Select Committee on Home Affairs Third Report


Specialised treatment for drug misuse and addiction

220.  The Committee believes that much could be gained in reducing the harm associated with drugs if the treatment element of the Strategy was further strengthened. The Government's commitment to treatment is clear:

    "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".[201]

221.  Nonetheless, we believe more could and should be done if the levels of need are to be adequately met. A recent report from the Audit Commission on community drug treatment services for adults found that drug users were faced with a number of problems in accessing treatment, including lack of appropriate services, long waiting lists and inflexible services. These problems are compounded by the inadequate training of many drugs workers, poor care management and co-ordination, patchy joint working between agencies and poor links with primary care.[202] Mrs Tina Williams described to us the problems she experienced when trying to find help for her son with his heroin addiction:

    "not only were there no services but there was the "shame and blame" culture where they said to him that, if he could not manage on 20 mls of methadone after he had waited six months, then it was his fault, not theirs. Then, it would be my fault because I was not tough enough, that I should chuck him out onto the streets, that I should refuse him a bath. This was the kind of support that we got from our local services and they still continue to peddle that type of information...I just wish that help could have been there sooner because he has thrombosis in his legs and he has a lot of nerve damage and vein damage, but at least he is alive...In this country, three people die a day from addiction and I think it can all be avoided. If the services were in place, then death could be avoided".[203]

222.  Many, if not most, of the witnesses to the Committee have been keen to impress upon us that the drugs issue is, at root a health rather than a criminal justice issue, and that it is both more appropriate and more effective to address it as such. With this in mind, concern has been expressed that responsibility for drugs policy has moved to the Home Office from the Cabinet Office. The drugs charity, Release, told us in evidence that "It is obvious that neither the use nor the misuse of drugs should be dealt with by the police and the criminal justice system".[204] A survey conducted by Drugscope of its 900 members (of which almost one third responded) found that "The main way in which the drug strategy is thought not to be working was in the over-emphasis on the criminal justice elements of drug misuse, and that this focus has had adverse effects on the health agenda".[205] The Substance Misuse Faculty of the Royal College of Psychiatrists told us that "We believe that criminal justice initiatives are in conflict with health priorities".[206] In a recent policy review, the Association of Chief Police Officers said:

    "The diversion of misusers of Class A drugs into treatment must be the primary aim to achieve greater impact in reducing demand...[the Association] looks forward to when detainees appearing in court following the misuse of Class A drugs are able to have the opportunity to immediately access treatment...diversion direct to treatment should be a real option rather than a caution or in some cases a conviction".[207]

223.  The Association of Chief Police Officers said in evidence that the division of funds "may represent a disproportionate distribution of resources".[208] Mr Keith Hellawell told us:

    "When I first looked at the amount of money we spent on anti-drug activities in this country in 1998, we spent 63 per cent of all our money on the criminal justice system. I said in my first report to the Treasury that two thirds of our money spent on dealing with the consequences was a bad policy".[209]

224.  The Minister told us that this is changing. He said: "one of the myths...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". He went on to emphasise:

    "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".[210]

225.  Nonetheless, we would still question the effectiveness of money spent on criminal justice interventions of questionable effectiveness which could more usefully be put into treatment. Treatment of drug users is imperative on ethical grounds. As Mr Nelles of the Methadone Alliance told us, drug users deserve palliative and, where possible, curative treatment:

    "Because they are human beings, they are our brothers, they are our sisters, they are our family, they are part of the fabric of our nation. They may have made a choice which was mistaken and they will pay for that choice in many cases, but I certainly do not think that we should abandon our commitment to these people as human beings and as people who need the best treatment and the best interventions we can give them".[211]

226.  There is also a strong evidence base which demonstrates that treatment works for many drug users. This should be the main basis for health care. The UK Harm Reduction Alliance told us:

    "In no other sector of health and social care does service provision prioritise the needs of other members of society above the health and welfare needs of its clients (as the focus on crime prevention does with drugs). This violates the principle of providing services in ways that prioritise the needs of the patient or client and undermines the relationship between services and their clients".[212]

227.  Research from the National Treatment Outcome Research Study showed that:

    "For every extra £1 spent on drug misuse treatment, there is a return of more than £3 in terms of cost savings associated with victim costs of crime, and reduced demands upon the criminal justice system¼The true cost savings to society may be even greater than this".[213]

228.  Mrs Tina Williams pointed out to us that:

    "to put somebody in residential rehabilitation costs about £400 a week and to put them in prison costs £700. If you offer that rehabilitation before the crime is committed, it not only saves the user but it saves the community and the family".[214]

229.  It cannot be said too strongly that, given the damage to the community that the chaotic drug user can cause, investment in effective treatment is in the wider public interest.


230.  Several witnesses described how addiction follows a cycle of behaviour in which there is an optimal time to introduce treatment interventions. As Professor Henry of Imperial College School of Medicine at St Mary's Hospital told us, however, it is rarely possible to point people to treatment at this crucial moment when they come forward asking for it:

231.  Lord Adebowale of Turning Point reiterated this:

"For young people there is a cycle of recovery where people contemplate getting information about treatment. They need that information quickly, they need to access information quickly; if they do not, then they will continue using".[216]

232.  The length of the waiting list and the quality of the service varies dramatically around the country. According to Professor Nutt "it should be possible for anyone who wants treatment to get it within a week". He went on:

    "we are so far away from that it is probably the biggest single hurdle we have. Certainly in Bristol if you are a street heroin user there is no treatment available unless you have some other problem like a psychiatric disorder or you are pregnant, because the services are so stretched dealing with the complicated cases that there is no resource for the simple cases".[217]

233.  The Substance Misuse Faculty at the Royal College of Psychiatrists told us:

    "It is estimated that addictions account for over a third of the health problems treated by the NHS...[however] training in addiction is grossly inadequate...there is an alarming lack of trained professionals to deliver the Government drug strategy".[218]

234.  We welcome the setting up of the National Treatment Agency, with its aim to provide "more treatment, better treatment and more inclusive treatment".[219]

235.  We recommend that training for healthcare professionals in addiction is improved, and we believe that it ought to be possible to provide treatment for those urgently in need within a week.

236.  We also believe that the quality of the service needs to be improved. Drug Action Teams need to make more effort to involve the families and carers of drug abusers and listen to what they have to say rather than simply tell them what is good for them.

Treatment or harm reduction?

237.  In many cases of drug use, treatment is not immediately possible. This may be because effective models of treatment do not exist—for example, in relation to crack cocaine users—because treatment places are not available, or because a user does not come forward to access treatment, however often it is made available to him or her. A new user who has not yet experienced problems with his or her use may simply not see any reason for treatment, or feel that it is necessary. Mr Danny Kushlick of Transform used an analogy with tobacco smoking:

238.  Where, for whatever reason, a user is not taking up treatment, there is still an urgent need for harm reduction actions, which may themselves be a bridge to treatment, to reduce the risks of the user's habit. Harm reduction spans many different interventions, and is an umbrella term for pragmatic action taken to reduce the harm caused by drug use without the necessary predication of abstinence as an end goal or imperative. If abstinence is not immediately possible, appropriate or likely, it is still necessary to deliver interventions which will reduce harm caused, on the basis of humanity to the user and benefit to the community. This is not in conflict with the aim of treatment for users who can take it up; both a treatment strategy and a harm reduction one are necessary, as Mr Nelles of the Methadone Alliance told us:

    "It is very important that we have harm reduction initiatives and prescribing approaches for people who are not able to give up and we have rehabilitation and detoxification approaches for people who do want to give up".[221]

239.  Professor Gerry Stimson of Imperial College School of Medicine, reiterated this point:

    "treatment is only relevant for a very small proportion of the population. Even for those hard drug users who would benefit by treatment there is a long time lag between the development of their drug problem and when they come into contact with treatment services".[222]

240.  Harm reduction actions include needle exchanges, the provision of safe injecting rooms where injecting users can take their drugs in hygienic conditions, and advice on safer injecting and using techniques. Harm reduction is based on the idea that improving the health and lifestyle of the user who poses a danger to him/herself or to others is more important than abstinence. In the words of the UK Harm Reduction Alliance:

"Harm reduction is a pragmatic approach that:

  • accepts (while not necessarily condoning) drug use;

  • recognises the poor results of drug supply and demand reduction policies (desirable as these may be); and

  • targets achievable changes in the way drugs are used".[223]

241.  Harm reduction is becoming a matter of some urgency in relation to blood-borne viruses—particularly Hepatitis C—amongst drug users. Similarly, preventable overdose deaths could be targeted by concerted harm reduction:

    "the number of overdose deaths caused by illegal drug use in this country is unacceptably high. Most injectors take their drugs in isolated, unsanitary conditions so that where an overdose occurs, first aid responses that could save a life are rarely available. In some areas of the country, innovative schemes have had a big impact on death rates. For example distribution of naloxone, first aid training for users. (Injection rooms established in other countries are also showing promising early results.)"[224]

242.  Several witnesses pointed out that it was through harm reduction that the UK managed to stave off a major AIDS epidemic in the 1980s and early 1990s:

    "Between 1987 and 1997 Britain led the world in developing a harm reduction approach to drug use. The clearest achievement was in the prevention of HIV infection among people who inject drugs (by heeding advice outlined in the 1988 report of the Advisory Council on the Misuse of Drugs). The UK has thus far averted an epidemic of HIV infection associated with drug injecting and there is evidence that harm reduction has resulted in lower rates of Hepatitis C Virus (HCV) infection than found in comparable countries".[225]

243.  While we welcome the continued acceptance and promotion of harm reduction principles by the Department of Health and the National Strategy, we believe that not enough emphasis has been explicitly placed upon this approach. Mr Trace, former Vice UK Anti Drugs Co-ordinator, told us that "the drug strategy did not prioritise action in this area because it was felt that existing actions were sufficient". In his opinion, it has now become clear "this area of activity does need further attention, as new generations of injectors who have not been exposed to previous campaigns emerge". He proposes that the strategy should add a fifth key objective of "reducing the number of deaths and infections relating to injecting drug use, with a well-resourced programme of actions aimed at reducing infections and overdoses".[226]

244.  Mr Ainsworth told us: "we are looking at introducing to a greater extent in the Drug Strategy the concept of harm minimisation"[227] as part of the stock-taking review. The UK Harm Reduction Alliance suggested adding a specific target along the following lines:

    "Individual and Public Health—To minimise harm to the health of individuals and communities arising from drug use".[228]

245.  We recommend that a target is added to the National Strategy explicitly aimed at harm reduction and public health, in addition to the Treatment objective. This target should be measured through two indicators: to reduce the number of overdoses (measureable through Accident and Emergency records) and to reduce the number of new infections through injecting of HIV and Hepatitis (measureable through medical records of drug users).

201   Mr Ainsworth, Q. 1288. Back

202   Changing habits: The commissioning and management of community drug treatment services for adults, Audit Commission, 2002, pp. 33-61. Back

203   Q. 1356. Back

204   Ev 165. Back

205   Ev 80. Back

206   Ev 174. Back

207   A Review of Drugs Policy and Proposals for the Future, the Association of Chief Police Officers, Drugs Committee, April 2002, p. 15. Back

208   Ev 23. Back

209   Q. 67. Back

210   Q. 1280. Back

211   Q. 603. Back

212   Ev 189. Back

213   NTORS at one year, p. 51. Back

214   Q. 1382. Back

215   Q. 519. Back

216   Q. 567. Back

217   Q. 519. Back

218   Ev 174. Back

219   Mr Paul Hayes, Chief Executive of the National Treatment Agency, Q. 41. Back

220   Q. 256. Back

221   Q. 615. Back

222   Q. 521. Back

223   Ev 188. Back

224   Mr Mike Trace, National Treatment Agency, Ev 182-3. Back

225   Ev 188. Back

226   Ev 182-3. Back

227   Q. 1273. Back

228   Ev 189. Back

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