Words into deeds

The new drug strategy offered real opportunities for change, heard the All Party Parliamentary Group for Drug Policy Reform, but it would take commitment from professionals to make these a reality 

It was initially hard for many in the field to work out exactly what the government’s new drug strategy was, Forward CEO Mike Trace told a special All Party Parliamentary Group for Drug Policy Reform session on the document, as ‘all of the press pieces and political messaging were about tackling middle-class drug users, zero tolerance and bashing down doors. But the vast majority of it is about other – and broadly more sensible – stuff.’

Mike Trace: Welcomed the ‘whole system’ approach

The most influential page of the entire document may well be page 60, he said, which contained a framework of the strategy’s objectives – ‘if you want to read just one page to see what’s likely to happen in the future, have a look at that matrix.’ The three headline objectives were reducing overall drug use, reducing drug-related crime and reducing drug-related deaths and health harms, with the government saying ‘very clearly that it wants a whole-system approach, with the money spent behind achieving those’.

Prof Dame Clare Gerada: Needs ‘joined-up effort’ on underlying causes

‘I broadly welcome the strategy – it’s about trying to bring people into treatment, providing them with evidence-based treatment, looking for the people who are hard to reach, and trying to prevent people from getting into substance misuse in the first place,’ said former council chair of the Royal College of General Practitioners, Professor Dame Clare Gerada. ‘I think it will go some way towards addressing the problems we face. But we do need to address the underlying causes, and the ACMD has told us this many times – the deprivation, the hopelessness, the lack of housing. Unless there’s a joined-up effort then I’m not sure just a drug strategy in isolation is going to touch those underlying social causes.’

Drug poisoning and overdose deaths were being overtaken in terms of mortality by long-term conditions among people who use substances, Harry Sumnall of Liverpool John Moores University pointed out. These couldn’t be separated from drug treatment services, said Gerada, with the aging population now dying from co-morbid conditions such as cancers and cardiovascular disease. ‘I started my career going into needle exchange schemes carrying my equipment in a tiny bag and treating intravenous drug users who had no access to healthcare – doing cervical smears, blood tests. That would be completely illegal now, because it wasn’t CQC registered.’

Prof David Nutt: What are they actually going to research?

‘I was disappointed by the one paragraph on research, because it doesn’t actually say what they’re going to research,’ former ACMD chair Professor David Nutt told the session. ‘We should be researching safe injecting rooms, and if we’re not going to do it in England we should do it in Scotland.’ We should also be establishing pilot sites for drug testing, he said, as there was a real threat that the American fentanyl epidemic could hit the UK, as well as evaluating current initiatives such as Project ADDER and Scotland’s ‘innovative decriminalisation approach’ to see which provided the best outcomes. Another disappointment was the lack of any mention of alcohol, he added – ‘it has a huge impact not just on deaths from other drugs, but the health harms from other drugs.’

In terms of supply reduction, the document was ‘broadly saying let’s follow the same strategy we’ve followed for 50 years and hope it works this time’, said Trace. ‘You need to be clear on the outcome you’re hoping to achieve.’ In terms of the reducing drug-related crime objective, the government needed to articulate what it meant by that, he said. ‘Let’s say we want less violence related to the market, less victimisation of vulnerable people – if those are clearly articulated then we should be looking at different PCC areas to see which initiatives they’re following and who’s getting the best results. That’s eminently possible, but you’ve got to set your objectives first because we’ve been measuring the wrong stuff for 50 years.’

‘I did get a sense that it was a “year zero” statement – there’s no literature review,’ said former chief constable of Durham, Mike Barton. When it came to talk about clampdowns on middle-class drug users, the reality was that they were ‘immune from policing’, he said, and always had been.

Mike Barton: Crackdowns can increase violence

‘And when we talk about crackdowns, if we take out organised crime groups then we’ll just increase the violence. As soon as there’s police intervention you’ll see a significant rise in violence, because the police destabilise the market. I’m not saying we shouldn’t enforce the law, but there’s a direct effect from that destabilisation.’

The document discussed ‘world-class intelligence’, but the one system used to track organised crime was the Police National Database (PND), he pointed out. ‘That’s the only mechanism, but the PND has been starved of any development by the government since 2017. If parliamentarians want this to work, then the Home Office has to be confronted with the withering on the vine of the only intelligence system we have in the UK to tackle it.’

County lines gangs operated by ‘cuckooing’ – finding vulnerable people and using their homes as a base for moving into local drugs markets – so it was vital to ‘capture those cuckoos’, he said. ‘When we’re talking about the criminal justice system getting tough, the people the police are capturing at the moment are principally victims themselves,’ with a significant decrease in the mean age of people involved in drug distribution.

On the subject of prisons, the worry was that ‘we can’t actually cope with the number of offenders coming out at the moment. The one thing you have to do is make sure it’s not the drug dealer who meets them coming out of the prison gates, and that’s what we tried to concentrate on. At the moment, we dislocate them from their family support network, then release them on a Friday with about 50 quid and if they’re lucky a travel warrant. So I worry about any expansion of prison places because we can’t make safe the people coming out as it is.’

‘Whatever happens with the rest of the strategy in the coming months, we do have an opportunity to invest more in treatment, which is the one area of consensus,’ stated Trace. ‘And I’d like to put out a call to the politicians to make sure that as we do that we don’t fall down the rabbit hole of “do we have a substitution treatment system or recovery/abstinence system” – we need a menu of treatments. Politically and professionally we’ve got to keep saying that, because there are people who still think it’s either/or. And in this political climate we do need to be very careful about bringing in punitive methods to push people off their prescriptions, because that will raise the death rate rather than bring it down. You achieve recovery by motivating and encouraging people to choose a different pathway, so everywhere we have this debate – from the House of Commons down to local drug projects – we’ve got to remember that we’re talking about having high ambitions for our clients.’

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