Off track? Drug treatment is being derailed by the sector’s refusal to push for reform, says Ian Sherwood The distressing reality of drug dependence alters little over time, but society’s response to drugs and drug users has changed markedly over 30 years. During this time the field has developed an avoidance of the drug reform debate including decriminalisation, legal regulation and the role of criminal sanctions in treatment. So why has this happened? The even-handed position we took then was usually a pragmatic one stemming from overriding priorities at the time; firstly to call for services for drug users in the 1980s, and then to argue the necessity and priority of harm reduction in the 1990s. Treatment providers were urgently distancing themselves from the moral panics stirred up in the tabloid press about drugs and HIV/AIDS, placing themselves within a safe, rational medico-therapeutic narrative. For those on public platforms or official business representing treatment services it was a necessary but painful tactic to close down legalisation questions quickly, to ensure that the message about services wasn't derailed by being ‘legalisers, soft on drug users’. Statements such as ‘my organisation is involved in treatment not politics’ became a default position. It now appears that the parameters of acceptable debate have shifted to ‘recovery’ and little else. Despite a major upsurge in overdose deaths, talk of ‘harm reduction’ is increasingly taboo – and completely absent from government communications. The term ‘recovery’ has become a banner for anything broadly related to care, self help, therapy, coaching, training, social support, treatment and mutual aid. ‘Full recovery’ is the government’s preferred term, signalling a shift away from methadone towards abstinence-based interventions. But the deployment of ‘recovery’ to mean everything to everyone leads again to the avoidance of debate and an inability to take positions. In 2015 this feels distinctly out of step with most informed opinion and global debate, disdainful of service user arguments for equality and social justice and ultimately negligent in reducing the risks and harms of drug use. We all know that drug dependence only affects a very small minority of the many people who use drugs to the extent that they may require significant interventions. It is these clients of drug treatment services in the community and in prison that are cited by ministers as the justification for the Misuse of Drugs Act and the reason why legal regulation will not be entertained. Treatment providers’ fear of biting the hand that feeds may have strong historical justification. But the factors that prohibition creates – a thriving black market with easy credit and violence – reduce the ability to provide treatment, undermine the communities in which drug use is most prevalent and demonise people who use drugs. Now that’s what I call an obstacle to recovery and it’s time for the field to find its voice. It’s time to recognise that between those in recovery and those who provide treatment, care and support, there is a tremendous expertise that could articulate a way forward that is broad-based, constructive and reformist. Disappointingly, it seems that the sector is content for almost anyone else to lead the way in this debate – even though it has potentially profound implications for them and their clients. Most recently police and crime commissioners have called for a ‘comprehensive review of strategy’ in a letter to the home secretary, with many chief constables also supporting reform. When Portugal decided to decriminalise possession and replace it with a health response it wasn’t because they had discovered a radically effective approach to treatment; it was because they saw the criminal justice-led response as being both ineffective and harmful. In adopting a health-based policy they were choosing treatment approaches that have been used in the UK for more than 25 years – methadone, rehabilitation, detox, care planning, social reintegration – where people may still drop out of treatment, but can re-engage later without the threat of criminal sanctions. Recent statistics on overdose in the UK are a depressing but timely corrective to the complacency regarding the success of drug treatment in the UK, and it seems very peculiar that no one is arguing for anything other than naloxone and training. It appears that an older cohort is dying, probably linked to the increased availability of imported heroin. There hasn’t been any mention of drug consumption rooms (DCRs) – a widely researched, effective harm reduction intervention, again commonplace in Europe (and also found in Switzerland, Australia and Canada). Similarly, is anyone arguing for supervised injectable heroin – a well-researched intervention that comes under the heading of legal regulation? Surely if we are serious about wanting to stop people using and dying from illegal heroin we would look at quality evidence-based interventions for the hard to reach and the even harder to keep in treatment. Another voice in the debate belongs to those who have been bereaved by drugs. The Families for Safer Drug Control group (now under the banner of Anyone’s Child, http://anyoneschild.org), are simply people who had lost a loved one to drugs and found the prohibitionist rhetoric hard to reconcile with their experience that in no way are drugs actually ‘controlled’ in the UK; all the laws seem to do is make drug use more risky and create vastly profitable, often violent, illegal marketplaces. This, I would suggest, is the reality that most drug users, their families, service user organisations, the police and treatment providers see everyday – but the treatment providers aren’t talking about this, with some honourable exceptions. Does your organisation take a position on drug reform? Take a look at the Count the Costs of the War on Drugs campaign (www.countthecosts.org), an in-depth and fully referenced resource on the reform debate, and sign up to examine the alternatives. Ian Sherwood is a volunteer at Transform, www.tdpf.org.uk. He worked in drug treatment from the mid 1980s in voluntary and statutory sectors, as a clinician, manager and commissioner, and served three terms on the ACMD. He would love to hear from you at email@example.com.