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I do not how many noble Lords know about cannabis farms. Do you know that private houses are rented out to gangs who turn them into cannabis farms? They create one by pulling out all the interior, taking the electricity and water for the spray and heating system, and using polythene. Fortunately, the smell is extremely strong and the police can detect it using infrared technology in helicopters. Thereby, many of the cannabis farms are found. The police discovered a number of cannabis farms in private houses near Heathrow that were being tended by Vietnamese children as young as eight or 10. They had of course been trafficked into this country and all they did was tend cannabis farms in private houses.

It is difficult to know the best way to deal with drug abuse and whether drugs should be decriminalised. One thing is absolutely certain, which encouraged those of us who signed the letter sent by the noble

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Baroness, Lady Meacher, to Kofi Annan-the present system around the world is not working. It is certainly not working in the United Kingdom. It is costly, time-consuming and is, overall, ineffective, as the noble Baroness told us. The successes in the discovery of loads of drugs only highlight the huge difficulty of keeping up with the inflow of drugs to this country and through this country to other countries. We all know that sentencing, however severe, does not seem to have any deterrent effect on drug abuse.

One possibility might indeed be to decriminalise, but one would have to be extremely brave as the Government of a country to do that in light of the 180 countries that deal with sentencing severely. One only has to go to Singapore and walk into the airport to be told that to carry drugs means death. We are a long way from making Singapore decriminalise drugs.

I was interested in what the noble Baroness, Lady Afshar, said about Afghanistan. For a long time I have wondered why this country, perhaps in concert with other countries, does not buy the entire Afghan production of opium. We know that there is a world shortage of morphine and I should not have thought that it would be difficult to sell at a profit. If we bought it, we would do down the Taliban at one stroke-certainly to a large degree.

The proposals of the UNODC are extremely interesting. There seem to be two ways in which one could go on this: either by keeping the criminal system, whereby offenders go through the courts but do not go to prison; or, preferably, by diverting entirely from the prison system. I cannot believe that setting up a large number of clinics in the United Kingdom could be anything like as costly as keeping the drug addicts in prison and releasing them to reoffend whereby, again and again, they are a charge on the state.

I should like the Government to try out further pilot projects that divert from prisons to alternative remedies. It would be crucial that clinics were free, freely available and properly set up to deal with drug offenders. I urge the Government to do something such as that and see by how far they could cut out the people in prisons.

7.03 pm

Lord Adebowale: My Lords, after not speaking for some time in this House, I find myself on my feet twice in the same afternoon. It is a privilege to take part in this debate. I add my congratulations to the noble Baroness, Lady Meacher, on initiating it. This is a different debate from the usual one we have on substance misuse. It draws our attention to the discussion paper, which is a step forward-but only if we do more than just read it. We have to act on it, of course.

I declare two interests-first, as chief executive of Turning Point, which is probably one of the largest providers of substance misuse services outside the NHS, and as a member of the Government's ACMD, the Advisory Council on the Misuse of Drugs.

Our current system is questionable; indeed, I think that it is broken. All the evidence points in the direction that substance misuse is best treated through health and social interventions. Substance misuse has roots in an individual's psychosocial state. For treatment to

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be effective, the whole of the person needs to be the starting point of intervention. My organisation is incredibly ambitious for our substance misusers. It is a mistake to assume that providers of treatment for substance misusers allow them to languish on methadone without any intention of moving them towards work. That is wrong, certainly in the case of Turning Point and many of my fellow providers of treatment services, both within and outside the NHS.

We know the numbers, but it is worth repeating them. There are 400,000 problematic heroin and crack users in the UK, while 1.5 million people will be significantly affected by a family member's drug use. I congratulate the noble and learned Baroness, Lady Butler-Sloss, on her remarks about children. About three years ago, Turning Point produced research showing that one in 11 children goes home to parents who are misusing alcohol. We must not forget the impact on children, as the problem is generational. We know that those children are more likely to fail in education and we know that failure to be educated thoroughly leads to low job attainment and a greater likelihood of ending up in the criminal justice system. The line that can be drawn between substance misuse, criminal justice, poverty and family breakdown is clear and well understood.

Recovery is dependent on the stability of the individual and is more likely if someone has a steady personal relationship, meaningful employment and stable housing. For me, the question has always been how to get people to the position of having the quality of life that makes recovery more likely.

The use of coercive techniques and prison to prevent substance misuse is questionable. When the noble Baroness, Lady Afshar, spoke about cannabis, we all laughed, but what she said was interesting. If you are caught with cannabis and happen to live in one of the 14 poorest boroughs, the chances of your ending up being able to give a speech in the House of Lords are severely limited, but if you are a member of the Royal Family or on the Front Bench of either party and you admit publicly that you have used cannabis, you will get off. It is an offence, but the impact is variable, depending on your status. That seems entirely unfair.

Leaving that to one side, I have yet to meet a substance misuser who has benefited from a spell in prison. Some might say it, but I have yet to meet anyone for whom prison as an intervention has been effective in removing their drug problem. Addiction is an irrational state. You can punish people until the cows come home, but you will not move them from their fundamentally irrational position. It does not work in that way.

Also, we are naive to think that prisons are drug free. They are not. As the noble Lord, Lord Thomas, said, prison imposes a stigma, but it also imposes a significant heroin problem. A number of clients whom I have known over the years have, immediately on moving out of prison, scored heroin and died, because their tolerance has been reduced by their spell in prison. They have been able to get hold of heroin in prison, but only in smaller amounts; when they come out of prison, they go back on to the dose that they were on before they went in and they die. In that respect, prison kills people.



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The use of prison as a sanction for substance misuse is short-sighted and fails to acknowledge the nature of substance misuse. We should pay attention to the challenge not just of illegal drugs but of substance misuse generally. Many sufferers from substance misuse have dual diagnosis: they have mental health problems as well as substance misuse problems. It seems rather obvious that, if you decide to be in or are forced into a position where you are killing yourself through the misuse of any drug, you are probably challenged in terms of your mental health. The Royal College of Psychiatrists has suggested that approximately half of all clients in substance misuse services have some form of mental health condition, most commonly depression or a personality disorder. Prisons simply are not suitable places in which to manage personality or mental health disorders. Nevertheless, some people who misuse drugs will end up in prison because they commit heinous crimes. We must ensure that these people are given adequate support to address the root of their personal problems, and this means that health and social care interventions within prisons are a must.

My own organisation, Turning Point, was one of the first to pilot the drug courts programme in Wakefield. We campaigned for many years to get drug courts established because we saw the impact that they had on individuals and their ability to turn people away from substance misuse, and indeed the criminal justice system, towards work and a normal life.

The document that has been drawn to the attention of the House is not the only one that looks at drug treatment. My organisation has signed up to a drug treatment consensus, which has also been signed up to by many leading drug treatment providers. This consensus document encourages the coalition Government to remember that there is more to drug treatment than getting someone off drugs or stabilising them on methadone, which often ends up being the focus of the debate. Rather, we should consider the needs of the individual. Recovery from addiction is a journey on which there are different paths. However, when it comes to addressing their addiction, for some people it is better also to address what is influencing it in the first place. That is seen in the ambition of the signatories to the drug treatment consensus for those with substance misuse problems, although we acknowledge that methadone is a step on the journey towards recovery from heroin addiction.

Although it is an interesting issue, it is worth pointing out that I am not too concerned about having a debate on whether or not to legalise drugs. In a society with a system of legalised drug misuse, would we not have addicts? We would, and we would still be faced with the challenge of what to do with them. That is at the centre of this debate. However, let us move away from illegal substances and draw attention to the legal ones. Alcohol specialist treatment services are much needed.

Solutions to this problem do exist. Often they are denied not because of a lack of evidence-the evidence is there-but because of moral panic and a desire to play to the gallery. We have a once-in-a-lifetime opportunity to set aside moral relativity and to focus on the evidence and the interests of those who suffer from this terrible problem.



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7.12 pm

Baroness Massey of Darwen: My Lords, I am most grateful to the noble Baroness, Lady Meacher, for introducing this debate with such thoughtfulness. The previous speeches have been so fascinating that I am only sorry that we cannot spend more time on this very complex topic.

I begin by declaring an interest as the chair of the National Treatment Agency for substance misuse. The NTA was set up in 2001 with the aim of doubling the numbers in treatment and reducing waiting times. I am glad to say that these targets were achieved early. However, we are alive to and will address the issues that remain. As an organisation, we work across the health, criminal justice, education and welfare ministries and systems. Drug use everywhere has to be tackled across systems and not by one system alone.

Any addiction is a public health concern, and I am very interested in the coalition Government's intention to improve public health through a new public health delivery system. Public health, of course, involves family and community issues, as well as housing, employment and education.

The UNODC paper takes a somewhat polarised view and approach, using terms such as treatment being an,

I would say that we need effective treatment systems but that we also need effective criminal justice systems where treatment is available. I have worked in countries where the situation is polarised and where prison, labour camps and compulsory treatment centres are the norm. That is not the case in the UK and I want to give some examples.

There has been a dramatic expansion of our drug treatment arrangements over the past nine years due to more money being put into the system. The money has been there largely to fight crime but it has also benefited health. The number of people in England completing treatment and being free from dependency has increased from 9,000 to 25,000 per year. Offenders are systematically referred into treatment, preventing millions of crimes each year and saving costs. England now engages more than 60 per cent of the most problematic drug users in society in treatment, compared with less than 20 per cent in the USA. There are some success stories.

There is an emphasis on two things in the UNODC paper: one is outcomes and the other is evidence-based approaches. Many countries have not had drug strategies. England has a drug strategy against which outcomes can be measured and evidence bases set out. We know that drug users commit crimes to fund their habit; we know they often have other health, social and educational problems, as many noble Lords have said; and we know that each user is different and that successful treatment will address those differences. Recent debates in the media might suggest that treatment for drug use involves a simple choice between an abstinence-only approach and one based on methadone prescribing or other substitute prescribing. Individual users often do not subscribe to ideologies; they use.



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The starting point for the NTA is that the majority of addicts want to overcome their addiction and get off drugs. We need a treatment system that helps them to realise that ambition. It may take time. It may take many attempts and different approaches in order for recovery to take place. Users want to recover from addiction. For some, this will be with the help of substitute prescribing or residential rehabilitation and for others it will be detoxification or community services. The NTA has long supported psychological and pharmacological interventions provided by multi-professional teams, as recommended in the UNODC document. Does the Minister agree that that approach is more appropriate than secure accommodation for offenders and drug abstinence orders?

I want to speak briefly of two initiatives in which the NTA has been involved where improvements have been made. One has been the development of the treatment outcomes profile. This is an individual client monitoring tool to reflect progress in an individual's drug treatment. It has received international recognition and was praised in the Lancet last year. It is a simple tool which motivates self-analysis and a change in habits.

The other initiative is the integrated drug treatment system in prison. It was developed to bring together the fragmented delivery of drug treatment in prisons and to ensure that drug misusers could access a range of evidence-based services which are clinically appropriate to the individual. As has been said already, more than half of those in prison are heroin and crack users who will remain in custody for three months or less. They are not in the system long enough to undergo abstinence-only regimes. Good clinical practice is to continue the treatment that the prisoner had before arrest, or prepare them for the treatment that they will receive on release. Not to do so leaves that population vulnerable to suicide or overdose on leaving prison, which is not a healthy option. The Integrated Drug Treatment System means that many offenders are being released into the community having been successfully engaged in drug treatment and not needing to go back to a life of crime. I have visited many prisons involved in this scheme and professionals and users alike speak highly of the system. If noble Lords are interested, there is an NHS/NTA short report called Breaking the Link, which addresses the issue.

So it is not a case of either coercion or cohesion, as suggested by the title of the UNODC paper, From Coercion to Cohesion. It is a case of having a strategy and a policy which address individual health and social needs and which, in turn, have a positive impact on crime, on families and on communities.

7.19 pm

Lord Cobbold: My Lords, this document from UNODC is the dawn of a new era. It calls for drug dependence to be treated through healthcare not punishment. For 50 years the United Nations has underwritten the war on drugs and its conventions have inhibited member countries from adopting alternative strategies. Now our task is to challenge Her Majesty's Government to acknowledge this change and, as suggested by my noble friend Lady Meacher, to take a lead in

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setting up a conference of UN member countries to discuss how the new policy can best be implemented. Many member countries have already experimented with the substitution of a health-oriented approach in place of prohibition, and they should all be invited to share their experiences at the proposed conference.

The common sense and valid arguments in favour of decriminalisation and regulation are well known. Decriminalisation means that drugs will be treated in a similar way to alcohol, tobacco and prescription drugs. It would ensure quality control and reduce the role of the criminal gangs that now control the international market.

However, in current deficit circumstances, an especial benefit would be financial. We and other Governments are desperately looking for sources of finance to extract ourselves from the recession. It is estimated that the war on drugs costs this country about £18 billion per annum. According to the Prison Reform Trust in its prison briefing of May 2010, the prison system as a whole has been overcrowded in every year since 1994 and the overall average cost per prison place is £45,000. About 55 per cent of those received into custody are problematic drug users. We are also told that 49 per cent of adults are reconvicted within one year of being released and, for those serving sentences of less than 12 months, that increases to 61 per cent. It is difficult not to deduce from those figures that prisoners are well looked after in prison and can probably fulfil their drug needs more easily there than in the open market. Clearly, if drugs were to become a healthcare issue, there would be increased costs from the provision of rehabilitation and treatment centres, but there would be an immediate benefit from new taxation and savings from prison and legal costs. In our current circumstances, the financial arguments are very strong.

I congratulate the noble Baroness, Lady Meacher, on the success of her dealings with the UNODC and hope that our new coalition Government will respond positively.

7.23 pm

Baroness Murphy: My Lords, I add my voice to those of others in thanking the noble Baroness, Lady Meacher, for her untiring efforts to change UN drugs policy. The UN thinks that she can change the world, and I have to tell your Lordships that, after many years' experience, it is wholly right.

The past 10 years has seen some modest reduction in harms. I pay tribute to the work of the National Treatment Agency in getting so many more people into treatment and care, but there is no doubt that our current emphasis on the criminalisation policy, which we have pursued here and abroad with minimal accompanying strategies on prevention and care, has been unhelpful. At the moment, we spend less than 7 per cent of the drugs budget on healthcare and less than 0.5 per cent on research into effective prevention and treatment strategies. There are no formal figures on how much is spent on education. Those figures alone must make us pause and rethink in the way that the noble Baroness advocated today.

I return briefly to the differences between decriminalisation and legalisation, which are seriously different strategies. Around the world, we know now,

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especially from studies in the United States, in different states' policies, and in Australia, that eliminating criminal penalties for possession of small quantities of drugs has no effect on the prevalence of drug use. That is true for marijuana and it is probably true for hard drugs as well, although I have to say that only Spain and Italy among major industrialised countries have tried it, and they do not collect outcome statistics that are in any way meaningful, so there is a serious problem there.

I love the story of the American academic researcher MacCoun, who works at Berkeley in California. He asked his undergraduate students whether they would be in favour of California removing penalties for possession of small amounts of marijuana. About two-thirds said yes, and the rest were opposed. Almost none knew that it had occurred 25 years ago.

Decriminalisation is not the same as legalisation, which allows some form of regulated sales or distribution, and of which there is only one contemporary example: the well known Dutch model of de facto legalisation which began in 1976. There is no instance of legal commercial access to cocaine or heroin in a modern, industrialised nation. Switzerland has probably come nearer than most and has concentrated significantly on improving health and reducing criminality among participants in its heroin prescription programme but, again, more rigorous research is needed.

Nevertheless, we can blame prohibition for much of the crime and violence around the illicit drug markets, for a large fraction of drug overdoses and drug-related illnesses and for corruption and the violation of civil liberties. However, other harms are due to the drugs themselves and the influence they have on the user's health and behaviour. Legalisation would eliminate the harms caused by prohibition, but it would not eliminate the harms caused by drug use. Thus, there is a trade off. If average harm went down under legalisation without an increase in use, we would clearly be better off than we are today, but if legalisation produced a significantly large increase in total use, total drug harm would go up, even if each incident of use became somewhat safer. Total harm can rise, even if average harm goes down. It is true to say that at present there is no firm basis for projecting the relative magnitudes of these effects.

What we need to do is perhaps to have some decriminalisation, but to refocus on the prevention and treatment strategy. President Obama's adviser, Thomas McClellan, has given many talks in this country and has described very well the new prevention strategy focusing predominantly on school and adolescent education, the re-engagement of parents, constant police monitoring and the involvement of all community organisations that come across young people. They are all pushing a specific message. I should remind noble Lords that drug addiction and misuse start between the ages of 10 and 21. Practically no one becomes an addict after that point. It is therefore very clear where we can focus our prevention strategies.

Overcoming addiction is very difficult. We know that compulsory coercion in the criminal justice system and compulsory treatment do not work. However, there are good forms of coercion. People need to take

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an active part in the choices that they make. That is part of the NHS commitment to all patients. They need to make active choices, and there are good forms of negotiation and coercion that can get people happily into treatment as a voluntary act. We should use coercion in the good sense of negotiating with individuals and asking what we can do to help them in their lives to make it sensible for them to come in and stick with the treatment. It is a long, hard graft and covers all the other issues that the noble Lord, Lord Adebowale, so eloquently described, but it is well worth it for the good outcomes that we can achieve.


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