Select Committee on Home Affairs Minutes of Evidence

Examination of Witness (Questions 1280 - 1299)



1280.  You mentioned the actual number of treatment places and that provision is very patchy. Let's assume that the recommendation is that there need to be a lot more treatment places for stimulant users. How confident can you be that the Government will provide those places?

  (Mr Ainsworth) As I have said to you, we have substantially increased the amount of resources for the Drug Strategy overall and one of the myths, I think, that is sometimes peddled by those who advocate a substantive change to the legal framework that we have in this country is that we over-concentrate on prohibition and criminal justice and the enforcement measures as against treatment measures, but over the last few years we have moved substantial amounts of money in terms of the proportion of spend towards treatment. We have not cut back on the amount of money that we are spending on availability, but as the amount of money has grown, the amount of money that we spend on treatment has grown substantially. For instance, in 2000-01 the amount of money already allocated only represented a third, 33 per cent, of the money within the Drug Strategy just for treatment, and by 2003-04 it is estimated that it will grow to 40 per cent, so that is 40 per cent of a growing amount of money as against 33 per cent of the amount of money in the year 2000-01, so there are substantial resources going in now to providing treatment facilities.

Mrs Dean

1281.  We know that in Staffordshire and parts of Nottinghamshire there is a scheme whereby those who are charged with such crimes as burglary are being tested when they are charged. Of course we are talking about acquisitive crime here. Has there been anything learnt from that so far and could you tell me whether there are links into treatment from that scheme?

  (Mr Ainsworth) Your whole remit as a committee has been, "The Drug Strategy: is it working?". Perhaps I may make a couple of general comments, and then come specifically to the point you raise. I think that if you make that judgment, and this is something you will be deciding in the near future with regards to drawing up your report, if you make that judgment in terms of, "Has the Drug Strategy already now had a massive impact on use here in this country, or are we going to be able to hit every single one of our targets?", then I think that your report may well find in the negative, but if you judge the Drug Strategy on, "Has it managed to allow us to focus the effort that is needed into the most efficient and into the areas that actually work?", then you will see that there is a massive amount of work which has been done which is having a very real effect on the problem of drugs in this country. Now, the communities target within the Drug Strategy, which is really at the moment defined as a re-offenders target, has led to the kind of initiatives that are now being piloted in Staffordshire, Nottingham and Hackney where we are testing people, whether they are being charged for acquisitive crimes or drug-related crimes, for the two class A drugs that are known to be associated with those acquisitive crimes, that is cocaine and heroin, and a very high proportion of those who are being charged are being shown to have tested positive. Something like, across the three, 50 per cent of those who were being tested were shown to be positive for either or both of those substances, and that has enabled us either to get them into treatment by a DTTO, a drug treatment and testing order, or if their problem is not perceived to be of a level where a DTTO is necessary, then we are able to apply a drug abstinence order or drug abstinence requirements. So the criminal justice system is giving us the opportunity to get people into treatment and we would not be developing the kind of initiatives that we have piloted in Staffordshire and I do not think we would have pushed out arrest referrals to now where we have got it in practically every police force in the country without the focus that the Drug Strategy has given us.

Bridget Prentice

1282.  Minister, I am going to take you through the question of heroin. First of all, I want to ask you about numbers again and I will try not to ask you to repeat answers which you have given us earlier. Then I want to talk about treatment, particularly in prisons, and then finally about prescription. Can I just go back to the question of numbers, and I understand the difficulty, but can you give us even a broad indication of the numbers of people that the Home Office believes are heroin addicts altogether and those who are on treatment programmes, if those figures are actually available?

  (Mr Ainsworth) I gave you the figures for all class A which was 160,000 to 240,000 problematic drug users. I am just trying to put my hands on heroin on its own. We have got about 118,000 people in treatment at the moment and that is growing at a rate of 8 per cent a year which is just above the target that we set in the Drug Strategy which will require at least 7 per cent annual growth in order to reach the levels of treatment that we are attempting to reach. Those are not just heroin figures, I am sorry.

1283.  If we can come specifically to heroin users in a moment, just for the record, can you explain the difference for me between problematic and non-problematic heroin users?

  (Mr Ainsworth) Explain the difference? I think there are people who have managed, and I think they are relatively few with regard to heroin, but there are people who have managed to use heroin for a period of time and yet maintain a stable lifestyle and not fall into addiction to the extent where it begins to be a massive problem with their lives, they lose their jobs and they turn to crime or prostitution or whatever in order to fund their habit. There are probably more people who fall into those categories with other drugs than there are with heroin which is a highly addictive substance, as you know.

1284.  But there would be a small number of—what were the numbers, did you say, for heroin? According to a reply that you gave in a written answer, there are 46,000 users. Does that figure ring a bell?

  (Mr Ainsworth) Forty-six thousand?

  Chairman: That is in treatment, is it not?

  Mr Cameron: No, that was users. It was my written question.

Bridget Prentice

1285.  That was 16 to 24-year-olds, a figure you gave from the British Crime Survey. This is one of our problems, actually trying to pin down some idea of numbers. In proportion to the population at large, the number of people who take drugs of any sort is very small. Within that, those who take hard drugs is quite tiny.

  (Mr Ainsworth) Yes, but this is an area where it is extremely difficult to pin down exact figures, for a start. I said "problematic users" and you can see the range that there is there. From 160,000 to 280,000, there is an enormous variance between the top and the bottom of that. The overwhelming majority of those problematic drug users are heroin addicts.

1286.  How many of them have any relationship with a treatment programme?

  (Mr Ainsworth) Again, as I say, there are 118,000 places of treatment in the country and that is overwhelmingly opiate users.

1287.  Do you think that the NHS has the capacity to treat problematic opiate users?

  (Mr Ainsworth) You will know, and I am aware of the evidence that was given to the Committee, about the problems that we have got with regard to GPs becoming involved with drug treatment overall, not just heroin treatment. As we are attempting to grow the treatment facilities and all these other measures, like DTTOS, the interventions that there are within the Prison Service, drug abstinence orders, they are not going to work unless there is the treatment there to back them up. They are not going to be successful unless we manage to increase the preparedness to be involved in treatment. That is the whole purpose of the setting up of the NTA and we are looking to the NTA to provide training, quality assurance and to do a proper evaluation of where the gaps are, to see to it that treatment is widely available where it is needed, so yes, with the money that is going in and with the input of the NTA, we think that we can substantially grow the treatment facilities that there are in the country at the moment. It is, as I say, on target with regard to the growth that was anticipated within the Drug Strategy.

1288.  What sort of target is that? Are we talking now over a ten-year period?

  (Mr Ainsworth) Well, in order to hit the targets, we need to grow treatment at about 7 per cent per year. We have managed to grow it at about 8 per cent per year, so we are really ahead of target at the moment.

1289.  That is good to see that some people are reaching their targets, if not everyone. I will come back to the question of treatment and GPs in a moment. Let me first look at treatment in prisons because some of the evidence which has come before us seems to suggest that where users end up in prison, their treatment will either stop or they will be given a different type of treatment and all the problems which may arise from that and that particularly if their treatment stops, they are then met at the doors of the prison on their release by the sharks who are prepared to sell them the drugs again and put them three steps back if they have even managed one step forward in the first place. What plans have you got to ensure that people who go to prison can have some kind of continuity of care?

  (Mr Ainsworth) This is a major problem and this is one of the biggest problems that we need to confront and I would suggest to you that it is caused by the fact that we have managed to grow in triplicate capacity within prisons at a much faster rate than we have managed within the community. If you go back just a few years then prison involvement in effective treatment was practically non-existent. It is not true to say that detoxification is the only thing that is available to people in prisons. Where people are on remand or where they are on very short-term sentences, an evaluation is done when they enter prison as to whether or not detoxification is appropriate or whether or not they need some kind of maintenance because they are just not going to be there for long enough to be able to control that situation. One of our main needs with regard to where the Drug Strategy goes now is effectively to pick people up on release and that is not easy and it is not cheap. We run the prison estate in as efficient a manner as we can and in order to do that, to get effective follow-through so that we are not losing people as they come out of prison, is a massive difficulty, but a lot of effort is being made in terms of advice to prisoners on pre-release, and there is a video which has just been made available warning people of the risks of overdose because their susceptibility to these substances has been massively reduced, or they may have been using when they first went in or in the earlier parts of their sentence, in order to try to avoid the level of deaths, which I am afraid has risen in recent years, the level of deaths amongst recently-released prisoners, so this is one of the main areas that the NTA needs to look at in terms of the growth of community treatment to make absolutely sure that it is available to prisoners on release, that they are able to pick them up and we do not immediately throw them back on the market at great risk to themselves and at great risk that they will return to the life of crime which put them in prison in the first place, and that is not cheap and that is not easy. This is where we hold our hands up and say, "This is a big job that needs to be done. We are aware of it and this is one of the main tasks of the NTA over the next period of time".

1290.  It is important that you recognise the problem that there is there. Two things really arise out of what you have just said. One is what are you doing about drug use in prison because one of the things which has been put to us is that heroin addicts particularly will not admit to being heroin addicts when they first go to prison, but then end up buying drugs from other prisoners and drugs are fairly freely available in prisons, and there are all the consequences of that, that it is not pure and so on, so what are you doing about that?

  (Mr Ainsworth) There has been a big growth in treatment provision within prison. Since the mandatory drug-testing regime has been introduced within prisons, we have seen a substantial drop in the positives resulting from those tests, almost halving in percentage terms from 26 to 14 per cent, or something like that. I am not sure of those figures—


1291.  You can correct them.

  (Mr Ainsworth)—but there has been a substantial drop in the positives on the mandatory drug treatment. We have got to remember that whatever is wrong or deficient within the prison regime, they have come a very long way in a relatively short period of time and, as I have said, part of the problem that we have got is that they have outstripped the provision in the community and we have now got this very real gap on joining people up when they get released from prison.

Bridget Prentice

1292.  So are you saying then that a heroin addict who is taken into custody will be getting their treatment, partly because they will have had the testing and partly because you will continue treatment that they may have started outside or you will be giving treatment for them, even though there is a risk that they may not continue to receive that when they leave prison?

  (Mr Ainsworth) Well, let me just give you the figures. Since the mandatory drug-testing procedures were brought in, the positives which have come back have fallen from 24.4 per cent in 1996-97 to 12.4 per cent in 2000-01, so it has halved over that four-year period. As I have said, there is often a misrepresentation put around that the only thing that is offered to people in prison is detoxification. That is not the case. Where there are people who are going to be in prison for a prolonged period of time, their sentence is such that people effectively believe that they can go through a detox programme, then yes, detoxification is seen to be an answer. They then need a lot of advice on leaving because if they return to their old lifestyle and their old habits, they will potentially kill themselves and they will certainly wind up with a major problem, but where there are short-term prison sentences or remand prison sentences, there is a proper Department of Health assessment that now applies to all prisoners which is done to see whether or not a treatment programme is offered to them is effective and appropriate to their needs in those circumstances, so it could be, if they are already on a methadone maintenance programme before they go into prison and that has been shown to be beneficial, they will be maintained on methadone within the prison environment.

1293.  You have certainly answered part of the next question. Does every prisoner now get tested?

  (Mr Ainsworth) I am not sure.


1294.  I think they are random, are they not?

  (Mr Ainsworth) Yes.

Bridget Prentice

1295.  I would like to move on now. You mentioned the Department of Health and we have talked earlier about the expert group in relation to cocaine. I presume that this is the same expert group who will be advising on the action plan on the minimisation programmes which will include the possibility of further heroin prescribing. Do you have a timetable for when that decision is likely to be made?

  (Mr Ainsworth) The cocaine group is not the same as the heroin group.

1296.  Different experts?

  (Mr Ainsworth) Yes, in part, if not in whole. Can I just say that on cocaine there is a need, as I said, to drag up the level of involvement, the level of availability and expertise that exists from a far lower level that exists with heroin. On cocaine, because certainly with crack cocaine there is a very real problem at the moment, we know that, for instance, Operation Trident who are looking at trying to deal with the gun crime, black-on-black violence which is taking place in London and has very real cocaine motives in almost every incident, they know that they cannot solve that by just policing alone, so they are looking at community input with regard to how they spread that methodology, so maybe we are going to look at joining together the work that is looking at the treatment side of crack cocaine with the policing side of crack cocaine because there is no need while we ought to be looking at spreading best practice on two separate parallel lines, and there are so many cross-sections between the two, so we may approach the Trident group to see whether or not there is work to be done across the piece. On heroin, this is specifically looking at prescription advice. The consensus group met only last week and they are due to have another meeting in the spring and again before the end of the year we think that we can get to a situation where we have agreement and we need, if we are going to carry GPs with us, we need to try to build confidence around whatever is provided as to what the guidance should be on heroin prescription.

1297.  Have you looked or has this group meeting looked at the results of the trials in Holland and elsewhere? I think the Dutch trial has just reported and the conclusion seems to be very positive.

  (Mr Ainsworth) There were involved in the consensus group some of the experts in both Switzerland and Holland, so we are not ruling out some of the things which are being looked at in those countries with regard to prescription here. We do not necessarily see the Swiss experiment as being the answer to the situation or necessarily better able to reach the people whom we need to reach than community provision. We equally do not see, and I think we need to make this clear, heroin prescription as becoming the main treatment that is offered to heroin addicts. We still believe in the overwhelming majority that it is the ability that is provided by the drug, and because it gets people away from the injecting habit, that methadone will be the most appropriate form of treatment for the majority of people.

1298.  So you would much prefer us to go down the line of methadone treatment than expanding prescribing heroin in very restricted circumstances?

  (Mr Ainsworth) What we are worried about is that the current guidance has led us to be a little too restrictive as to where we are prepared to offer heroin as a form of treatment and that there are situations where people are not being allowed access to that treatment where it may well be appropriate and that is in part because, or we believe it is in part because, of the guidance that we have given and the effective restriction of the guidance which has been given, so what the group is looking at is changes to that guidance, trying to reach the maximum consensus about that change so that everybody can buy into it and feel comfortable with it and we will not get a reaction from health professionals to say, "This isn't working as anything that we have confidence in or that we are prepared to operate within that new guidance", so that we can more appropriately use heroin prescription, and there are people who are in such a chaotic state and are so dependent on the drug that are currently not being accessed to heroin prescription because of the nature of the treatments that are being provided where maybe it is appropriate, but we are not seeing it taking over from methadone as the main form of treatment being offered. Heroin has a much shorter effect on people. There is a requirement to go back repeatedly within hours of a particular episode of treatment in order to get some kind of a boost. Methadone, first of all, it is taken orally so you get people out of the injecting syndrome and also it has a much longer-lasting effect, so they only need to go back on a daily basis and on occasions on a wider than daily basis.

1299.  Let me just ask you one final question on this and that is, is one of the problems of what you are trying to do, either to get heroin users on to methadone or whatever, and you have touched on the business of some GPs being reluctant, is one of the problems not the fact that the Department of Health and the Home Office are ideologically at opposite ends of the spectrum on how to deal with this?

  (Mr Ainsworth) I do not think so. I do not think that is true at all. The consensus event was run by the Department of Health and not the Home Office. We totally buy into the way in which they are trying to examine the appropriateness of heroin injection as a treatment. I cannot perceive a difference between the two departments at all. We have no intention or desire, and I am sure the Home Secretary did not give you the impression that we wanted, just to change the regime with regard to heroin use and to do it without the necessary safeguards and going through the necessary procedures in order to do that. I cannot perceive any reluctance from the Department of Health to examine this issue, to facilitate what is necessary in order to have it properly evaluated, and to change the guidance if that is what is appropriate and if they can get consensus. As it seems from the reports back that I am getting from the meeting which took place last week, there was a high degree of consensus around some new potential guidance.

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