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6.49 p.m.

Baroness Mallalieu: My Lords, this could have been a depressing debate but I do not think that it has been. From all sides of the House there have been indications that discussion on how to deal with the problem is at last beginning to expand beyond current thinking, current wisdom and attempts at solutions which have not worked. There is no doubt at all--no speaker has suggested otherwise--that we are currently losing the drugs battle. A number of speakers have suggested that it is one which cannot be won. A wider variety of drugs than ever before is readily available to our young people and indeed to anyone else who takes the trouble to look for them. There is a steady and alarming increase in the number of registered addicts, many of them HIV-positive or suffering from AIDS.

Drugs are now, I understand, the major single contributing factor to the crime figures. And the position is worsening, not improving. The problem is not just ours; it is world wide, as the noble Lord, Lord Moyne, said. No one has yet found the right answer. I thank the Minister for introducing the debate and I want at the outset from these Benches to welcome the consultation document. I do so with particular and real enthusiasm in one important respect. Its general approach, if different government departments, particularly the Home Office, Education and Health, are at last to adopt a joint approach, is one that we on this side of the House applaud. If achieved, that will be a major advance because, too often and in too many ways, some of which I shall come to shortly, the fact that the Home Office sees drug users as criminals hampers, stifles and even stamps on initiatives in medical practice and treatment generally which the Department of Health, seeing drug users primarily as patients, should be trying but feels that it cannot try. To overcome that fundamental difference of approach would, I believe, lead to a great deal being achieved.

My criticism and my fear about the paper is that it is couched in language and indeed clings to many of the approaches which have been tried and have not

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succeeded. It in a sense reinforces the usual conventions and the usual methods as being effectively the right approach and one from which we should not even think of deviating. If we are to make any real progress in this battle we have to dare to think the unthinkable. We have to tackle the problem from the realities in 1994 and not from wishful thinking.

We would all of us wish to think it possible to stop, or virtually stop, all illegal drugs entering Britain. But it is not possible. We would all of us wish to see those who use drugs weaned off them. But some of them cannot be and never will be, or at least not in the foreseeable future. All of us, especially those with children, would like to see drugs cleared from our schools, from the streets and from the clubs that our children in particular frequent. But the reality is that those drugs are there; they are entrenched; and they are likely to remain there in the foreseeable future. We have to tackle that reality with realism.

I hope that the consultation period will not in the end prove to be a simple rejigging of old policies which have not met the problem. I hope that we can use it as an opportunity to look at radical alternatives and to innovate instead of taking the safe routes yet again. I simply ask this: can we in fact worsen the position if we do? I suggest that we cannot.

Many noble Lords have spoken from a background of great experience, particularly in relation to education, treatment and health. My background is that of a criminal lawyer. The matters I should like to raise, I hope briefly, arise from direct and recent experiences I have had in this area which fall largely within the province of the Home Office, in relation to which the noble Baroness, Lady Blatch, is, I understand, to reply.

The noble Lord, Lord Gisborough, referred to the importation of heroin and cocaine, which of course are not produced here. We have not managed to find any satisfactory way of stopping large quantities of those drugs being illegally imported. The drugs come here because there is a lucrative market for them; that makes it worth the risk being taken by the smugglers. The prison sentences now being imposed for drugs offences in reality exceed those served for murder.

The drug trafficking provisions passed through this House in strengthened form relatively recently mean that those who are caught can be stripped effectively of all their assets. But they have not stopped consignments being sent and have not stopped them getting through. It is clear that unless demand is cut a supply will continue to come. Surely we must tackle both the supply and the demand. As to supply, am I, apart from the noble Lord, Lord Rea, who mentioned it, alone in feeling alarm at the announcement made yesterday that out of what I understand from the consultative document are some 800 specialist investigation staff in Customs and Excise, it is proposed over the next five years that some 550 anti-smuggling officers should lose their jobs?

Baroness Masham of Ilton: My Lords, may I intervene to say that I was worried about that too?

Baroness Mallalieu: My Lords, the noble Baroness, Lady Masham, is quite correct. She too referred to the matter. I wonder, in the light of the concern voiced from

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various sides of the House, whether the noble Baroness who is to reply will tell us why that reduction is proposed at this time. How is the vigilance of those officers to be replaced? May I also ask the noble Minister for urgent reassurance that the ability of Customs and Excise to detect and intercept consignments of dangerous drugs will not be reduced by the cutbacks?

I shall come back, if I may, to the question of demand. But a second matter of great concern is what is taking place in our prisons in relation to drugs. Three times in the last six weeks three different prisoners in three different prisons--one in Oxfordshire, one in Buckinghamshire and one in London--have told me that drugs are more readily available to them in prison than they were outside. I note that the consultative document refers to research being done and proposed to be done into the extent of drug misuse in prison. I am confident from what I have been told repeatedly that the end result of that work will be the conclusion that misuse is rampant.

I ask your Lordships for a moment to dare to think the unthinkable and to consider the options. They fall into two categories. We could, on the one hand, look at countries such as Hong Kong which, in relation to drug offenders in particular, have, with very considerable success, isolated them in a single prison. Visiting takes place through a screen so that drugs cannot be handed over. There is routine daily urine testing, and there are proper and comprehensive treatment facilities available within prison and supervision on release which would be the envy, I think, of the probation service here. Checking on curfews takes place, often several times during the course of a night. The treatment has had a measure of success and, certainly, in some cases has reduced, if not eliminated, the taking of drugs in prison.

Such measures may not be acceptable here; indeed, they may be impractical here. If that is right and if we are accepting that some drugs will be available to people within our prisons, surely the time has come to ensure that clean needles and a means of sterilisation such as bleach are available to prisoners in the inevitable circumstances of their making use of drugs and possibly injecting.

We must also surely ensure, particularly if we are taking the trouble to test people's urine to see whether they are taking drugs, that there are facilities in every prison, and not just a selection of them, where help, advice and treatment can be provided while in prison and after release. The present position in relation to drug misuse in our prisons is a scandal. I am desperately concerned that young people especially who are sent to prison should not come out with a newly acquired drug habit, and possibly HIV, as well as a criminal record. I hope that urgent action can be taken about that at the earliest possible date.

The next matter that concerns me greatly is that of needles and needle exchanges. There can be no doubt that the setting up of needle exchanges has been a great benefit not just in assisting towards a reduction in the transfer of HIV and AIDS but in affording a means of providing existing addicts with a source of advice and

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help. But it would be wrong to overlook the fact that there are drawbacks in relation to certain of the needle exchanges. In some places, addicts have tended to congregate, to the annoyance of local residents; drug dealing has taken place in or near the premises; and, perhaps even more commonly, there is the borrowing and repaying of drugs which have been lent by one addict to another.

Those who need to be removed from the drug culture are sometimes pushed back into it by the need to go along to needle exchanges to obtain clean needles. I know of one GP who advises his drug addict patients not to go near one of London's largest needle exchanges for that reason. Other ways must be found, and readily found, to enable addicts to obtain quantities of clean needles which will prevent the passing and transmission of HIV without contact with other users.

I come back to the issue of demand, as I said I would. I had recently the experience as a barrister of appearing in front of a Home Office misuse of drugs tribunal, representing a doctor accused of irresponsible prescribing. It would be wholly wrong for me to make any comment about the specific case as the tribunal has yet to report to the Home Secretary. A number of disturbing features emerged from the evidence that I heard during the course of that hearing. First--this applies to London but may apply elsewhere, I do not know--registered addicts find it hard to discover GPs who are prepared to take them on and prescribe for them. It is virtually impossible for them to find a GP who is prepared to prescribe any quantity of injectable drugs or at the level to which hardened addicts have become accustomed.

One can readily understand the reasons. Addicts are often difficult patients. They may be devious, manipulative, and dishonest. They are certainly demanding. But what concerns me greatly is that GPs are, I believe, frightened of taking on drug addicts, because they fear the attention of the Home Office drugs inspectorate. It is easier to send addicts away. Few doctors in London will take them on, and addicts are sometimes driven into the private sector.

There are no published limits of what quantities of drugs, such as methadone, a GP may prescribe or what combinations of drugs a GP may or may not prescribe. There are guidelines. The decision is left to the individual GP's clinical judgment. Faced with a long-term heroin addict, such a doctor finds himself in an impossible position. His clinical judgment may tell him that the addict before him requires a high level of prescription or a combination. The consultative document draws attention to the fact that increasing numbers of addicts are now coming to light who are addicted to a range of drugs--not just opiates but opiates, benzodiazepines and often amphetamines, and sometimes all three.

If the GP fails to prescribe either a combination or at a level which the addict in his judgment requires he knows that the addict will merely supplement whatever prescription he gives by going to the black market and buying often impure drugs. That will bring him back with a range of health problems. What is more, the addict is likely to turn to crime as a means of funding

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his purchase of black market drugs. If the GP prescribes as he thinks right, he may well see the addict's health improve. In some instances there is not merely health improvement but the ability to hold down a job, to form stable family relationships, and to be removed from the drug scene and the necessity to become involved in crime. The GP then attracts inevitably the attention of the Home Office drugs inspectorate whose staff is often not medically qualified who tell him that he must stop prescribing in that way.

If the GP remains adamant that he will prescribe in accordance with his clinical judgment, he may well face a Home Office tribunal with serious consequences for his career. So what is a GP to do? And what is to be done about the gap, as it seems to me, in the provision of treatment for addicts at that basic level? If there are to be limits as to what a GP may properly prescribe, surely they should be set out.

If it is felt that specialists are the only people who should be prescribing in that way and dealing with such addicts, then that specialist help must be available. Amphetamine is perhaps the largest growing addiction at the moment. Huge quantities of amphetamine are available readily and cheaply on the street, much of it seriously adulterated. There are often fatal consequences for the health of those who take it. To find a doctor--a specialist or otherwise--in central London, who is prepared to continue to prescribe clean amphetamine for an addict seriously addicted in that way is difficult if not impossible. Every patient whom a GP turns away, every patient for whom he prescribes less than the patient needs to keep him straight, is a customer for the black market and an incentive for the smuggler and drug dealer to increase their trade.

What I have learnt in the past year from the evidence I have heard before tribunals is no more than other noble Lords have spoken of this evening. Every such patient who is sent back onto the black market is put at serious health risk. It may be abscesses; it may be the consequences of unsafe injecting practices; it may be as serious as the risk of HIV. What is the doctor to do? As a GP said to me recently, "What am I to do when a prostitute who is HIV-positive and a drug addict comes to me and wants a high level of drugs prescribing for her? If I do not give her the drugs she needs, she resorts to prostitution to pay for black market drugs, and she spreads her infection. If I do, I am likely to face a Home Office drugs inspector telling me that I have done wrong and threatening me with the consequences if I do not stop."

The role of the general practitioner in the treatment of drug addicts needs proper examination. Our general practitioners must know the scope of what they may or may not do. The present uncertainty is driving many addicts onto the black market and hence into crime in order to pay for their drugs. Doctors do not know what they can do and are unwilling to take the risk. Those same patients return to the health service with serious problems.

I am anxious that this is one way in which we should examine the question of how we try to reduce demand. It may be that we should be examining realistic prescribing either by general practitioners or by

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specialists and specialist units. As was indicated by the noble Baroness, Lady Cumberlege, and the noble Lord, Lord Russell of Liverpool, I have no doubt that education is one way forward. However, as other noble Lords said, it must be of the right kind.

Treatment was referred to by a number of noble Lords. It was perhaps the most optimistic part of the speech of the noble Lord, Lord Mancroft, and one that I would readily endorse, in particular in the voluntary sector through organisations such as Phoenix House. That organisation was referred to by the noble Baroness, Lady Masham, and I too have had some experience of it. Invaluable work is being done in providing methods of approach and treatment which are not necessarily the convention or the norm and which may not be capable of being provided by the National Health Service. I welcome the way in which the consultative document appears to recognise their role. However, I should have liked to have seen them given higher priority in the order of events.

During many of the hottest days of July this year I sat listening to what I can describe only as "hard core" drug addicts talking about their life histories. They were in their thirties and forties, which means that they came after the Rolleston Committee in the 1960s changed our approach to the way in which we prescribe to addicts. All have been through not only one drug rehabilitation or treatment scheme but perhaps as many as six or seven. Finally, they had all broken down. Some were optimistic that there might come a time when they were able to abstain from drugs. Some were resigned to never being able to do so. At present such people are relatively small in number. They are people who, unless doctors are prepared to prescribe for them--and that requires a degree of considerable bravery--have no future other than the black market and no means of paying for the treatment they need other than by resorting to crime. If in 10, 20 or 30 years' time we cannot provide for people in that category there will be an explosion in the number of others like them. They were at the forefront of those who started to take heroin and then moved on to methadone.

Various noble Lords referred to methadone maintenance programmes. It is becoming increasingly clear that a substantial body of medical opinion is coming to believe that methadone was and is more harmful than heroin which it was introduced to replace. Certainly, there is a widespread view among addicts that it is much harder to come off. I am glad to hear that the Government are looking at pilot schemes for long-term maintenance methadone but I am concerned that at this stage they have gone only as far as contemplating the possibility of long-term oral methadone.

It is clear that many of the addicts who gave evidence in the summer were addicted to the needle as much as to the drug. Some of them explained in terms that I had never previously understood why they failed to respond to treatment programmes. It was the view of all of them that the best chance for a long-term user eventually to stop taking drugs was to get into a state of good health. That can probably be done only if a doctor is sufficiently understanding to provide the addict with a supply of

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drugs which will enable that person to put on weight, to master his personal life, to get himself a job and to "get your life together", as they put it.

If that person is asked to reduce quickly or abruptly he will find himself having to face the reality of the kind of person he has become--a person who often has lied, cheated and deceived those closest to him. More than anything else, it is the pressure of facing up to that which drives a person back to the drugs; he cannot face the reality. Where there are doctors who believe that there is some merit in a long-term methadone maintenance programme--whether it is injectable, oral or trying to reduce the injectable element, which is surely desirable--the long-term results are amazing. Often there appears to come a point when even the hardest addict becomes bored--that is a curious word to use--with taking the drugs; bored with going out and obtaining them; and bored with the degrading procedures involved. However, it is abundantly clear that one cannot force people to come off drugs before they are ready. That is one of the mistakes that our present programme is making and it is one of the reasons why there are so many instances of failure. There are so few success stories even in the specialist units.

We must be frank about the fact that our present policies have failed those who are currently addicted. What troubles me is that they have also failed the public. We are not bringing about any reduction in drug-related crime, any reduction in wrecked lives or any substantial reduction in the spread of HIV through drug taking. We owe it not only to addicts but perhaps even more to the public whose ordinary lives are affected by addicts, in particular on the receiving end of crime, to explore every avenue that is open to us. The consultation process could provide us with that chance.

As I said at the outset, I am discouraged by what appears to be a conventional approach to the problem. However, I am greatly encouraged by what has been said by noble Lords on all sides of the House. The noble Lord, Lord Russell, said that we should look for no single response. The noble Lord, Lord Kilmarnock, said that no tools or weapons should be neglected. I hope that in reply the Minister will say that the debate can be extended in the period between the publication of the Green Paper and the White Paper and that we can look further at proper long-term methadone maintenance, where that is appropriate. I hope too that we can examine the issues that have been raised by other noble Lords and look more seriously at the possibility of future legalisation of some of the drugs.

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