After six years of looking at the evidence for what works to tackle drug problems, the UK Drug Policy Commission (UKDPC) has come to the end of its work, although we will still be doing some limited activities this year to ensure our legacy continues. Our demise has been long planned – we were set up to run for a fixed period – and in anticipation we have spent much of our last year developing our final conclusions. The result is our report, A fresh approach to drugs (DDN, November 2012, page 4) which sets out our view on the current state of drug policy in the UK and our recommendations about where improvements could be made.
So what have we learned? Our findings split into two parts– our conclusions about the policies themselves, and what we have concluded about the processes of policy making. While there is much that can be improved about drug policies, we should not lose sight of the fact that the UK does some things very well. Harm-reduction policies, like needle and syringe exchanges, have saved many lives and kept blood-borne diseases like HIV at an internationally low rate among injecting drug users.
The great expansion of treatment and recovery services over the last 15 years has also reduced deaths and helped many more people to recover from drug dependence and move on with their lives. The evidence is clear that such services provide value for money. At the same time, fewer people are using drugs – particularly among younger age groups – although we should be wary about any claims of credit for this, given similar trends are seen in several countries with quite different drug policies.
But while some policies are backed by a strong evidence base, others have much less evidence behind them. Indeed, of the roughly £3bn a year known to be spent annually in the UK on addressing drug problems – the actual figure is almost certainly higher – only about £1bn has clear underlying evidence. That is what is spent on treatment for dependence.
At the heart of the challenge of how we make drug policy more effective is the question of what we are trying to achieve. For decades, political approaches have been built around prevention, treatment and enforcement – treating these as if they are goals in themselves, rather than as tools to achieve wider aims. Because we are not clear about what we are trying to achieve, we have been stuck in arguments like the one between harm reduction and abstinence. If we were more explicit about what our goals are, we might recognise that both can contribute to the same end.
We have concluded that policy could be built around two goals. The first of these is creating an environment that encourages responsible behaviour – both seeking to reduce drug use and lowering the harm that drug use and supply can cause to users and the people around them. The second goal is promoting recovery for individuals, families and societies.
Taking these goals, we have suggested a number of ways that drug policy could be made more effective. In seeking to encourage more responsible behaviour, some evidence-based early interventions and prevention programmes can both bring wider benefits and be cost-effective in the long run. Policy can also more effectively promote activities that allow people to reduce the harms associated with drugs if they do use them. This includes the wider provision of naloxone and facilities for pill testing and drug consumption rooms. These may also have a benefit in promoting recovery.
We can do a number of other things to improve the way we try to overcome entrenched drug problems. Recovery is an individual process, and the timescale for support and method of recovery will differ from person to person. This means that treatment needs to be individually tailored, and it is important that there is a range of different types of support available, including mutual aid groups and, where appropriate, heroin-assisted treatment. The criminal justice system can help this, for example by diverting drug-dependent offenders into the treatment system and working with communities to support their reintegration.
But there are huge challenges in society that undermine recovery. Drug users and their families often experience a stigma that can be a significant barrier to recovery. Tackling this stigma will be important for helping those in recovery to reintegrate into communities – in practice this means employers being prepared to give jobs to recovering drug users, and accommodation being available for people with drug dependence. But it also means addressing entrenched professional attitudes. The families of those with substance use problems also need support, both to assist their family member in treatment, and to help them deal with the stigma, stress and health problems that they may themselves experience.
But while we have seen much about which different policies could be introduced to improve the results of drug policy, we need to ask whether this is enough. Our goal at UKDPC has been to identify the evidence for what works in tackling drug problems. But this would be of little use if evidence is then ignored by policymakers. Fortunately, evidence is not often ignored completely – but then neither is it generally used as thoroughly as it could be.
We have concluded that the way we collect, analyse and use evidence in UK drug policy has often been inadequate, and that this has held back cost-effective policies. The Home Affairs Committee (HAC) report (see page 4) also recognised this and called for ring-fenced research funding.
Part of the solution may lie in creating a new body to commission and manage national research and the HAC recommended that the ACMD should do this. We suggested a genuine independent model such as exists in Canada. Given the different approaches that are increasingly being taken locally across the UK, there will be growing opportunities to learn and share knowledge.
The Home Affairs Committee spent the last year examining drug policy and their core conclusion was that a Royal Commission should be set up – but the prime minister and home secretary rejected that out of hand. At the same time, policy changes internationally – from Uruguay to Washington and Colorado – will change the terms of debates and generate new evidence about the impacts of different policies.
But in the UK, the impact of austerity will have the most far-reaching consequences. Most of us have not fully appreciated the profound reshaping of public spending which will happen over the next decade. As more money has been invested, the recent history of drug treatment has been one of growing professionalism as voluntary bodies and NHS services expanded and became more established. But the new austere future means we will have to rethink that model. We are now seeing co-production and mutual aid coming to the fore, perhaps going some way to reversing the previous journey of professionalism. In many ways this is going back to the roots of much of drug treatment, that of self-help and peer support.
This evolution has been mirrored in my own path. I’ve just taken on chairing Build on Belief (BoB) a new charity founded on the work of the Kensington and Chelsea service users’ drug reference group. BoB aims to support service users in the design, implementation and delivery of a range of services that are, by and large, socially based. These services are to be run and ‘owned’ by their service users and are intended to help volunteers and service users move forward with their individual recovery from substance use. Unusually, BoB does not follow, promote or recommend one method of recovery to the exclusion of another. Its inclusiveness and the inspiration it offers to those who struggle are what attracted me to it.
So events, some predictable, some less so, may shape what happens after the UK Drug Policy Commission has disappeared. But our aim when we established UKDPC was to provide evidence about what works and to change the way evidence is used in drug policy. Whatever the future may bring, a new relationship with evidence would ensure we are better prepared to meet it – at the individual, professional, political and public level. DDN
Roger Howard was chief executive of UKDPC