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What does it say? Under the heading, “Questions for Consultation”, it asks:
“What are the most effective ways of preventing and reducing the harms caused to young people and families by drugs ... How can we improve the effectiveness of specialist drug treatment services”?
Those are two admirable questions. It continues:
- “How can we further reduce the supply of drugs and improve detection and the prevention of importation”?
That is a pretty strong question. Finally, the question that the document should have addressed at the outset:
On any view of the matter, the Government’s drugs policy has transparently failed. I do not particularly blame the Government for this. The same is true of almost every other country on Earth, whether that country has capital punishment for drug dealers and carriers or whether, as in this country, we have strong prison sentences.
It is worth while looking for a moment at what the drugs strategy was meant to achieve. As I understand it, when it was amended in 2002 it had four major elements: first, preventing today’s young people from becoming tomorrow’s drug users; secondly, reducing the supply of illegal drugs; thirdly, reducing drug-related crime and its impact on communities; and fourthly, reducing drug use and drug-related offending through treatment and support, and reducing drug-related death. Taken as a whole, none of these has been entirely successful, and most have been spectacular failures. We have not succeeded in controlling the supply of drugs. We have not succeeded in curbing the number of young people who are becoming users. We have not succeeded in radically reducing drug-related crime, and we have not done very much to give drug addicts proper treatment and support.
Like the noble Lord, Lord Cobbold, I recommend that noble Lords look at the document issued by the North Wales Police Authority in response to the consultation paper we are considering today. Its view is clear, and interesting not only for what it says but whence it comes: that that police authority should
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I have not come to any conclusions easily or quickly. If the drug strategy were working, then it would clearly be much better that it should be allowed to work successfully. But it is not working successfully, and we must now accept the reality of its failure and start asking ourselves what alternative policies we could substitute which might be more successful. I am not in a firm position to suggest many such policies. My inclination now is much the same as that expressed recently by the noble and learned Lord, Lord McCluskey, in somewhat bold phrases:
“If people are addicted to heroin, give them heroin. I'm not suggesting you sell it at newsagents, but if you were to offer it to addicts in a medically controlled setting, there would be no criminal market”.
That argument seems to me to be unanswerable.
The politics of this issue are decidedly complicated. It is one of those topics that a Member of Parliament who has to stand for re-election would find very difficult indeed to discuss. There are no votes in the reform of drug policies, but there may be votes in drug toughness; certainly, there would be greater peace from the tabloids if an MP or Government were to do that. It is, however, precisely the sort of issue that your Lordships’ House is very well fitted to examine. Like the delicate issues of human fertilisation and embryology, a detailed examination of the existing drugs position, the present drugs policy and the alternatives should be undertaken either by a committee of your Lordships’ House or, alternatively, by a Royal Commission.
The problem will not go away. Governments have for many years tried to make it go away and they have not succeeded. It is time that we had, at some level, a major, dispassionate and objective look at the policy and the possible alternatives. This House is in a position to play a major role in areas where the other place cannot. The problem is not at present being solved and it needs to be. I frankly know of no other way of sensibly proceeding with the matter.
6.03 pm
Baroness Finlay of Llandaff: My Lords, I intend to address the evidence base for the strategy on drugs and the changing face of drug use and addictions. They are not synonymous but, of course, associated. I also intend to question how our domestic drugs policy is linked to international policy, because demand and supply are integrally linked. Last week, we debated a major drug: alcohol. Alcohol is a legal drug associated with the problems of other substances that are not legal, but seems to have slipped through this drugs policy net.
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First, let me congratulate the Government on taking a harm reduction approach, following on from the 1998 strategy. I declare my interest as a member of the UK Drugs Policy Commission and the Advisory Committee on the Misuse of Drugs.
Much has been achieved. The national treatment agency seems a good idea. The National Institute for Health and Clinical Excellence guidance is clear and draws on evidence, as far as we have evidence. But that is the problem. The knowledge base to underpin the strategy is woefully underdeveloped through lack of investment in UK research in the field. Changing classifications, legalising or not, is tinkering with the drugs while crime is rife. But why is addiction occurring? We understand neither the problem nor the efficacy of some potential interventions. Why is the young brain physiologically so susceptible to addiction? What are the causal pathways into and out of problematic drug use? Why do UK youths have higher levels of addiction than our European partners? Among school children aged 11 to 15, the use of any drug was 21 per cent in 2003 and fell to 17 per cent in 2006, with a commendable reduction in frequent use among children who have truanted or been excluded. But perhaps we could do better—much better.
Interventions such as the drug interventions programme and enforcement activity form the centrepiece of the strategy. Which are the most effective and for which sub-population? We just do not know. Do new substances emerging pose an even greater threat? Or how might some new substance-antagonists that could be produced decrease addiction risk in the long term? Some of those who turn up in accident and emergency with hepatitis C or HIV, or are victims of sexual assault and so on, are sad, pathetic, vulnerable people—victims at the end of a chain of social disaster and exploitation. And then there is another group, if one can generalise, who are locked into crime and criminal activity. Third-party, innocent people in our society are the victims of that.
I ask the Minister why Home Office funding to evaluate and monitor our drug strategy is only about 0.5 per cent of this year’s budget for drugs and how that will be rectified. Contrast that with 20 per cent of the US federal drug treatment and prevention budget allocated to research. Will the revised strategy have a dedicated pillar to improve the research and knowledge base, and a programme to deliver this? Without evidence, these policy proposals will be open to unfettered attack from polarised and ill-informed opinion.
Since 1998, the number of people in contact with structured drug treatment services has doubled to 195,000 recorded in 2006-07 in England. Harm reduction programmes have expanded, but one in four of those entering treatment dropped out within 12 weeks of triage assessment and only 14 per cent successfully completed treatment. There are about 320,000 problem opiate and crack users in England, with an unknown number of problematic cocaine and cannabis users and unknown numbers of new problem drug users each year. As a member of the Advisory Committee on the Misuse of Drugs, I have read much about cannabis and we will look again and afresh at it. I
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The trends in drug use are changing. Syringe exchange schemes reveal a very high use of anabolic steroids as well as opioids, with over 50 per cent of needle exchanges in some areas being anabolic steroid users, often obtained in body-building gyms. Thus needle exchange schemes have become an important source of information to agencies over what is happening in the illicit drug market world. By contrast, UK Sport is very active and indeed effective in its work to rid competitive sport and all sports of all drugs and it is to be commended for its work.
Industrial substances such as benzylpiperazine, gamma-butyrolactone—known as GBL, a precursor of gamma hydroxybutyric acid, or GHB—and also 1, 4-butanediol are being imported through the internet and increasingly abused. Substances such as GBL and 1, 4-butanediol have very wide industrial uses, such as cleaning motorcycle chains, among other things. They are imported by the barrel-load for our industry, so they are particularly difficult to monitor, and as soon as one website is closed down, another pops up, so it is an ever-chasing game.
There is recent evidence of contamination of ecstasy tablets. Ecstasy appears to be ubiquitously available in clubs on Saturday nights, and I remind noble Lords that Methaqualone, also known as Mandrax or Mandy, was prevalent in the 1970s and then LSD had its peak, so we have a constantly changing picture.
The greatest return on investment in managing drugs is likely to be found by further widening the availability, choice and quality of treatment and self-help programmes. The National Treatment Outcomes Research Study estimates the benefit-to-cost ratio as somewhere between 18:1 and 9.5:1, which suggests that for every £1 spent on treatment for opioid users, almost £10 will be saved, but no programme can be effective without motivation to change behaviour, which is why NICE guidance stresses the importance of short interventions to begin motivational change and why programmes such as Narcotics Anonymous and Cocaine Anonymous are effective.
Prison services need improving. I remind noble Lords that deaths from opioids are particularly prevalent in drug addicts who have been away from drugs for some time and have lost tolerance. They go back on the street and have a dose at the same level as previously, but having lost tolerance, they get respiratory depression, often vomit, inhale their own vomit and die. Those particularly at risk are prisoners coming out from prison into the community and those coming from a detox regime who relapse. HM Inspectorate of Prisons recently published The Mental Health of Prisoners: A thematic review of the care and support of prisoners
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Lastly, I shall address the contentious area of the international dimension, which has already been referred to by the noble Lord, Lord Mancroft. The Government state in their report that:
“At an international level, effective counter-drugs policies cannot be separated from broader foreign policy”,
“About 90 per cent of the heroin that reaches the UK originates in Afghanistan and passes through Turkey and the Netherlands”.
The current policy is failing. The cost of street heroin has fallen to £54 per gram, despite record drug seizures. The consultation document goes on to point out that:
In a response to Frank Field MP regarding the UK counter-narcotics strategy in Afghanistan, the Prime Minister wrote:
“Eradication is the responsibility of the Afghan Government and is set out in the National Drug Control Strategy. The Strategy takes an integrated approach and focuses on four key priorities - targeting the traffickers; strengthening alternative livelihoods; developing institutions and reducing demand. It is not an eradication-led strategy, but recognises that there is an important role for eradication”.
The experiences of Pakistan and Thailand have demonstrated that ridding a country of illegal opium production is a “long and difficult process”—those words are from the Government’s own report—so why not encourage contracts with farmers who grow poppies? Buy up the raw opium through contracts, rather like a common agricultural policy, and require the production of another crop as well. A breach in the contract by selling to organised crime could have some sanction associated with it, and policing would be the responsibility of the Afghan Government, not ours, which is compatible with their declared policy. If I were a farmer with mouths to feed, I would grow what I know best, and I would hate with every ounce of my body someone who destroyed my livelihood and my ability to feed my family. That is human nature. With a steady contract and a decent price, the farmers might even have a higher standard of living than at present.
The noble Lord, Lord Malloch-Brown, informed this House last week that the market for legal poppies for medicinal use is already crowded and there is no additional demand. I do not believe that it is beyond the wit of government to use financial incentives in other parts of the world to encourage diversification. Others growing poppies could easily divert and start producing other substances. I am thankful that the UK does not endorse the US approach of herbicidal spraying, but however a crop is destroyed, there are costs. There are indirect costs to our international security. It must be better to grow poppies than to grow terrorists.
Nearly 20 per cent of the world’s top medicines were discovered in Britain. This pharmaceutical expertise is a national strength. With drug development costs at
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The raw opium could be supplied for research and drug development, to develop new analgesics with lower addiction potential and fewer side effects and to develop longer-acting antagonists to help addicts stay off drugs. Our pharmaceutical industry should also be urged to manufacture cost-controlled analgesics to supply those countries where millions suffer and die daily without any analgesics because they are too expensive, even if their country allows them to be prescribed. Make no mistake; in some countries you cannot even get analgesics.
I urge the Government to think again; it is not too late to rethink the international dimension to the drugs policy.
6.15 pm
Lord Ramsbotham: My Lords, I am conscious that there are many experts in this House who know a great deal about this subject. I hope that the Government will listen carefully to what they say.
We are frequently told that what we are involved in is a war on drugs. So, as a former soldier, I thought that, rather than just look at the consultation document, I would carry out an appreciation of the problem as one might if one were taking part in a war—by looking at all the factors to be considered and at whether there are gaps or anything else that needs to be weighed in the balance. I shall run through this appreciation very shortly, because I should like to expand later on a number of its aspects.
An appreciation begins with the ground—but I do not think that there is any argument about the ground over which this war is being fought. It is the economic, social and political well-being of every country in the world and the well-being of every man, woman and child in those countries. It is nothing more, nothing less.
Where is the enemy whom we are considering? Again, I think there is little argument about that. The enemy are those who grow and supply the harmful substances that put the ground at risk, in particular the dealers, whom I regard as about the most despicable beings on Earth. Terrorists, murderers and paedophiles all may have some reason for turning to those particular activities; dealers are interested only in themselves. Their greed and demand for personal gain pay no attention to the misery that they are causing to the people to whom they deal these substances.
Our own troops are difficult to identify in this largely intangible war. International co-operation has already been mentioned. The Government mention national policy and strategy in their documents. Information and statistics have been quoted. There is also public opinion. Finally, there are treatment agencies, which also have been mentioned. Those are five things and perhaps there are more.
What is the aim of this war? The Minister expressed it very clearly in the introduction to the consultation document. It is,
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of damage caused to individuals, families and communities by illegal drugs.
That is the aim of the war and the ground. The enemy has been identified, and our own troops have been identified. One has now to look and see how effective our own troops are at tackling the enemy. Looking at the evidence, I believe that this war is not being won. All the evidence, however produced, does not seem to satisfy any suggestion that it is being won.
Complacency has been mentioned, and the Minister said that the Government are not complacent. However, any document that can show such figures on the appalling number of people still involved in taking these drugs while using the phrase “huge success” is complacent.
I was interested that one response to the consultation document, by an organisation called Transform, said that the Government know,
- “that its support for drugs prohibition creates significant harms ... The submission demonstrates how the Government: manipulated the entire consultation to close down genuine debate on drug policy; set the framework in such a way as to have determined the outcome before the consultation had even finished; ignored ten years of constant criticism of its drug policy; hid internal reports critical of prohibition; treats criticism of drug policy with disdain and contempt; refuses to evaluate prohibition; is a hostage to US inspired geopolitical forces; and uses drug policy for electioneering ... This is despite the fact that the Government admits that prohibition itself is a significant cause of harm”.
Transform is not just a back-street organisation; it is extremely serious, involving a number of people coming together to discuss the problem, which they have done for many years. The response continues:
“The consultation should have been a thoroughgoing review of the policy making process and the impact that policy has in the everyday world. In the event, it turned out to be a sham. The consultation document is another dodgy dossier. It contained no proposals, breaking one of the fundamental rules for consultations”.
I am sorry that the Government did not produce a more substantial consultation document after the first strategy from 1998 to 2002 and the second period from 2002 until now. I now come to the next element in all this, which is the information and statistics that are presented. They have already been referred to by the noble Lords, Lord Mancroft, Lord Cobbold and Lord Richard. I have always been especially concerned about prisons, which have been mentioned. When I first went into prisons, I was told that policy was being built around something called a mandatory drug test, in which 10 per cent of prisoners were tested every month. The aim was to reduce the number who tested positive. The figure of 10 per cent has gone down to 5 per cent. In one prison, I found a man with nine certificates on his wall. I asked what they were. They told me that he did not use drugs and that they showed that he had tested negative and if I came next week, there would be a 10th. That meant that they could always keep their figures up.
In Wymott Prison, a large prison half for training and half full of sex offenders, they said that there were no drugs. I did not believe a word of it walking around the training wing and I then discovered that the only people that they tested were the sex offenders who did
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I mention that because I am extremely concerned that if you are fighting a war, you must do it on hard information and evidence. You cannot do it on fudge. If you do, you will end up with a fudged result. That is why I am extremely concerned about two things. One I shall deal with very shortly, because I hope that the Government will take note of it.
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