Going Public

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The UK’s public health bodies have added their voices to the call for decriminalisation.

Reports advocating the decriminalisation of drugs come along fairly regularly these days, but opponents of changing the law are usually able to say that it’s just the ‘usual suspects’ making the call.

Last month’s Taking a new line on drugs report, however, was more unexpected in that it’s the work of the Royal Society for Public Health (RSPH) with the support of the Faculty of Public Health (FPH) (see news, page 4). The document gathered some favourable media coverage, including a front-page story in the Times, but some people might still be taken aback that organisations like this want to see drugs decriminalised.

‘I don’t think it should be a surprise,’ RSPH spokesperson and the report’s co-author, Ed Morrow, tells DDN. ‘In the UK we’re quite behind the debate if we look at what’s happening internationally. That’s the way the wind is blowing, with very positive and encouraging results in some places. We’ve now seen the World Health Organization, which is historically quite a conservative public health body, actually coming out and publicly saying that too much of a focus on a criminal justice approach is counter-productive and that we should be focusing far more on public health.’

The Times editorial went further and said that decriminalisation should be the first step to full legalisation. Is that something RSPH would back? ‘At the moment the reason we’re calling for decriminalisation, as distinct from legalisation, is that that’s where the evidence lies,’ he says. ‘That’s where we’ve seen the approach tried internationally with positive results. We’re aware that there are potentially strong arguments to be made for full legalisation of certain substances, especially around having a product where people know what’s in it, and taking supply out of the hands of criminal gangs. We think the evidence for that should be kept under review and we’d be interested to see what emerges internationally, but we think that what there is the evidence base for now is decriminalisation.’

As a public health body, however, what would they say to people who argue that it would mean increased levels of use, and therefore of harm? ‘Well I think we just have to look at the evidence internationally, look at where it’s been tried. We’ve seen no significant increase in use, and what we’ve seen go down is the number of problematic users and the number of people in their late teens and early 20s using drugs.

‘I think we have to be pragmatic and acknowledge that no matter how hard we try to prohibit drugs, some people will always be unwilling or unable to stop using them,’ he continues. ‘We have to deal with the world as it is, rather than how we wish it was, and make sure that if people are going to be using substances to any extent then the amount of harm being done is absolutely minimal and that our health services aren’t having to pick up the pieces later down the line.’

The report doesn’t just focus on the legal framework, however. It also wants to see responsibility for the country’s drugs strategy moved to the Department of Health so that it’s more closely aligned with the alcohol and tobacco strategies, and for ‘evidence-based drugs education’ to be a central, mandatory component of Personal, Social, Health and Economic (PSHE) teaching in schools.

While education is a ‘hugely important’ part of the equation, says Morrow, provision has been ‘very patchy’ and often not grounded in evidence. ‘We know now that a “just say no” approach doesn’t work and that young people don’t tend to respond very well to that. It’s much better to have a frank, open discussion about drugs and what the harms are, and that includes legal drugs as well. We think all young people in this country really have the right to that through PHSE education instead of putting themselves into dangerous situations by using drugs in some of the riskiest ways. Some parents who’ve tragically lost children to drugs have come out and expressed a wish that their children had been better educated about the dangers.’

The report contains much on drug-related harm and its impact on public health. However, many treatment providers have said that, since responsibility for public health was moved back to local authorities, drug treatment is simply not a priority for their local director of public health and that they’ve been sidelined when it comes to dividing up the money. What can be done to address that?

‘This is part of a wider picture that goes beyond drugs,’ he states. ‘We know that funding is severely under threat and being constrained for all kinds of public health services at a local level, and we’ve been saying and lobbying on a national basis for a long time that this is a complete false economy and that it ends up costing more in terms of the health services picking up the pieces in the long-term. We acknowledge that there is an issue with funding and we’re still doing all we can at a national level to say that these services need to be funded properly.’

Report at www.rsph.org.uk