Examination of Witness (Questions 1280
TUESDAY 12 FEBRUARY 2002
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
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.
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 ofwhat
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
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
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
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.
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
(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.
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
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.