, outside of a clinical trial) to all Schedule 1 drugs, including so- called psychedelic drugs such as psilocybin and LSD, which has the potential to be a more ambitious approach to reducing barriers to research with controlled drugs. In a further response, the Government proposed that the ACMD consider whether clinical trials authorisation and other forms of ethics approval could form the basis of an exemption from a licensing requirement.
We recognise that the Psychoactive Substances Act 2016 was enacted to deal with the surge in new psychoactive substances (NPS) and the related health harms. We note that it was successful in removing the open sale of NPS but are concerned with the use of NPS among vulnerable populations, such as homeless people and people in prison, and with the increasing potency of NPS. (Para 42)
The Psychoactive Substances Act continues to apply to all substances which are capable of producing a psychoactive effect in a person, but which are not exempt nor controlled by the Misuse of Drugs Act. The Government continues to refer substances to the ACMD for their assessment of harm, and the ACMD also reports to the Government with concerns about specific substances where it believes that these should be subject to the Misuse of Drugs Act. The Psychoactive Substances Act retains a vital role given the offences it provides for the supply, production, import, export and possession with intent to supply, as well as possession in a custodial setting, of psychoactive substances not subject to the Misuse of Drugs Act. Some of the new psychoactive substances that the Psychoactive Substances Act was introduced with the aim of addressing are also now controlled under the Misuse of Drugs Act, including synthetic cannabinoids and cathinones.
All prisons have a zero-tolerance approach to drugs, and we are committed to tackling the use of psychoactive substances in the prison estate. Delivery of the £100m Security Investment Programme (SIP) was completed in March 2022 and included measures to prevent the smuggling of illicit items such as psychoactive substances into prisons. SIP delivered Enhanced Gate Security at 42 high risk sites and 75 additional X-ray body scanners, resulting in full coverage of the male estate. Between July 2020 and October 2022, we recorded over 28,626 positive scanner indications, helping to tackle the supply of drugs into prisons.
To prevent the smuggling of illegal drugs such as psychoactive substances through the mail, we have also deployed 95 next generation drug trace detection units. We are aiming for full coverage of public sector prisons by March 2024. Furthermore, 84 X-ray baggage scanners have been installed at 49 sites.
Alongside our security measures, we are rolling out a range of interventions to support prisoners off drugs and into recovery. This includes increasing the number of Incentivised Substance-Free Living wings, recruiting dedicated staff in prisons to focus on tackling drugs, and supporting prisoners to engage with community treatment pre-release. The Prisons (Substance Testing) Act 20218 also allows HM Prison and Probation Service to test for a wider range of substances, by adopting a broader definition of psychoactive substances and allowing prisons to test for prescription only and pharmacy medicines.
We are concerned about the increasing prevalence of benzodiazepine use, and its implication in drug misuse deaths, across the UK. We await the outcome of the Home Office’s consultation on the creation of a new offence to better enable law enforcement to prove the illicit use of pill presses. The Combating Drugs Minister must write to us with an update on the outcome of the consultation before 18 December 2023. (Para 43)
The Government will provide the Committee with an update on the outcome of the consultation on or before 18 December 2023, once the consultation responses have been analysed.
The Government shares the Committee’s concerns on the misuse of benzodiazepines and the recent rise in drug misuse deaths in which benzodiazepines have been implicated. We have taken steps to address this threat, including controlling three new benzodiazepines under Class C of the Misuse of Drugs Act following advice from the ACMD. Earlier this year, the Government consulted on proposed new offences that would criminalise the making, modifying, supplying, offering to supply and possession of articles for use in serious crime, with the intention that this would include pill presses to disrupt the manufacture of illicitly produced benzodiazepines by organised crime groups.
We are alarmed by the health and social harms of synthetic opioids, such as fentanyl. We are concerned that a reduction in the global supply of heroin will have the effect of people with an opioid dependency turning to even more potent and harmful synthetic opioids, which have contributed to the ongoing opioid crisis in North America. (Para 44)
To mitigate this risk, we recommend the Government, in partnership with the devolved administrations, increase its monitoring of synthetic drugs being trafficked in, and around, the UK, and prioritise supporting people with a chronic heroin dependency into treatment and recovery. (Para 45)
We recommend that the Government must prepare a strategy to mitigate the risk of an increase in the supply and availability of synthetic opioids in the UK before the end of this Parliament. (Para 46)
UK agencies are highly alert to the threat from synthetic drugs, including synthetic opioids like fentanyl, as well as synthetic cannabinoids and benzodiazepines, which have been linked to drug related deaths in the UK.
Combating international drug and precursor chemical trafficking and securing our border are key elements of the Drug Strategy, which ensures there are established routes to share intelligence, guidance and promising practice at a local, regional and national level. This is underpinned by significant investment of nearly £900m over three years in both drug treatment services and in tackling the supply of illicit drugs.
We have provided additional resources to the National Crime Agency (NCA) and Home Office international networks in key source and transit countries to work with other governments to identify and disrupt criminals who seek to bring illicit drugs to the UK. In the year to March 2022 Border Force seized 172kg and over 1.2m doses of new psychoactive substances.
Along with law enforcement partners, the UK Government stands ready to respond to the threat from synthetic drugs. We have established a cross- Government taskforce to lead and co-ordinate the HMG response to the risk from synthetic opioids to the UK.
The aim of the taskforce is to consider evidence-based policy, programmatic and legislative action against the risks of synthetic opioids to the UK, including enhancing our early warning systems. The taskforce is already delivering a set of key mitigations to alleviate the risk to the UK. Members include the Home Office, the Office for Health Improvement and Disparities (OHID), Ministry of Justice, NCA, HM Prisons and Probation Service, Border Force and the police.
As part of the Drug Strategy, all areas in England have formed multi-agency Combating Drugs Partnerships that bring together all the relevant local partners across law enforcement, treatment and health, and prevention.
These partnerships have been advised to review their local processes around sharing of data and intelligence and reviewing overdoses and deaths related to drugs, noting the context of increasing prevalence of synthetic substances.
Regional networks are also being improved to ensure there is good communication and coordination between staff from relevant departments and organisations – including health partners and law enforcement.
We believe firmly in the importance of engaging with experts and delivery partners to respond swiftly to the evidence of emerging drug threats, including learning from international partners through international fora such as the US- led Global Coalition to Address Synthetic Drug Threats.
The UK Government and Devolved Governments continue to engage on the issue of synthetic drugs.
The ACMD seeks to provide scientific, evidence-based recommendations to support the development of evidence-based drug policy. We note that the Home Office appears more likely to adopt advice to increase the classification of a controlled drug than it is to adopt advice to reduce the classification of a controlled drug. For example, we note that in the cases of cannabis, MDMA, khat and nitrous oxide, the ACMD recommended a lower classification, or no classification based on a review of the evidence. We acknowledge that scientific evidence should remain a key driver but not the main driver in the development drug policy in all cases, including when the scientific evidence supports reducing the level of control placed upon a drug. (Para 54)
Advice from the Advisory Council on the Misuse of Drugs forms an essential part of our decision making, and we continue to have complete faith in its quality and rigour. However, the Government can decide to progress alternative action that it deems necessary, taking into account other relevant factors, and in some cases arriving at different conclusions to the ACMD on how to respond to the evidence of health and social harms of drugs in order to protect the public.
We are disappointed that the Home Office has repeatedly refused to publish the ACMD’s 2016 report, including to this Committee on a confidential basis. No other ACMD report remains unpublished and withholding this one contravenes established practice and undermines the ACMD’s transparency. We, once again, request that the Home Office publish the ACMD’s 2016 report. At the very least, we request that the Home Office provide us with a confidential copy of the document within one month of receiving this report. Failing that, the Government must explain in its response to this Report why this ACMD paper, and no other, deserves to be withheld from public view. (Para 55)
The Government will not publish the 2016 ACMD paper, and respectfully declines to provide the Committee with a confidential copy.
According to government guidance, scientific advisory committees are expected to publish final advice where the Chair and members deem it appropriate. Where final advice is not published, the Committee should record the reasons for this. The Home Office received a paper from the ACMD in 2016, which was marked by the ACMD as confidential. The ACMD is independent, and it would not be appropriate or proper for the Home Office to publish an ACMD paper which the ACMD did not intend for publication.
Any formal reports from the ACMD are and will continue to be published online, together with any government response to that advice when it is made.
In line with the spirit of the partnership approach in the 10-Year Drugs Strategy, we recommend that the Government make the Department of Health and Social Care and the Home Office jointly responsible for drug policy. We recommend that the Combating Drugs portfolio be held by a minister that sits across both departments. There is already precedent of Home Office ministers sitting across other departments such as the Ministry of Justice. The Home Office and law enforcement authorities would continue to respond to the illicit production and supply of drugs. (Para 65)
The Combating Drugs Minister and his portfolio go further than this recommendation, sitting across six government departments.
In 2021, the Government established the first sponsor minister for combating illicit drug use for 25 years. Appointed by the Prime Minister, the role is currently held by Chris Philp MP, Minister for Crime, Policing and Fire in the Home Office.
The Combating Drugs Minister has overarching accountability for delivery of the ambitions and outcomes in the strategy, while each of the six contributing departments – the Department of Health and Social Care, the Home Office, the Ministry of Justice, the Department for Work and Pensions, the Department for Levelling Up, Housing and Communities and the Department for Education, and their Secretaries of State – continue to be accountable for delivery of their elements of the Strategy, including holding their local partners to account.
The Joint Combating Drugs Unit, the first of its kind, sits across all six of the above departments to oversee and support delivery of the outcomes in the strategy and reports into the Combating Drugs Minister.
The six Drug Strategy departments oversee delivery, alongside experts and delivery leads, at the Drug Strategy Ministerial Forum. The forum has been effective in galvanising action-focused plans and tracking progress since it was established at the beginning of 2023.
We welcome the Government’s efforts to recognise and respond to the issues in Professor Dame Carol Black’s Independent Review of Drugs and we welcome the ambition of the 10-Year Drugs Strategy. In particular, we welcome the cross-departmental and partnership approach and the increase in funding for the drug treatment and recovery sector. We believe the strategy is an important step in the right direction. (Paragraph 66)
We are concerned about the long-term sustainability and security of funding for the drug treatment and recovery sector. (Paragraph 74)
a) We welcome the Government’s latest funding announcement, which provides funding in England over a two year period. However, we question whether this is a sufficient length of time for service providers to utilise the funding to embed change. We recommend that the UK Government provide funding throughout the 10 year lifespan of the strategy in three year cycles.
The Government does not accept this recommendation.
It is not possible to commit to providing funding for any longer than the current Spending Review (SR) period. HM Treasury carries out SRs to determine how to spend public money, usually over a multi-year period, in line with the government’s priorities. However, there is no typical length for an SR – previous SRs have allocated budgets for single years or multiple years. Several factors are taken into consideration when considering the length of time an SR sets budgets for. These include the economy, government priorities, the long-term national interest and the length of the Parliament. For example, the 2020 SR only set budgets for one year as a consequence of the uncertainty caused by the COVID-19 pandemic.
The overall amount of spending available is informed by the wider fiscal position. The money the government spends is reviewed to ensure future funding continues to be efficient and cost-effective. Despite the SR not allocating budgets for a longer period of time, we continuously conduct work to assess longer-term priorities, investment plans and pressures, as part of usual business planning to support decision making.
b) In relation to the public health grant in England, we recommend that the Government go further than placing a condition on local authorities to have regard to drug and alcohol treatment by requiring local authorities to ringfence funding allocated under the public health grant for these services.
The Government does not accept this recommendation.
The public health grant is ring-fenced for use on public health, allowing local authorities to invest in preventing ill health, promoting healthier lives, and addressing health disparities. In using the grant, local authorities must have regard to improve the take up of, and outcomes from, its drug and alcohol misuse treatment services. In addition, a condition of the Supplementary Substance Misuse Treatment and Recovery (SSMTR) grant is that local authorities maintain their investment into the local substance misuse treatment and recovery system from their public health grant at or above the levels reported in 2020–21. Only one local authority has not accepted this condition.
c) We recommend that the Government give service providers a minimum of three months’ notice of forthcoming funding allocations under the strategy and public health grant to enable them time to plan appropriately.
The Government does not accept this recommendation.
However, we are committed to giving as much notice as is feasible of financial allocations to local authorities. For example, the Government has already published indicative allocations for the public health grant and additional drug and alcohol treatment funding for 2024 to 2025 to support local authorities to plan and is committed to doing everything possible to publish final 2024 to 2025 allocations before the end of this calendar year. OHID has already begun work with local authorities to support planning for 2024/25.
The 10-Year Drugs Strategy recognises some harm reduction approaches but could go further. Abstinence-based recovery may not be an effective form of treatment for everyone. A broader range of harm reduction treatments are therefore required to help as many people into recovery as possible. (Paragraph 86)
We recommend that the Government update the strategy to increase the range of harm reduction approaches available to support a person’s treatment and recovery from drugs in line with the approaches outlined in this report. (Paragraph 86)
The Government’s 10-year Drug Strategy already provides strong support for harm reduction approaches. This is just one component of the broader government support for harm reduction, which is supplemented by, for example, National Institute for Health and Care Excellence (NICE) guidance on needle and syringe programmes (PH52),9 UK-wide clinical guidelines on clinical management of drug misuse and dependence, and the hepatitis C elimination campaign.
An integral part of action on drugs is reducing the harms associated with drug use, with interventions such as needle and syringe programmes; blood-borne virus screening, immunisation, and treatment; naloxone provision; and wound care. Many of these interventions were included on the Supplementary Substance Misuse Treatment and Recovery (SSMTR) grant menu of interventions and taken up by local authorities.
The strategy states a commitment to breaking down stigma but provides little detail on how this commitment would be actioned. Stigma is a key issue for people with lived experience of using drugs and for their loved ones. Tackling stigma in all its forms must be a priority in the Government’s entire response to drugs. (Paragraph 98)
We recommend that the Combating Drugs Minister leads on devising a cross departmental action plan to tackle stigma. In devising the action plan, the Government must engage with people with lived experience of drugs and stakeholders in the drug treatment and recovery sector to understand fully how stigma can affect people and how best to tackle it. The action plan must be published before the end of February 2024. We further recommend that the Government work with the devolved administrations to roll-out a coordinated, UK-wide campaign to tackle stigma. (Paragraph 99)
The Government partially accepts this recommendation. The Department for Health and Social Care will explore with all relevant departments how best to tackle stigma within the health and social care system.
The Office for Health Improvement and Disparities (OHID) is already supporting a specific programme in Project ADDER sites on tackling stigma. One of five priorities in OHID’s Reducing Drug & Alcohol Related Deaths Action Plan is to reduce stigma for people who use drugs and alcohol as well as for their families and carers. The headline intervention is to adopt and adapt an evidence-based Australian intervention across a range of partner agencies within eight self-selected ADDER sites.10 This is a two-year programme planned to commence in early 2024 and if proven effective then it is proposed that it will be scaled-up nationally.
We were concerned to hear about the barriers people, such as women and black, Asian and minority ethnic people, can face when accessing treatment. No-one should be unable, or feel unable, to receive treatment and support. (Paragraph 100)
We recommend that Combating Drugs Partnerships prioritise identifying the likely barriers to treatment and recovery for people within their local area and take steps to address these barriers as part of fulfilling their commitments under the 10-Year Drugs Strategy. (Paragraph 101)
The Government accepts this recommendation, as it echoes the expectations of local delivery of the Drug Strategy as outlined in the guidance for local delivery partners and the Commissioning Quality Standard. Guidance for local partners delivering the Drug Strategy sets out the principles that should be adopted by Combating Drugs Partnerships (CDPs), including access and quality. This states that “everyone is able to access timely, appropriate support in a form that respects the full, interconnected nature of their needs, wishes and background”. There should also be flexibility within local partnerships to respond and tailor approaches according to need.
The expectations of needs assessments to be conducted by CDPs were laid out clearly in the guidance and communicated and discussed through webinars and other meetings with local stakeholders. The guidance outlines that needs assessments, delivery plans and progress reviews should be seen as linked elements of a continuous process to analyse the situation, plan actions to improve it, take these actions, and reflect on what has been learnt – as part of a cycle to better understand the situation and how to improve it. The guidance states that this work should specifically include consideration of the accessibility of services and any disparities across demographics or geography.
The Department of Health and Social Care’s Office for Health Improvement and Disparities (OHID) published the Commissioning Quality Standard: alcohol and drug services in 2022. The CQS purpose is to guide processes, partnerships, and systems for effective commissioning of alcohol and drug treatment services to help improve treatment access, outcomes, and quality. This guidance refers to specific barriers to treatment and recovery and enables local partners to assess their commissioning practices, including through a self-assessment tool.
OHID has commissioned a National Institute for Health and Care Research call through the Policy Research Programme (call 30–02–08. Need for substance misuse treatment). The winning bid has the project title ‘Unmet Need for Substance Misuse Treatment among Opioid, Crack and Dependent Alcohol Users.’ The aim of this research is to explore the current circumstances and histories of out-of-treatment substance users, and the barriers to treatment engagement and how might these be addressed in future. It consists of two case studies, a literature review, interviews with professionals and drug users out of treatment. The project started in January 2022 and is expected to finish in 2024.
OHID released an unmet need toolkit on 23 August. It provides local areas with updated estimates of the prevalence of opiate and / or crack cocaine use as well as the estimated number of people with alcohol dependency. National Drug Treatment Monitoring System data is also included in the toolkit to report the levels of unmet need for the different prevalence substance groups as well as by age, sex and for people that are currently or previously injecting. This data shows for which cohorts treatment access is currently working well and for which it is not.
Additionally, a range of guidance documents have been incorporated that offer advice, evidence, and examples of good practice in reducing unmet need and in improving referral pathways and the general attractiveness of drug and alcohol treatment for those that require it.
We welcome the strategy’s recommendation that the membership of local Combating Drugs Partnerships should include people affected by drug-related harm because it gives people with lived experience a platform to help reduce barriers to treatment and recovery at a local level. However, we question whether this is reflected at a national level. (Paragraph 102)
We recommend that the Government explain how the voices of people with experience of drug-related harms are being recognised and included in national efforts to implement the strategy. (Paragraph 103)
Nationally, the Government recognises the need to include the experience of people affected by drugs in developing, delivering and improving work to combat illicit drugs and communities are at the centre of the outcomes to reduce drug-related harms, deaths, crime and use.
Examples of where such contributions have made a real difference include the roll out of Project ADDER, the development of the Commissioning Quality Standard, Drug Strategy guidance for local delivery partners, local guidance capability frameworks for treatment roles, and new guidance on recovery support services. We will continue to do more as we move forward.
For example, the commissioning quality standard has seen local partnerships seeking ways to improve involvement of people with experience and related recovery organisations.
Dr Ed Day, as the National Recovery Champion, has led work with the College of Lived Experience Recovery Organisations to promote and improve recovery support service provision and support the sustainable growth of such initiatives.
This has included engagement with lived experience recovery organisations, to help him to produce an information pack for commissioners and service providers to raise greater awareness and enthusiasm.
Dr Day has also worked with the Government to carry out a survey of local authority commissioners to better understand current provision in England, as well as a review of the international evidence. Dr Day’s work has informed the co-development of new guidance to help alcohol and drug treatment and recovery partnerships to understand the evidence for, value of and ways to foster and support lived experience initiatives and recovery support services.
The Ministry of Justice is also introducing a new temporary accommodation service providing up to 12 weeks of accommodation after release for prison leavers at risk of homelessness. The Department for Work and Pensions is developing wider employment support for people in treatment to help them find employment through peer mentors. They are able to use their own experience of addiction and recovery to help individuals disclose their dependency to Jobcentres and access the support they need to move closer to work.
At the heart of Project ADDER is embedding learning to ensure their reflections and personal experiences are considered through the interventions that are delivered.
The Home Office also works closely with The National Experts Citizens Group, a representative group whose members have relevant experience and join Project ADDER expert panel sessions. These are aimed at discussing ways in which we can improve the services we deliver through the programme.
We welcome the strategy’s commitment to supporting families. It focuses on the important role of the family in preventing drug use, particularly in relation to young people. However, it does not recognise the role that families can play in the treatment and recovery of family members who have already developed a dependence on drugs. Our discussions with families also made it clear that the level of support available for families, particularly mental health support, could be improved. (Paragraph 104)
We recommend that local authorities use the funding allocated under the 10-Year Drugs Strategy to embed specialist practical and mental health support within drug treatment and support services for the families and the loved ones of people who use, or used, drugs. (Paragraph 105)
The Government accepts this recommendation.
In 2023–24 local authorities earmarked over £10 million from the SSMTR grant to improve integrating responses to physical and mental health for people receiving drug and alcohol treatment in the community. This includes increasing the ability to identify, assess and ensure effective intervention for physical and mental co-occurring conditions, expanding psychosocial responses to common mental health problems within the treatment and recovery system, and expanding Alcohol Care Teams in hospitals.
OHID and NHS England are also developing a Joint Action Plan to improve access to mental health treatment for people using drugs and alcohol. This will also include looking at ways to improve links between services, including encouraging better referral pathways in each direction and more joint working practices. It will also consider training requirements for mental health staff to improve knowledge and skills around co-occurring conditions within mental health settings.
In addition, we are increasing the psychological support available in services through our workforce transformation programme. This is supported by the Drug Strategy commitment of 800 more medical, mental health and other professionals working in the sector by 2024/25. 18 new Mental Health and Wellbeing Practitioners started in drug and alcohol services in 2022/23. This new role was developed to provide wellbeing-focused psychologically informed interventions and coordinate care plans for adults with severe mental health problems in community mental health services. The strategic plan for the drug and alcohol treatment and recovery workforce to be published later this year includes commitments to increase the number of psychologists in the sector.
We welcome the Government’s ambition to reduce demand for drugs including recreational drugs. However, we have heard concerns that the three-tiered framework of escalating sanctions under the Swift, Certain, Tough: New Consequences for Drug Possession White Paper may have a negative impact in, for example, perpetuating stigma and in relation to young people. (Paragraph 112)
Though we await the outcome of the consultation on this White Paper, we ask that the Home Office further explain: (Paragraph 113)
a) How people with a drug dependency—to whom this policy will not apply—will be identified and directed into treatment.
b) The extent to which the policy is likely to affect young people aged 16–24 years old—among whom recreational drug use tends to be higher—and what analysis it has done on how effective the policy is likely to be among this age group compared to police-led diversion schemes.
c) To what extent the cost of implementing the policy would fall to the devolved administrations
An analysis of the consultation and a Government response will be published in due course. The proposals under the White Paper, Swift, Certain, Tough: New Consequences for Drug Possession,11 were designed to provide a clear and consistent structure for how policing could deal with those individuals who did not require treatment due to dependent drug misuse, but who had been caught for low level possession offences.
Those who misuse drugs need to know their actions have consequences and the Government has been clear that there should be a zero-tolerance approach to visible drug use, and that this approach should be embedded within policing. The implementation of a tiered framework for personal possession offences would enable a proportionate and consistent response across policing within England and Wales. It would provide the opportunity for individuals to change their behaviour, understand the consequences of their drug use and assess whether they require support, before sanctions escalated following repeat offending.
The proposals within the framework would operate on police discretion, with officers taking the decision on when it is appropriate to refer an individual to treatment, as is currently the case. Greater use of appropriate treatment and recovery services for those who need it is part of our ambition to support reducing drug-related demand and work is underway to assess how referrals into treatment from across the criminal justice system, which includes the police, can be increased.
We need to ensure that enforcement against possession offences is being tackled. Drug use has no place within our communities and can result in people feeling intimidated as well as links with associated anti-social behaviour and other types of offending. We need to ensure that those who are choosing to use drugs recognise the impacts of their use. The Government supports proportionate responses to dealing with possession offences, including requirements to attend education and awareness activity, or treatment where needed, to help people make better, safer choices in the future.
Dame Carol Black’s review highlighted that so-called recreational users of drugs were mainly concentrated within the under 30s. The proposals in the White Paper would only apply to those 18 and above. The Government recognises that appropriate interventions will enable individuals to correct their behaviours before potentially receiving a criminal conviction.
This is why we are funding an expansion of the use of Out of Court Disposals to tackle drug possession offences, which will also look at the efficacy of drug awareness course as a tool for interventions.
The responses to the consultation have supported in our ongoing development of policy in how to tackle possession offences. The Government has committed to publishing a response, which we will do so in due course. This will set out our future direction and how we can empower officers to do more to reduce drug use and related harms, cut crime and improve the quality of life for local people.
The White Paper set out the UK Government’s proposals for changes in England and Wales. However, tiers one and three could apply to Scotland and Northern Ireland, if they chose to implement the framework. As with all policy proposals, any changes and impacts, including on costs, would be discussed with the Devolved Governments prior to any changes being made.
We welcome the 10-Year Drug Strategy’s commitment to rolling up county lines but increasing law enforcement efforts is only one part of the solution. We therefore welcome the strategy’s commitment to reducing demand for drugs and to rebuilding the drug treatment and recovery sector. We believe that these actions will play an important role in tackling county lines. However, we believe the Government could go further to prevent children and young people from becoming exploited by county lines. (Paragraph 123)
To tackle county lines, we believe it is vital that the children and young people exploited (or at risk of exploitation) by criminal gangs are kept out of the criminal justice system. (Paragraph 124)
We recommend the Government build on the harm reduction measures within the strategy by implementing the recommendations on harm reduction outlined in this report, particularly our recommendations on expanding diversion schemes. (Paragraph 125)
The Drug Strategy already provides strong support for harm reduction approaches and expansion of measures to reduce drug use.
We recognise that a system wide approach is required to deliver interventions that support those caught up in county lines exploitation. The County Lines Programme forces (Metropolitan Police Service, Merseyside Police, West Midlands Police, Greater Manchester Police) take a holistic approach to tackling county lines, to not only pursue line holders but also work with partners to raise awareness of county lines exploitation, prevent vulnerable individuals from becoming involved in county lines and help those that already are to safely exit their involvement. This approach also seeks to reduce the harms associated with county lines, such as modern slavery, serious violence and homicide.
Furthermore, as part of the Government’s Drug Strategy, we will be rolling out the Out of Court Disposal Drug Pilots to a small number of police force areas in England and Wales. The project will seek to expand use of Out of Court Disposals for eligible drug possession offences, while exploring how effective drug awareness courses can be in changing offender behaviour and on reoffending.
We recommend that the Government work with local partners to link up drug treatment services for children and young people with exploitation services to ensure that they receive holistic support. (Paragraph 126)
Improving partnership working to prevent substance misuse is at the heart of the Drug Strategy and ensuring that local areas have robust multi-agency safeguarding responses is an important element of our approach to tackling county lines exploitation. The Government agrees that drug treatment services and exploitation services should coordinate interventions with children and young people in a way which best responds to local needs. We are already taking action to encourage local authorities to deliver joined up services in a number of ways.
Firstly, supporting local areas to link up drug treatment services for children and young people with exploitation services to ensure that they receive holistic support was a key part of what we set up Combating Drugs Partnerships (CDPs) to do. In particular, in the guidance for local delivery partners on the Drug Strategy, we asked CDPs to: link with their local safeguarding children partnership; include Directors of Children’s Services as key representatives; and ensure there is effective work in place to improve early intervention, referral pathways, and support available for children involved in the use or supply of drugs. More broadly, the guidance requests that CDPs share data and co-ordinate resource allocation across services to allow practitioners to better understand the holistic needs of the children and young people they are working with.
Some areas have developed effective sub-groups of their CDPs to address issues such as the links between drug misuse and exploitation – for example on whole family working, or on targeting those most at risk of exploitation (e.g. through school exclusions). The Government endorses this approach and we have established an online forum for CDPs to share challenges and promising practice. We will continue to consider ways to drive improvement in CDPs’ support for children and young people at risk of criminal exploitation as we develop milestones for the coming years.
In addition to defining the ways that local partners should work together through CDPs, we are also directly funding programmes which take a local partnership approach to addressing drug use and criminal exploitation in some of the areas most affected in England and Wales. Although Project ADDER mainly focuses on services for adults, local areas have developed interventions for young people under 18 years old and young adults under 25 years old that help with access to treatment, wider needs and risks from their involvement in county lines. The focus is on safeguarding and reducing vulnerabilities. As part of the County Lines Programme, we are investing in specialist support services for victims of county lines exploitation and their families which have strong links with substance misuse services in local authorities and other charities.
We recommend that the Government consider adopting a statutory definition on Child Criminal Exploitation. (Paragraph 127)
The Government does not accept this recommendation. We recognise that a thorough and robust response is required to protect victims of child criminal exploitation (CCE), who are often the most vulnerable children in our society, to bring perpetrators to justice.
CCE is currently defined in statutory guidance for frontline practitioners working with children. This includes the Keeping Children Safe in Education (2023)12 and Working Together to Safeguard Children statutory guidance (2018).13
CCE is also defined across a range of guidance, including the Serious Violence Strategy (published 2018),14 the Child Exploitation Disruption Toolkit for frontline practitioners (updated 2022)15 and the county lines guidance for prosecutors and youth offending teams (published 2019).16
The Home Office is working across Government to identify areas of learning and improvement with regard to CCE and county lines and we regularly consult with partners, including the police, on the legislative framework in connection with CCE and keep this under regular review.
We welcome the British Transport Police’s efforts to improve responses to child exploitation through the secondment of two Prevention Officers from the Children’s Society. We recommend that the Government work with other police forces with a dedicated County Lines Taskforce to pilot the inclusion of Prevention Officers within those teams, and the sharing of good practice. (Paragraph 128)
The Government partially accepts this recommendation.
County lines gangs exploit children and vulnerable young people, coercing them into being ‘runners’ and transporting Class A drugs and money locally as well as around the country. Rail networks are a key method of transportation for these exploited young people and the British Transport Police have developed effective approaches in their response to child exploitation.
All County Lines Programme taskforces work closely with the British Transport Police to target transport networks in their area. They also have partnerships with different organisations, including schools and specialist services, to maximise safeguarding efforts. We monitor the delivery of the County Lines Programme through the established County Lines Task and Finish Group which meets regularly to drive forward progress and monitor the impact of the funding we are providing. We will use this group to explore with the taskforces whether there are opportunities for further partnerships.
As part of the Programme, we also fund Catch22 to provide a specialist support and rescue service for under 25’s and their families, from the major exporting force areas (Metropolitan Police Service, Merseyside Police, West Midlands Police, Greater Manchester Police) who are criminally exploited through county lines, to help them safely reduce and end their involvement. This specialist support and rescue service works directly with the County Lines programme taskforces to support their safeguarding efforts.
We found that the holistic, partnership approach adopted by the Project ADDER pilot has been largely well received. We conclude that Project ADDER demonstrates how effective joint responsibility for drug policy between the Home Office and the Department of Health and Social Care can be. (Paragraph 139)
We welcome the Committee’s view that Project ADDER demonstrates effective joint working across government and the positive reception of its success in piloting a more holistic, partnership approach to tackling drugs.
Learning from Project ADDER continues to inform the implementation of the Government’s Drug Strategy, including the development of combating drug partnerships.
As the Project ADDER pilot is set to continue until 2025, we recommend the Home Office provide us with an interim assessment of the pilot by January 2024. The Home Office must also provide us with an updated assessment of the pilot no more than three months after its conclusion in 2025. (Paragraph 140)
The Government partially accepts this recommendation.
As a pathfinder programme, Project ADDER is underpinned by a robust monitoring and evaluation framework. An independent evaluation is underway and an update will be shared with the Committee next year, at such a point that it is ready.
We recommend that Project ADDER be extended across all of England and Wales if the assessments indicate that the Project is effect in achieving all of its aims: reducing drug-related deaths, drug-related offending, drug use, and disrupting the supply and trafficking of drugs. If the Government does not extend Project ADDER beyond the pilot phase, we recommend that it must make clear how it will preserve the progress made in the existing 13 pilot locations beyond 2025. (Paragraph 141)
Project ADDER was mobilised in Autumn 2020 to test innovative new approaches to tackling drugs misuse. Over the remaining two years (FY2023/24 and FY 2024/2025) of Project ADDER funding we aim to build sustainability into delivery and deepen our evidence base of what works across a multi-agency approach. Beyond 2025, our vision is to build on the ADDER approach through the delivery of the Drug Strategy’s Combating Drugs Partnerships nationally. The Government accepts the Committee’s recommendation on preserving ADDER’s progress, and we will continue to work closely with the Joint Combatting Drugs Unit on embedding and expanding on good practice nationally.
An evidence base for a safe consumption facility in the UK is needed. (Paragraph 149)
We recommend that the Government support the piloting of safe consumption facilities in areas across the UK where there is deemed to be a need by local government and stakeholders. (Paragraph 149)
In particular, we recommend the Government support a pilot in Glasgow by creating a legislative pathway under the Misuse of Drugs Act 1971 that enables such a facility to operate legally. The pilot in Glasgow must be jointly funded by the Government and the Scottish Government. The Government must work with the Scottish Government and local partners to establish and operate the pilot. The pilot must be evaluated in order to establish a reliable evidence base on the utility of a safe consumption facility in the UK. We repeat the recommendation made by the Scottish Affairs Committee in 2019 that, if the UK Government is unwilling to support this, the power to establish a pilot be devolved to the Scottish Government. (Paragraph 150)
The Government does not accept the Committee’s recommendation and does not support the introduction of drug consumption rooms in England and Wales due to the risk of these facilities condoning illicit drug use and encouraging the continued criminal supply of drugs to users.
Since the publication of the Committee’s report the Lord Advocate has responded to a request from the Scottish Government for a focussed statement of prosecution in relation to a pilot drug consumption room. The statement indicated that, subject to certain conditions, she would be willing to publish a prosecution policy that it would not be in the public interest to prosecute drug users for simple possession offences (under section 5(2) of the Misuse of Drugs Act 1971 committed within a pilot drug consumption room in Glasgow.
The UK Government respects the independence of the Lord Advocate as Scotland’s prosecutorial authority and will not interfere with plans to introduce a drug consumption room in Glasgow, providing those powers are lawfully exercised.
We recommend that the Home Office and Department of Health and Social Care jointly establish a national drug checking service in England to enable people to submit drug samples by post anonymously. We recommend the Home Office consult stakeholders on how best to implement the service. In particular, we recommend that it learn lessons from the Welsh Government and Welsh partners on the experience of WEDINOS. We believe that, ultimately, a UK-wide drug checking service would provide the most effective approach, and we therefore encourage the UK Government and devolved Governments to consider jointly establishing such a service. (Paragraph 162)
The Government does not accept this recommendation.
The Government already facilitates Drug Checking Facilities provided that the possession and supply of controlled drugs are licensed by the Home Office Drugs and Firearms Licensing Unit or, exceptionally, relevant exemptions under the Misuse of Drugs Regulations 2001 may apply.
Ministers are clear that drug checking services must not condone drug use and should only be delivered where licensed and operated responsibly in line with Government policy to ensure that they discourage drug use and signpost potential users to treatment and support. We welcome potential applicants who wish to apply for a licence and who share these principles.
We recommend the expansion of on-site drug checking services at temporary events such as music festivals and within the night-time economy. We recommend that the Home Office establish a dedicated licensing scheme for drug checking at such events before the start of the summer 2024 festival season. The scheme must devolve the power to grant licences to local authorities. (Paragraph 163)
The Government does not accept this recommendation.
The Government recognises the potential harm reduction benefits of back-of- house drug checking facilities (DCFs) within the context of these types of events. Back of house DCFs are those which test surrendered or confiscated drugs, but do not return the drugs to the individual or give individualised information on the content of the drugs. Instead, they enable localised public alerts if toxic or extremely dangerous drugs are detected to avoid sending a message that taking any illegal drug can be safe. Organisations wishing to deliver back-of-house DCFs have always been able to apply for a licence and we would encourage them to plan ahead to ensure that there is time to apply for a licence in good time for the festival season next year.
There are no plans to offer a dedicated licensing scheme or devolve the regulatory function of the Home Office to issue controlled drug licences for DCFs. The Home Office is the overall departmental lead for the Misuse of Drugs Act and the Misuse of Drugs Regulations. The Home Office therefore has the regulatory responsibility and the expertise to ensure that all applications for controlled drug licences are assessed fairly and in line with legislation. To perform this role effectively, it is important the Home Office retains control of all applications for controlled drug licences. The Home Office manages approximately 2500 applications for controlled drug licences per year, the purposes of which vary considerably and are not confined to applications for DCFs. There is therefore an extant controlled drug licensing framework and applications will be granted where they are in line with Government policy.
We recommend that the Government work with local authorities and health partners to ensure that people receive appropriate psychosocial support in addition to their opioid substitution treatment and ensure that they can continue to access opioid substitution treatment at a pace that meets their needs. (Paragraph 167)
The Government accepts this recommendation.
Providing psychosocial support in addition to opioid substitution treatment is already in practice and is the recommended approach in Drug misuse and dependence: UK guidelines on clinical management17 ‘Orange Book’ published in 2017. In addition, the Care Quality Commission inspects services on best practice in treatment and care through implementation of the national guidance, this includes the psychosocial offer available for services users.
We welcome the 10-Year Drug Strategy’s recognition of the potential positive impact of long-acting buprenorphine. We think that the use of Buvidal in Wales has provided a very encouraging UK evidence base and proved that it is an effective form of opioid substitution treatment. (Paragraph 169)
We recommend that the Government go further than its commitment under the 10- Year Drugs Strategy to explore the rollout of long-acting buprenorphine and commit to establishing it as a first-line treatment option in England for people with an opioid dependence. (Paragraph 169)
The Government accepts this recommendation and is already supporting the further rollout of long-acting buprenorphine.
126 local authorities provide long-acting buprenorphine as a treatment option to their population. From the end of 2021–22 to the end of 2022–23 NDTMS recorded an increase of 200% in the proportion of opioid clients being treated with long-acting buprenorphine in England.
The NICE recommended a balance between methadone and buprenorphine in their 200718 technology appraisal, meaning that both these two medicines are required to be available as options for maintenance therapy in the management of opioid dependence. It is the responsibility of a patient’s clinician to decide, with the patient, which drug is most appropriate for their treatment based on a number of factors. NICE reviewed their recommendation in 2016 and concluded there was no new evidence that affects their recommendations in the guidance. However, they have since agreed that OHID could, with their endorsement, develop updated guidance that helps clinicians and patients make decisions in the light of new products and new evidence.
We recommend that the Government replicate Scotland’s medication- assisted treatment standards in England to ensure that a consistent, minimum standard of care is available to people accessing opioid substitution treatment. In doing so, the Government must first consult stakeholders in the medical and drug treatment and recovery sectors on adapting opioid substitution treatment standards in a manner appropriate to England. (Paragraph 171)
The Government partially accepts this recommendation.
We are aware of the Scottish medication assisted treatment standards and wider international treatment standards. OHID will review these and incorporate them into English guidance where appropriate. In England, Opioid substitution treatment: service self-assessment tool for community drug and alcohol services is used.19 It was developed as part of an Opioid substitution treatment (OST) good practice programme that included an Over 6,000 learners have completed the full e-learning package and rated it on average as 4.5 out of 5. The OST self-assessment tool covers OST-specific issues and broader treatment issues, with sets of quality questions that service managers or team leaders (working with service commissioners where useful) can answer, along with evidence and action needed. It therefore functions as a set of standards similar to the Scottish medication-assisted treatment standards. Stakeholders from four voluntary sector, seven NHS and one independent treatment providers, plus two local authorities and two lived experience lead organisations were involved in the development of these products. .
In addition, Drug Misuse and Dependence: UK Guidelines on Clinical Management published in 2017 ‘Orange Book’ provides guidance on the treatment of drug misuse and dependence in the UK. The guidance is based on current evidence and professional consensus on how to provide drug treatment for the majority of patients, in most instances, clinicians are expected to take the recommendations in the guidelines fully into account when exercising their judgement, alongside the individual needs, preferences and values of their patients or service users.
The Care Quality Commission uses these guidelines and others to inform its registration and inspection of drug treatment services, providing a further layer of assessment against standards.
The Commissioning Quality Standard covers pharmacological interventions, including opioid substitution treatment but is a high-level framework for commissioning that will be supported with more detailed implementation products.
We are concerned by reported shortages of prescribed diamorphine, particularly because of the serious impact they may have on the health and lives of patients. As prescribed diamorphine is a viable form of treatment in England, the Government must work with suppliers to ensure that a sustainable supply is available to patients whom clinicians deem suitable for it. (Paragraph 175)
The Government does not accept this recommendation.
There are two UK suppliers of diamorphine, and both have experienced repeated manufacturing issues over the past five years due to the complexities of the manufacturing process. In response to the ongoing supply issues, following expert input, advice was issued to the NHS in February 2020 that morphine should be considered a first line treatment option.
The UK is the only country that uses diamorphine for medicinal analgesic purposes. Diamorphine is metabolised to morphine and, in terms of analgesic efficacy and effect on mood, it has no clinical advantages over morphine by oral or subcutaneous/intramuscular routes.
This advice has subsequently been reiterated to respond to further supply issues and usage of diamorphine has reduced in the NHS. We are in contact with both suppliers when there are supply issues and continue to update the NHS if there are any changes to the availability of diamorphine injections.
We support the use of DAT supported by wrap-around psychosocial support. The impressive Middlesbrough DAT programme that we witnessed held benefits for both the public health and criminal justice sectors. We are most disappointed that joint local funding from both the health and criminal justice sectors could not be secured for the programme. That said, we recognise the cost of the programme and the difficult decisions that need to be made by local stakeholders when allocating funds to services. Given the rate of opioid-related deaths in England, it is not further consideration that is required from central government, it is swift action. (Paragraph 184)
We repeat the ACMD’s 2016 recommendation that the Government provide centralised funding to support the provision of DAT for people with a chronic heroin dependency for whom other forms of OST have not been successful. The centralised funding should first be provided to Foundations Medical Practice in order to re-establish its DAT programme in Middlesbrough as a matter of urgency. The Government should then work with local authorities to identify other locations in England where a DAT programme supported by holistic and wrap- around care is needed. (Paragraph 185)
The Government does not accept this recommendation.
Diamorphine Assisted Treatment is a clinical guideline-supported intervention and, as referenced in the Government’s response to the ACMD report in 2016, local authorities are responsible for commissioning drug treatment interventions and it is for them to decide whether or not to fund the treatment, depending on local need and priorities.
Regarding the Diamorphine Assisted Treatment Programme closure in Middlesbrough, it was a local funding decision made by the local authority to not extend the pilot of this programme.
We recommend that public health guidance on the provision of diamorphine be changed to allow for the use of multi-dose vials instead of single-use ampoules to mitigate the additional cost and supply chain pressures associated with single-use ampoules. (Paragraph 186)
The Government accepts this recommendation as the existing guidance already recognises the use of multi-dose vials. The Injectable opioid treatment: commissioning and developing a service guidance20 sets out the circumstances and governance arrangements that should be in place to support both the pharmaceutical integrity of the product and patient safety, including the use of multi-dose vials where appropriate. NHS England has committed to reviewing this guidance to ensure it remains current.
We are concerned by the effect the Covid-19 pandemic has had on the provision of needle and syringe programmes. The UK must continue its efforts in preventing the spread of blood-borne viruses by ensuring needle and syringe programmes reach as wide a population as possible. (Paragraph 192)
The Combating Drugs Minister must work with the Department of Health and Social Care, the devolved administrations, and health partners to ensure that the provision of equipment—particularly low dead space syringes and safe water—is increased to reduce the transmission of blood-borne viruses and other illnesses. The Combating Drugs Minister must work to ensure that needle and syringe programme providers have the capability and capacity to provide additional services to people presenting to the service, such as blood-borne virus testing. (Paragraph 193)
The Government partially accepts this recommendation.
Needle and syringe programmes are already embedded into, or work alongside, drug and alcohol services, commissioned by local authority public health to meet local need. Drug and alcohol services already support blood- borne virus prevention, and provide testing, vaccination, and treatment for these viruses. The SSMTR Grant menu of interventions includes an expansion of these services, including specifying the grant could be spent on low dead space syringes. Local authority SSMTR Grant plans included an additional £1.3 million being invested in needle and syringe programmes in 2023/24.
The UK Health Security Agency, because of its interest in preventing blood- borne virus transmission and meeting agreed targets for hepatitis C elimination, has mapped needle and syringe programme sites in England and is now planning to pilot a new system for collecting needle and syringe programme data using automated data extractions from existing software systems.
NICE published guidance in 2014 on needle and syringe programmes for people who inject drugs to reduce transmission of blood-borne diseases.21 One of its recommendations is that commissioners of needle and syringe programme should provide a range of services to meet local need. These services should provide health promotion advice and provide readily available hepatitis B and C testing and provision of, or referrals to, services for vaccinations, treatment and secondary care.
The evidence on the lifesaving effects of naloxone in counteracting opioid related overdose is clear. We welcome the national naloxone programmes in the devolved nations but are concerned that no such programme exists in England. We also welcome the joint working between the Government and the devolved administrations to expand access to naloxone. However, progress is slow. The need to expand and embed naloxone within services and communities is crucial to saving as many lives from opioid-related overdose as possible. (Paragraph 205)
We recommend that the Government establish a national naloxone programme in England to bring it in line with the devolved nations. We also recommend that the Government speed up its work on expanding the provision of naloxone following the UK-wide consultation in 2021. Expanding provision must include any service and person who may come into contact with people who are likely to suffer an opioid related overdose. In particular, we think that community pharmacists and peer- to peer programmes are well-positioned in their local areas to supply, distribute and administer this life saving treatment. It must also include enhanced distribution of naloxone to prison leavers. (Paragraph 206)
The Government partially accepts this recommendation.
The provision of naloxone is already included in the majority of local authorities’ public health grant spend. In addition, the expansion of naloxone is currently supported through the SSMTR Grant, which has supported the expansion of naloxone availability and use across England through £1.6 million in additional funding.
OHID is in the process of developing legislative changes to enable more services to supply naloxone without a prescription, further updates will be available soon.
We are working closely with HM Prison and Probation Service to implement the availability of naloxone in all community contact centres. In 2020/21, of all the people treated for opioid use in prison, 46% were provided with a naloxone kit on release.
The efforts of UK police forces to roll out this life saving treatment is welcome. However, provision of naloxone across English forces is not universal, which risks creating a postcode lottery on the availability of this potentially life-saving treatment in England. Further, while we recognise the concerns of some officers to carrying naloxone, we conclude that the saving and preservation of life is too important, particularly when a person’s health is in a life-threatening condition due to overdose. (Paragraph 207)
We recommend that the Home Office requires all 43 police forces in England and Wales to roll out the voluntary provision of naloxone by operational officers. Volunteer officers must be provided with adequate training in the carrying and administration of naloxone before they can carry it on duty. The Home Office must provide additional funding to all 43 forces to supply naloxone and to support the training of officers on the administration of naloxone. The Home Office must also work with policing and health partners to devise guidance on the carrying and administration of naloxone for operational police officers. All 43 police forces must record when its officers have administered naloxone, and the surrounding circumstances, in order to better understand the use of the treatment in emergency situations. (Paragraph 208)
The Government partially accepts this recommendation.
As outlined in the Drug Strategy, the Government continues to support a range of evidence-based approaches to reduce the health-related harms of drug misuse, such as widening the availability of naloxone to prevent overdose deaths.
We have increased the availability of naloxone, including naloxone nasal spray to prevent drug-related deaths and have committed to supporting local provision of a broader range of medicines including newer medicines such as long-acting buprenorphine injection.
The decision to carry naloxone is an independent operational decision for Chief Constables and currently 18 of 43 forces carry naloxone. The National Police Chief’s Council, with support from the Home Office and OHID, is working to address the barriers presented to police forces on the carriage of naloxone, this includes developing a national guidance and cooperating with the Independent Office of Police Conduct and the Police Federation.
We support the use of diversion schemes for low-level offences. The use of such schemes by police forces in England and Wales is increasing and we welcome the efforts of those forces in rolling out these schemes. However, we are concerned that the use and substance of diversion schemes can vary across police forces. This can result in the criminal justice system responding differently to individuals for suspected drug- related offences. This postcode lottery is wholly unfair. It is time that a more coordinated, national approach is adopted. (Paragraph 218)
We recommend that the Home Office place a duty on all 43 police forces in England and Wales to establish diversion schemes in their force area for young people and adults who have committed low-level offences. The duty must outline requirements for the diversion schemes in order to ensure a minimum standard that all diversion schemes must satisfy. In drafting the duty, the Home Office must consult with police forces and relevant stakeholders on what the minimum standards should include. The Home Office must also publish guidance on the implementation and operation of diversion schemes. (Paragraph 219)
We recommend that police forces record the use of diversion schemes in their force areas to develop a national picture and an understanding of best practice. The Home Office must regularly update the guidance to incorporate this evidence base. (Paragraph 220)
Most police forces in England and Wales already have a range of options at their disposal, for instance via Out of Court Disposal (OOCD) pathways. These routes offer approaches based on the operational judgement of forces. Where appropriate, forces have the option to use such pathways to deliver meaningful consequences, such as treatment or education. As committed to in the Drug Strategy, we will soon be rolling out pilots to expand the use of OOCDs within a small number of forces for drug possession offences, and to better understand efficacy of educational interventions for offenders. As part of the OOCD expansion pilots project, the Home Office also aims to establish a more detailed national picture of OOCDs, by examining their provision in all 43 territorial police forces in England and Wales. The pilot will also support work to develop immediate justice as a sanction police could place on drug users. The overall programme of work on OOCDs will provide valuable evidence base for future policy approaches, so that we can ensure the OOCD pathways provide best possible outcomes for communities and for offenders.
We welcome the increasing adoption of trauma-informed approaches by UK police forces. As drug use—particularly problematic or chronic drug use, can often be a consequence of trauma—we conclude that trauma- informed policing should be extended to situations involving drug use. We believe that this aligns with the Government’s commitment to adopting a whole system response to drugs outlined in the 10-Year Drugs Strategy. (Paragraph 224) We recommend that prevention training and practices be expanded to all 43 police forces in England and Wales, including those focused on trauma-informed. The Home Office must work with police forces and stakeholders to establish proportionate training and guidance on trauma-informed policing. The training and guidance should take into consideration the types of trauma associated with drugs and the ways to reduce stigma linked to drugs. (Paragraph 225)
The Government welcomes the Committee’s recognition of the work we have supported through funding of Violence Reduction Units and trauma-informed practice (TIP). However, we would like to clarify some of the findings in the report. The Committee’s report implies that £17m was invested in TIP for frontline professionals, however this was only one of three types of interventions eligible for investment through the Early Intervention Fund and accounted for £2.6m.
In 2021/22 the Home Office invested £17m into early intervention and prevention programmes, delivered via Violence Reduction Units (VRUs) to support young people at high risk of involvement in serious violence. Of this, £2.6m went to seven VRUs to deliver trauma informed training to frontline workforces who support children, and young people at risk of involvement in serious violence. These projects trained over 14,000 frontline professionals from different sectors. Many VRUs continue to deliver TIP programmes, both directly to police as well as other frontline professionals.
The Home Office also commissioned the Early Intervention Foundation (EIF – now ‘Foundations’) in 21/22 to carry out research into the TIP models VRUs implemented as there is currently limited research and evaluation of TIP.22 To help bridge this gap, the Home Office is also co-funding the Youth Endowment Fund’s (YEF) current TIP grant round. The aim of this grant is to find, fund and evaluate trauma informed practice programmes or approaches in England and Wales delivered in youth justice, education, and children’s social care services.23
While we recognise TIP is seen as a promising, innovative and increasingly popular approach, there is also limited robust evidence of its impact and a broad diversity of approaches in relation to its implementation. Therefore further pilots, research and evaluation should be carried out in order to better understand effectiveness and implementation before it is scaled up significantly.
In regard to the Committee’s recommendation that the Home Office works with stakeholders to establish training and guidance on trauma-informed policing, the Home Office has shared insights and lessons learned from the delivery of its trauma-informed work with the College of Policing. The College of Policing is the professional body for policing in England and Wales. It was established in 2012 and it sets standards, provides training and shares good practice to reduce crime and keep people safe.
The College provides quality assurance for all accredited training programmes delivered in forces which includes the initial entry training for all police officers. The College also regularly reviews the policing curriculum to ensure that it remains fit for purpose.
More widely, the College has secured £1.8m from the Cabinet Office Evaluation Accelerator Fund to evaluate the implementation, impact and cost- effectiveness of police-led drug diversion. Uniquely, the research looks at both crime and health outcomes. It aims to assess whether police drug diversion reduces reoffending and unplanned hospital admissions, and increases entry into drug treatment and, if it does have these benefits, how and why diversion produces them. The work is being carried out by a partnership led by the University of Kent, and involves the Department of Health and Social Care, the National Police Chiefs’ Council and several police forces. The project is funded until March 2025.
Whilst training standards and the national policing curriculum are set by the College of Policing, forces also provide local training and development at several different levels ranging from initial entry, leadership and ongoing development to reflect and reinforce organisational values. Local training is the responsibility of individual chief officers, according to policing needs and priorities. Decisions about local police training are a matter for Chief Constables and Police and Crime Commissioners, who are best placed to make decisions based on their knowledge of the local area.
We support cannabis-based products for medicinal use (CBPMs) where there is an evidence base that it can be an effective form of treatment for managing conditions or symptoms. We welcome the ACMD conducting a further assessment of CBPMs following on from its 2020 report. However, we are concerned that there is currently a lack of access on the NHS for patients with a genuine medical need. Access continues to be a problem despite the high-profile cases of Billy Caldwell and Alfie Dingley—two children with severe and rare forms of epilepsy who have received medical cannabis to treat their conditions. (Paragraph 233)
Pending the outcome of the ACMD’s review, we recommend that the Government widens the accessibility of unlicensed CBPMs on the NHS before the end of this Parliament. (Paragraph 233)
The Government does not accept this recommendation.
Whether to prescribe medicinal cannabis, or any other drug, is a clinical decision and not a matter for Government policy. Licensed cannabis-based medicines are routinely available and funded on the NHS. However, for unlicensed cannabis-based medicines, clinical guidelines from the NICE demonstrate a clear need for more evidence to support routine prescribing and funding decisions. Until that evidence base is built, clinicians will remain reticent to prescribe and no decision can be made by the NHS on routine funding. Clinicians can apply for NHS funding in exceptional clinical circumstances, these requests are assessed by an independent panel made up of doctors, nurses, public health experts, pharmacists, NHS England representatives and lay members.
The Government remains committed to taking an evidence-based approach to unlicensed cannabis-based medicines. That is why we continue to encourage manufacturers of unlicensed products to conduct research – our medicines regulator and the National Institute for Health and Care Research can offer them scientific and research advice if they do. Furthermore, we are working with regulatory, research and NHS partners to establish clinical trials to test the safety and efficacy of these products.
There is evidence of the potential therapeutic value of CBPMs to treat chronic pain. (Paragraph 234)
We recommend that the Government supports researchers to conduct randomised control trials into the effectiveness of CBPMs to treat chronic pain. If the evidence base supports this, and it is deemed to be cost-effective, we recommend that the Government enables the use of CBPMs for this purpose and works with clinicians to ensure that it is a treatment option in appropriate cases. (Paragraph 234)
The Government accepts this recommendation.
Any researcher wanting to conduct Randomised Control Trials on the effectiveness of medicinal cannabis on chronic pain can ask the medicines regulator and the NIHR for scientific and research advice. NIHR welcomes funding applications for research into any aspect of human health, including medicinal cannabis to treat chronic pain. Applications are subject to peer review and judged in open competition, with awards being made on the basis of the importance of the topic to patients and health and care services, value for money and scientific quality.
NICE recommend that unlicensed medicinal cannabis is not offered to manage chronic pain in adults and that cannabidiol (CBD) medicines only be offered as part of a clinical trial.24 NICE recognises the lack of evidence to support the use of these medicines and recommends that further research be carried out on the clinical and cost effectiveness of CBD as an add-on treatment for adults with fibromyalgia or persistent treatment-resistant neuropathic pain.
We are concerned by the harms that cannabis for non-medical use may pose, particularly in relation to young people. We do not believe that cannabis should be legalised and regulated for non-medical use. (Paragraph 243)
The Government shares the Committee’s concerns about the harms of cannabis and does not intend to legalise and regulate cannabis for non- medical use. There is clear scientific and medical evidence which shows that cannabis poses a large number of health risks, including psychological and respiratory disorders. The legalisation of cannabis would also not address the harms associated with drug dependence.
We are deeply concerned by the role paramilitary groups play in organised drug crime in Northern Ireland, and the impact that this has on local communities, children and young people. We are also deeply concerned by the effect the current political stalemate is having in Northern Ireland and the extent to which it restricts Northern Ireland’s response to drugs, among many other issues. However, we welcome the continued efforts of public services and stakeholders to respond to drugs, particularly efforts that adopt a multi-agency response. (Paragraph 248)
In the absence of an operational Northern Ireland Executive and Assembly, the Government must further support officials and communities in Northern Ireland to respond to drugs. This must include support to develop and sustain early intervention and prevention initiatives under the Tackling Paramilitarism, Criminality and Organised Crime Programme, which seeks to draw young people away from paramilitary groups. It must also include the extension of the harm reduction policies outlined in this report. (Paragraph 249)
The Government remains committed to supporting, to the fullest extent possible, the Northern Ireland Executive-led efforts to end paramilitarism and organised crime. Following commitments made in the ‘New Decade, New Approach’ deal in 2020,25 the Government committed c.£8 million per year for the Tackling Paramilitarism Programme to match NI Executive funding until March 2024. The Government has also committed to providing up to a further c.£8 million for the financial year 2024–2025, which will see a sustained level of Government support beyond the current phase of the Programme.
The main legal framework relating to the misuse of drugs, including the Misuse of Drugs Act 1971 and the Psychoactive Substances Act 2016, is reserved to the UK Government. The Misuse of Drugs Regulations 2001 apply to England, Wales and Scotland only but Northern Ireland has equivalent legislation, the Misuse of Drugs Regulations (Northern Ireland) 2002, which broadly mirrors these. Northern Ireland, like Scotland and Wales has its own approach towards tackling drug misuse in areas where responsibility is devolved including policing, criminal justice, healthcare, social care and education.
As set out in the Drug Strategy, we are committed to building a stronger UK- wide approach so that we further embed collaboration, share practice with each other and collectively build the evidence base on drugs issues. This includes working collaboratively to achieve shared goals in preventing drug- related deaths.
The Minister for Crime, Policing and Fire will be meeting with representatives from the Devolved Governments in November, for the next UK Drugs Ministerial meeting to discuss how we can continue to work constructively and collaboratively together.
4 Figures taken from the Crime Survey for England and Wales estimate the number of 16–59 year olds who reported use in year ending June 2022 to be 2.46 million for cannabis, 678,000 for powder cocaine, 444,000 for nitrous oxide, 303,000 for ketamine and 246,000 for ecstasy.
8 This was a Private Members’ Bill sponsored by Dame Cheryl Gillan MP and Baroness Pidding.