Select Committee on Home Affairs Minutes of Evidence

Examination of Witnesses (Questions 340 - 359)



  340. Mr Hayman?
  (Mr Hayman) I understand the debate you are proposing. I just think the right people to be asking that are the medical people. When you look at the evidence it does not necessarily follow that prescription of heroin would give you the results that you are describing, but they will know better than we will know.

  Chairman: We are going to be asking them.

Mr Cameron

  341. We are trying to get the police perspective on this point. I was quite interested in something you said that most deaths from heroin are from overdoses. I think I am right in saying that 39 people died last year from unclean heroin in Edinburgh. That is a huge amount, is it not?
  (Mr Hayman) Yes, one is.

  342. If these addicts had access to prescription heroin none of those people would have died.
  (Mr Hayman) I am tempted not to get into the medical bit but what I have read is that the overwhelming evidence is that by getting them into treatment is a better gain and more satisfactory long-term gain than it is prescribing heroin. Again I would have to bow to other people's expertise on that.

  343. What proportion of property crime is drug-related?
  (Mr Hayman) We know that, do we not? If you look at the issue that is going on with the drug testing of arrestees, we have got figures of 80 per cent. It just so happens I thought it was a very interesting brief read, the NTORS study—


  344. What is it?

  (Mr Hayman) National Treatment Outcomes Research Studies. It is a very, very easy flip read. If you look at drug-related crime: "During the course of the study—which has been going on for some years now—"there were marked reductions in criminal activity—this is following treatment—" At one-year rates acquisitive crime had approximately halved among both residential and community clients. These improvements were maintained at the two-year and four- to five-year follow-ups." NTORS is not the only research that is being done. There are other bits of research and others are more informed than I am. Every indication is that with drug-related crime if you get people into treatment you can cut this revolving door syndrome of continual offending.

Mr Cameron

  345. This is where I think the police and the medical fraternity are coming quite close. Everyone agrees that the way to reduce crime is to get people into treatment. Do you think a heroin addict is more likely to get into treatment when they come into contact with the criminal justice authorities because of the crimes they are committing or if they are having heroin prescribed by a doctor and they are already in a medical environment?
  (Mr Hayman) Whether you are in the scenario of a doctor prescribing will not necessarily have an impact on the level of drug-related crime, they may still be committing that crime. I think we need to get a much more informed view on this. It follows that at the three points of intervention for treatment—and I do not think like the word "control" but I am sure you understand what I am saying here—we are in control of the situation that client. We know the client will go in and out of treatment and it is problematic but nevertheless the agencies there are working closely with that client, and the end game is that they, hopefully, will come off that addition and drug-related crime will come down. I am not sure that the evidence indicates that by prescribing heroin that is the same end game. It does not improve the situation too much other than what you have said in highlighting those 39 deaths.
  (Mr Howard) Could I pick up a couple of points. Again I do not recognise necessarily the evidence base for some of those comments. If we look at the Swiss experiment on the prescribing of heroin particularly for intractable cases (I think you may have had copies of the recent Lancet article made available to you) the evidence there is very sound; that in certain circumstances, for certain groups of people, prescribing heroin is very, very successful is reducing crime and, indeed, can be a bridge into treatment. Not necessarily treatment in its own right but it is a bridge into treatment. Can I pick up the other question Mr Cameron raised and that was about the link to drug-related crime. This is an incredibly complex area. We commissioned Professor Mike Hough as part of our evidence to you to do an international review of the evidence base about what the linkage is between drugs and crime. What he found is that for most people who have heroin problems their drug addiction, if I can put it that way, their drug dependency is so inextricably inter-linked with their criminal behaviour that trying to derive causative effects is very, very difficult. What is found is that most people's criminal careers started well before their drug use started. These people were engaged in criminal behaviour well before their drug behaviour. For most other forms of drug use, recreational drug use, there are those people who are essentially law-abiding citizens who use ecstasy or cannabis at the weekend. Their major crime is obviously in the possession of it. And there are other criminals who are, if you like, engaged in a lifestyle where drugs is part and parcel of that lifestyle and it is not necessarily a driver, it is not a causative factor, so disentangling the extent to which drugs cause crime is difficult. I think Andy is quite right to say and as I said earlier, treatment is really the jewel in the strategy crown. The evidence base does demonstrate that you can reduce criminal behaviour by targeting particularly heavy heroin users and crack cocaine users as well.

Mr Watson

  346. Just to follow on from that, Mr Howard. You say in your submission that there are 100,000 people, those people with so-called "chaotic" lifestyles who are engaged in crime to finance their habit, and the figures show that the average veteran heroin addict requires £13,000 of street heroin to finance their habit. When you were talking about the possibility of people being prescribed heroin, were you talking about those 100,000 people?
  (Mr Howard) I think some of those 100,000, the intractable. We know that a lot of people go into treatment and fail, come back out again, and go through this cycle. We have commissioned research in the past and a lot of people, especially youngsters, are triggered into more severe use by instances like bereavement. There are some people where heroin prescribing can be a very useful bridge into treatment. There are others who can successfully benefit from methadone programmes and there are others who can successfully benefit from much more structured abstinence based programmes. I think one size does not fit all and I think we need to be aware of that and we need a range of responses. The only thing I would add is that in this country, of course, doctors can prescribe heroin if they have a licence, and we have had some of that going on for some time, although not on the scale and not perhaps in a structured way as in other countries.

  347. The Home Secretary in his submission to us announced a five-fold increase in the prescription of heroin from 300 to 1,500. In your view, is that an appropriate number of people who would benefit from the prescription of heroin?
  (Mr Howard) I cannot honestly answer you and say and it should be 1,500 or 2,000. You need a clinical assessment and you need to look at the individual careers of people. I do not think we have enough evidence to be able to say there is this solid number of people who are intractable and everything else has failed and really we need to focus on those. I cannot answer that precisely.

  348. Would you agree with the statement that says if you prescribed heroin to veteran heroin addicts it stabilises their drug use and you then can attack the causes of their addiction.
  (Mr Howard) Yes.

  Chairman: Mr Prosser has some questions now for Mr Ledger.

Mr Prosser

  349. For more than 20 years ago the Probation Service and other service workers have been pressing for the whole issue of addiction and drugs to come under the umbrella of health and education rather than the criminal justice system. I suppose you were pretty discouraged when the new strategy came in which did not really address that?
  (Mr Ledger) We had concerns about the proportions. Obviously we are at a different end from the police about the breakdown of the budget and the way in which the money has been distributed. From our perspective it seems to be looking at it from the wrong end of the telescope. I need to return to some of the comments that have been made. From my members' concerns and working in the communities with drug users who are on probation or on court orders, where we see the problem they are, of course, by definition, criminals if they are using and they are therefore driven underground in terms of obtaining their supply and the way in which they keep themselves addicted or using. The problems that arise out of that are a significant number of health concerns. People put themselves at risk by sharing needles, by the way in which they use the drug (it is cheaper to inject than to smoke it for instance) and therefore they increase the likelihood that they are going to put themselves at harm. I do not accept Andy Hayman's point about not changing the impact of not just death but health as well, hepatitis and HIV risks. People also are less able to take care of themselves and their dependents, if they have any, and other people around them. They are also less able to find the basics they need, whether it is for their drug use or anything else so they are more likely to resort to crime. We see it as self-fulfilling in the way in which the process works at the moment. We start from the point that we know about people on the basis of their crime rather than the basis of their problem and we would like to see a shift around that. If we can achieve that maybe we will start to feel differently. We have called for decriminalisation and obviously my Association's policy has been that for over 20 years, certainly in relation to cannabis. It is very welcome to see the debate now going on and it is a very responsible debate and people obviously have a different perspective on this. We do not call for or think that there should be a radical or single approach. You obviously need to give signals to people in changing the way in which we see possession, for instance, of all drugs. You have to also look at what you provide to people. Drug use is still a problem even if it is not criminal. So the focus on health and education as well as treatment is absolutely essential. We do not want that to be an isolated event. We want it to be part of the package. It probably involves shifting the budget, shifting the way resources are distributed at the moment. One more thing in a long answer to a simple question concerns harm reduction. Certainly the Probation Service's approach is predicated along the harm reduction technique and of course that in itself acknowledges that people are likely to be engaged in criminal activity. You are trying to reduce the harm, you are not necessarily achieving abstinence. You hope to achieve abstinence but it is through a process of harm reduction. It is built into the system at the moment that one acknowledges there is some form of criminal activity continuing while you are trying to help and assist the person, whether it is the Probation Service or other agencies.

  350. If the Government were looking at ways of legalisation, relaxation or decriminalisation of drugs of any category, might not a less radical approach—and you have explained in your answer this change need not be a radical shift—might not a less radical approach be to look again at the present restrictions and criteria for prescribing drugs so that the licence is relaxed and starts to widen and provide more people rather than just suddenly changing them all overnight?
  (Mr Ledger) I think we would support that because I have been trying to indicate that an evolutionary approach tends to be the best way. We need to be sensitive and certainly we need to look at the evidence and maybe have pilot projects so that we can establish these things very gradually. Whilst obviously it is very important, imperative, that you speak to the medical authorities about this, we would see that as a much more constructive signal because, not least ,it starts to redefine the way drug users see themselves, not as criminals, people who are looking over their shoulder, constantly wondering whether they are about to be back in court or imprisoned, but people who have got a significant problem. It is a problem for them, it is a problem for their families and those who rely on them, it is a problem for the communities where they live because of their pattern of offending behaviour. It starts to shift the way in which people see themselves and the way society sees them as well so that could be very positive and, yes, it is a very gradual and careful approach.

  351. On the question of treatment, on occasions I get drug addicts coming into my surgery looking for treatment crying for help, looking for a way out and it is much more difficult to engage them in rehabilitation or detox if they are that category of people who have just managed to keep a roof over their heads and keep their family together and are surviving, as opposed to the common picture of the addict, living a chaotic, harum-scarum, unstructured life, and they make the point to me that if they were to widen their habit and become more involved—some of these people are supporting support their habit out of their own funds their own earnings—if they were in the other category and committing serious crimes then they would have more chance of accessing the services they are seeking than otherwise. Have you got a view on that?
  (Mr Ledger) Anecdotally I was talking just yesterday to a colleague in the North of England who works as a probation officer delivering drug treatment testing orders and he was saying that they had an initiative in his area where people can fast-track if they are on those orders for treatment. He comments that it is still very difficult to actually obtain funding via local authorities, which has been the case for some years. Yes, there would be an irony if that were the case. I do not think our experience is that that is the case. We have a huge and very difficult problem now getting even doctors' referrals. There are some hostel workers who have people in probation hostels awaiting trial or perhaps as part of the sentence, who are saying it can be six to eight weeks to get a doctor's appointment, let alone then move on to the stage of detoxification and then into treatment or rehabilitation. So actually you can be looking at a process over several months and for people who are quite chaotic and somewhat desperate that does not work. No, there cannot be rewards for offending and I understand the concerns about that, that would not be right. At the moment the only way—not the only way—a significant way in which we pick up people who have got drugs problems is via their appearance in courts and their processing to agencies, such as ourselves, who then can refer them on. If there is a different way of thinking, if there is a way that actually means that people do not feel they have to go underground for their drug use, then maybe we can draw people into the community and ensure that everybody gets a fair and equitable opportunity to get treatment.

  352. The union has held its opinions for a long time but to what extent are those opinions guided by the academic studies that you have told us about as opposed to actual every day, on the ground anecdotal stories from people who are dealing with them day-in and day-out? Why do you think that the views of your members vary so significantly from the views of the Superintendent members and the Police Federation members?
  (Mr Ledger) Obviously, although we are in the same system we have a different job to do. As I indicated when I first answered earlier, we work with people at the other end of the system after court rather than in terms of apprehension and prevention. Obviously the police are charged with protecting the community through direct apprehension and prevention in that way. We are then dealing with the people in terms of why they have done it. We are beginning to ask the questions why are they here with us, why have they done this, what are the problems and issues around that? That obviously gives us a different perspective. Yes, we have probably drawn anecdotally more over the years on what our members have been saying throughout England, Wales and Northern Ireland in terms of their experiences rather more than the scientific studies, although obviously evidence is mounting and we have quoted some of it, the people next door to me are quoting a great deal of it. That seems to be influencing the debate more broadly so we are probably less exceptional in the view that we have been expressing now than we used to be and that is very welcome.

Mr Watson

  353. Mr Howard, I am going to ask you about the National Drugs Strategy. I know you have submitted evidence to say the performance indicators need to be changed but if we could focus on the current strategy and then talk about what you want to see changed. Do you think the current strategy is working and, if not, can you highlight areas where it is not?
  (Mr Howard) If I can leave the law aside just for a moment. I think there are three broad positive areas that we must recognise. One is I think there is a very clear political leadership and a priority given and a readiness to address the issues. I say that not only for the UK but in Scotland, Northern Ireland and Wales where there are corresponding strategies. I think it has given a strong focus for bringing people together, for giving this issue a profile, helping the debate locally, nationally, and leading to a much better understanding of the issue. I think that is one very important area. The second area, as Andy indicated earlier, is I think there are more resources going into, if I can put it this way, the right areas of the drugs strategy. If we look at the evidence, as I said, about treatment, the success of treatment, there is more money going into treatment and that is good. Whether it is sufficient to keep pace with the expectations and the growing demands, members from my organisation have quite severe doubts on. I can elaborate on that if you like. I think that is leading to better service development, better treatment options for an awful lot more people. I also want to add I think there are more resources going in to education and prevention work, which is very welcome, money and resources going into help local communities so that tenants' groups, residents' groups and people like that begin to address the problem, and that is good. The Chancellor in the last Budget announced extra money for people going into work based programmes. All these are very, very good. One of your colleagues mentioned process factors and I do not think we should under-estimate these. These are very, very critical in trying to get a better response; long overdue, I would hasten to add from the view of my members. The other issue, as Andy Hayman has recognised and my members are saying, is it has brought together people better at the local level. That is not to say it is all well. A lot more needs to be done. They are the good things. As I say, on the downside of this, we have 900 member organisations drawn from a whole range including police, probation, education and health.We are unique in that respect, having a very broad membership base. We surveyed them and what they were saying to us was that they felt the strategy was too skewed to the criminal justice, the enforcement aspects. Much more needs to be done in reinforcing public health issues, treatment and areas around prevention. Much, much more needs to go into that. I mentioned the balance of spending earlier. I mentioned about the strategy targets, that these are not responsive to local needs. An inner city area in Birmingham does not need necessarily the same sorts of targets, or cloning the targets that come down from on high, as in, say, Worcestershire or somewhere like that. There needs to be much, much more local sensitivity there. Where we have to ask the question "is this strategy working" is in the prevalence rates. We still have the highest prevalence rates of drug use across Western Europe broadly speaking and we have the harshest penalties. There must be some questions raised in our minds, all our minds, is that right, is that what we want to achieve?

  354. Could you just say why you think that is the case?
  (Mr Howard) I do not think there is any simple explanation for drug use, for crime even. I think there is a whole mixture of reasons for that. There are cultural reasons. I just think we need sensitivity around this. If we had a simple answer we would have cracked this problem a long time ago. It is a very rich, difficult problem.

  355. Sure. If we were to recommend changes to the National Drugs Strategy, what would be your main priorities? What would you say we should do?
  (Mr Howard) We have said in our evidence to you we support what the Home Secretary has proposed in the reclassification of cannabis. Our members were overwhelmingly in support of that. We would also say that the Government ought not to lose the opportunity to look at the fine tuning of the classification of other drugs as well. I think a contemporary risk assessment would suggest that some of the drugs, and other people have talked about ecstasy and LSD, are not of the same order as heroin and cocaine. I think we would recommend that the Government ask the Advisory Council on the Misuse of Drugs—I declare an interest having been a member of that—to look at that and argue a risk assessment be done. We would want to see that. We would also say, and this may be more controversial, we think that for simple possession of any proscribed drug criminal proceedings, criminal sanctions, are not the most appropriate vehicle for dealing with this problem. Having said that, you will be thinking, "does this send a wrong message", and do we abrogate from international treaties? We do not say that. We recognise that we are obliged under international treaties to prohibit drugs, in fact to criminalise them. What we would say is there are a raft of other measures that have been adopted throughout Western Europe, in Australia, in Alaska, and I know that has been an issue before you. There are other alternative measures that can be used to actually show disapproval and signal disapproval. In Italy they take driving licences away and there are other measures that can be used. In Australia they use fines. There are other measures that can be used to signal disapproval but which do not involve the full weight of the criminal law being exerted on users.

  356. So we are back to this de facto decriminalisation, if I can take you through that. Are you saying de facto decriminalisation should apply for all drugs?
  (Mr Howard) Andy Hayman has come up with the issue around language. All I would say is let us ask the question," are punitive sanctions and the weight of the law the best way to deal with the drugs problem facing the world today"? I think the international evidence that we have before us from other countries where they have adopted a less punitive approach is they do not put people in prison for minor offences. Where they use other sanctions, is there is no evidence that this has led to increased drug use, drug consumption, nor that it has led to increased crime. That is what we want. We do not want to see crime go up, we do not want to see consumption go up. We have to ask the question is the law an effective vehicle for that? I think on the evidence that we have we have to raise questions about that.

  357. If I can take you through the specific drugs. You have been very clear on cannabis and you have said that the Government should consider reclassification of ecstasy and LSD as well.
  (Mr Howard) All other drugs we would say.

  358. Other than cocaine and heroin?
  (Mr Howard) We would say that the Advisory Council ought to look at the whole issue because it is about bench marking. Some are more serious than others.

  359. Okay. With ecstasy, do you think that the law currently prohibits effective harm prevention strategies? I am thinking in particular of purity kits and licensing laws. Would you be in favour of broadening the law to allow purity kits in clubs, for example?
  (Mr Howard) The European Monitoring Centre for Drugs and Drug Addiction recently published a report looking at pill testing arrangements that operate in different States and found these to be quite an effective measure in terms of harm reduction. What I would say though is my understanding from the Forensic Science Service and all the analytical information, is that by and large, most of the substances that are found that go under the name of ecstasy or whatever are relatively pure. Whether there is a harm reduction need in terms of risk of toxicity and things like that, I think there is a question there. But in terms of getting out much better health information, much better harm reduction information—it was the Police Foundation that made the comment—we are sending the wrong signal to youngsters by classifying ecstasy and LSD alongside heroin and cocaine. I think it acts as an obstacle to some of that important harm reduction work

  Mr Watson: I just want to focus on heroin and crack cocaine. You have said there should be an extension of the prescription of heroin to long-term offenders. I just want to talk to you about some of the important practical points in relation to that.

  Chairman: Briefly.

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