Select Committee on Home Affairs Memoranda


Submitted by the Ethnicity & Health Unit, University of Central Lancashire

  The inquiry seeks evidence on the following:

    —  Does existing drugs policy work?

    —  What would be the effect of decriminalisation on (a) the availability of and demand for drugs (b) drug-related deaths and (c) crime?

    —  Is decriminalisation desirable and, if not, what are the practical alternatives?

  The inquiry will also examine the effectiveness of the 10-year National Strategy on drug misuse launched in 1998 and the preliminary results of the three year research programme costing six million started in 1999/2000. It will look at the revised role of the UK Anti-drugs Coordinator and assess the effectiveness of Drug Treatment and Testing Orders (DTTOs).

  In providing evidence the Ethnicity & Health Unit have drawn on four key areas of recent study:

    —  A substantial literature review covering the last fifteen years and including various reports and surveys undertaken at local levels.

    —  The national Scoping Study on the delivery of drug treatment and prevention services to Black and minority ethnic communities.

    —  A series of service reviews undertaken by the Ethnicity & Health Unit.

    —  The Department of Health drugs misuse and Black and minority ethnic needs assessment project.

  Our main area of concern is with the overall effectiveness of the national strategy and local area service planning and delivery for Black and minority ethnic communities. It should also be borne out that while we are able to draw on initial findings and learning from the process the Department of Health-funded needs assessments project is not yet complete and final analysis of this data is currently under way.

  "Tackling Drugs to Build a Better Britain" (1998) recognises the evidence that has consistently shown that Black and minority ethnic drug misusers regard much of the existing treatment services as run by, and for, white people, that drug workers require training on not only race but also wider equality issues, and highlights the need for better targeting and design of services to capture these client groups. Drug Action Teams (DATs), in the undertaking of needs assessments, are encouraged to take a detailed look at patterns of drug misuse in Black and minority ethnic communities and consider the diversity of cultures that may require services. Consideration is also given to the development of specialist, race-specific services as a method of targeting Black and minority ethnic drug misusers and of harnessing the skills within the Black and minority ethnic communities to tackle drug problems.

  However, the Drugs Prevention Advisory Service (DPAS) Scoping Study on the delivery of drug treatment and prevention services to Black and minority ethnic communities (Ethnicity & Health Unit and Goldsmith's College) found little evidence of effectiveness in meeting the aims set out in the national strategy regarding these issues. This National Scoping Study was commissioned in order to inform the development of the Government's drugs and ethnicity initiative and it aimed to "Provide a clear overview of the issues surrounding the delivery of drug prevention and drug services to minority ethnic communities, and; Identify issues and prioritise areas of work that require further attention."

  Detailed case study analysis of six Drug Action Teams were undertaken, the six teams were chosen from six different geographical points of England, which has a large number of Black and minority ethnic representation, as well as newly established communities such as Vietnamese and Somalian, they also provided a good geographical spread and a diverse range of community types. A total of 99 commissioners, planners and providers of services such as the police, service providers, drugs workers, teachers, and youth workers were interviewed. In addition to these interviews, a community consultation exercise also took place, which was made up of 13 group discussions with 130 representatives from African, Caribbean, South Asian, Somalian and Vietnamese communities and 14 individual interviews were conducted with practitioners and policy makers who were not based in areas studied but were known to have expertise in the area of ethnicity and drugs. Analysis was also undertaken for statistical indicators looking at client representation in the case study areas.

  The study found that:

    —  In most of the DAT areas no local needs assessments among Black and minority ethnic communities have taken place, neither has there been any effectiveness audits addressing the appropriateness of mainstream drug treatment interventions for Black and minority ethnic drug users.

    —  Many of the areas that do have evidence of local initiatives are undertaking these outside of the DAT structure.

    —  Many community groups do not feel able to form effective partnerships with statutory bodies.

    —  Many of the methods for approaching communities, such as talking with traditional and religious leaders often leaves more isolated individuals and families un-represented, this is particularly true in relation to consultation with Black and minority ethnic drug users themselves.

  There is even less awareness regarding the emerging trends and patterns of drug misuse among young Black and minority ethnic people or in relation to vulnerable children. Yet it can be expected, given the emerging knowledge about drug use within Black and minority ethnic communities that young people in these communities will be equally at risk. A number of recent action research projects focusing on Black and minority ethnic communities, clearly show this to be the case, highlighting that these groups have drug taking patterns similar and in some cases more problematic than the white population (Ahmed 1997; Awaih et al, 1992; Bentley and Hanton 1997; Bola and Walpole 1997; The Bridge Project, 1996; Chantler 1998; D.P.I 1998; Gilman, 1993; Khan et al 1999; Mistry 1996; Patel, 1998; Patel et al 1995; Patel 1997a; Patel et al 1997; 1999; Patel N et al 1996; Perera 1998; Shahnaz 1993; Sherlock et al 1997).

  In the Government's 10-year strategy for tackling drug misuse, guidance notes it states:

    "Information, skills and support need to be provided in ways which are sensitive to age and circumstances, and particular efforts need to be made to reach and help those groups at high risk of developing very serious problems" (Chapter three, Helping young people resist drug misuse in order to achieve their full potential in society). (Tackling Drugs to Build a Better Britain. 1998).

  In relation to drugs education and prevention the government strategy goes on to state,

    "Drug education and prevention is best delivered by building cumulatively on knowledge, attitudes and skills. Teachers should ascertain what their pupils already know. This is particularly important at transition points such as the move from primary to secondary education. Drug education and prevention should also be appropriate to the child's age, experience, gender and race".

  The HAS report (1996) examined risks in relation to young people and identified young offenders, truants, school excludees, those in local authority care and those from families where drug misuse was already taking place as being at most risk of developing a drug problem. Black and minority ethnic young people in many communities are over-represented in most of these areas yet standard drugs education often fails to address particular cultural and linguistic barriers. These are issues for Asian children who often miss significant periods of schooling, as a result of the family returning to visit India or Pakistan. For younger children this often has a serious impact on language development making the reception of standard drug education messages problematic.

  Focus groups undertaken by the Ethnicity and Health Unit have revealed some instances where young people have taken leaflets home from school on drugs education and have been "hit" or verbally abused by the family for bringing such pictures in to the home. Young people themselves have complained of the lack of appropriate literature that they can give their parents who don't speak English fluently, in order to help them understand what drugs education is for and why it takes place.

  The Government's 10-year drug strategy supports a programme of action to ensure that:

  1.  Young people from all backgrounds, regardless of their culture, gender or ethnicity, have access to appropriate programmes of intervention.

  2.  All problem drug users, irrespective of their age, sex or ethnicity, have proper access to support from appropriate services with specific support services for ethnic minorities when they are needed.

  Black and minority ethnic drug misusers remain under-represented in drug treatment services. Very few mainstream or even specialist drug services have managed to attract or work with these groups of drug misusers. The ACMD (1998) suggest "the under-representation of Black people among populations of drug users known to agencies might, for example, be a consequence of the failure of agencies to make themselves accessible and meaningful to all members of a multi-cultural society".

  Concern has been voiced by a number of Black community groups about the rise in crime and drug use (MuAAD 1997, Pratt 1997, 1998). Black African-Caribbean drug users are under-represented in the majority of drug services. Furthermore, the over-representation of Black African-Caribbean men in the criminal justice system and the new drug treatment projects planned within the context of prison and probation services suggest an urgent need to develop drug treatment approaches which are culturally meaningful and sensitive. There is now increasing evidence that the number of young Muslim men entering the criminal justice is increasing, many with drug-related offences.

  Current responses are, often poorly assessed, planned, or commissioned and often fail to address the lack of culturally sensitive services, institutional racism and under-representation of Black and minority ethnic drug users.

  In summary, drug treatment services are largely failing to address whether their services adequately respond to the diverse needs of Black and minority ethnic clients. There is a lack of understanding about the social, political and economic structures within which racism is constructed and experienced and this is important when planning service delivery. Drug services have not adequately considered what is needed and what they can do to improve service delivery, retention and outcome to all members of the community:

  "It is incumbent upon every institution to examine their policies and practices to guard against disadvantaging any section of our communities" (Macpherson 1999).

  Earlier this year important legislation in the form of the Race Relations (Amendment) Act, (RRA Act) came into force, this challenges all public services to eradicate discrimination and disadvantage and the RRA Act will require public organisations to have clear race equality action plans. Effective consultation with local Black and minority ethnic communities and the effective collection and analysis of ethnic data must be a crucial starting point, yet these are areas that were found in the scoping study to be particularly problematic.

  The following is drawn from a series of drug service reviews undertaken by the Ethnicity & Health Unit since the summer of 2000. The reviews covered Drug Action Teams areas with predominantly South Asian populations, mostly Pakistani and Bangladeshi communities. Interviews and focus groups were conducted with commissioners and planners of services, providers in both statutory and voluntary agencies and community members including current and ex-drug users, parents, religious leaders and local residents.

  Among young South Asian men in the focus groups, in addition to use of heroin and cocaine there were reports of high levels of recreational drug use with cannabis and ecstasy cited as the most commonly used drugs, though participants had experience of a wide variety of different substances including heroin, crack cocaine, ecstasy, LSD, amphetamines and alcohol. Alcohol use in particular is reported as being more common, even within the Muslim communities including those under eighteen years old. There are a number of reports of increasing steroid use by South Asian men, many of whom obtain their drugs from the local gym.

  Strong links were made between substance use and mental health problems and there were reports of widespread tranquilliser and other pharmaceuticals use, particularly among South Asian women.

  In one area the local drug service provider estimated that in the past year, nearly 50 per cent or more of all weekly referrals had come from Black and minority ethnic communities, predominantly Pakistani and Bangladeshi clients.

  Some young people reported that smoking heroin is "safer" than injecting and is less addictive and that "weekend" use of heroin is "safe" as they have seen their older brothers and their friends doing this regularly with no problems.

  Several young people and ex-users agreed that heroin had become easier to obtain than cannabis.

    ". . . if you go outside and walk past 10 people, there may be only one person who might be able to get you cannabis, but if you ask the same 10 people about heroin, at least five of them can get you heroin" (ex-user, male, Pakistani).

    "you can get heroin as quick as a click of the finger . . . if I ring someone now . . . within 10 minutes there will be someone outside with a bag to sell" (user, male, Bangladeshi).

  Crack cocaine is reported as being used by Pakistani and Bangladeshi, and services in one area have recently seen Bangladeshis as young as 18 coming forward for help with problems from crack use.

  In one area there were several reports of young Pakistani girls (from 14 years old) using crack cocaine and heroin. This was linked to reports of increasing numbers of South Asian girls engaging in prostitution.

  Among participants who identified themselves as drug users this in itself was not viewed as a matter of concern and the young men did not view themselves as having a "drug problem".

  Issues related to identity and generational conflicts were the predominant problems cited by the young people.

  A significant number of the young South Asian men interviewed in one area reported involvement in criminal activities as a means of funding drug use and also for "thrills" or "kicks" such as stealing cars and joy riding.

  Boredom and lack of recreational activities and unemployment were most commonly cited as factors in both drug use and offending by respondents in the focus groups.

  Knowledge and awareness of drug issues and service provision within Black and minority ethnic communities

  Awareness of, and knowledge about, drugs, and services in particular, was generally poor among community respondents, though among parents there were strongly expressed concerns for their children whom they felt unable to protect from the destructive influences in the community around them.

  It was a common belief of service providers, verified by users and young people, that drugs are being sold by young South Asians, with even younger South Asian boys used as "runners" to deliver drugs. Respondents agreed that the financial incentives for those from areas characterised by poverty are very appealing, not only to the dealers, but also to their families, who may ignore the issues around drug use because of the advantages of the extra income.

  In some areas community respondents could name particular streets, which they felt, had become especially associated with a pattern of decline and abandonment that had direct links with increasing drug use in the community.

  It was reported that young Asian men who are involved in drug use often leave home and that families are particularly concerned about the stigma of drug use and the subsequent impact. Some said the ability of families to address these problems was affected by a lack of knowledge of service provision and language barriers.

  Some South Asian respondents reported that parents employ a number of protective strategies when drug use is identified within the family which is initially believed to protect the drug user from engaging in further criminal activity ie family members and parents provide funds for drug use in an attempt to contain the situation.

  However, these protective strategies are not viewed as generally effective often resulting in more extreme responses such as sending the person to India or Pakistan or forcibly detaining the person in the home while they undergo a "cold turkey" detoxication. It is also suggested by the evidence that some of these protective actions prevent young drug users entering treatment earlier only to create a more serious crisis at a later point that often results in entry to the criminal justice system.

  The lack of knowledge about drug misuse, coupled, with issues in relation to community stigma create, for many, a high level of fear about drugs. This often means that drug users who turn to family members for help or who are "caught out" do not get the support and treatment they require. Practices such as home detoxication without suitable medical intervention have been known to pose significant health problems for the user.

  In some cases highlighted in the Ethnicity and Health Unit's work, young Asian drug users were sent to Pakistan or Bangladesh in an attempt by the family to "remove them from western drug using influences" and "stop their access to drugs". Instead the young people returned some months later with hugely increased drug habits, due in the main to the availability and cheapness of drugs, particularly heroin, in the countries of origin.

Utilisation of services

  Very few of the participants with experience of drug use had ever made any contact with drug service providers. Of these, some were not aware at all of the types of services available. Amongst others, there was the feeling that service providers had not attempted to establish contact with their communities:

    "I think they (service providers) have failed to make connections with the Asian community. We sometimes get asked but it's always a bit last minute, tokenistic."

  One agency dealing with domestic violence reported increasing drug use among young South Asian women accessing the service but that there is little or no contact between these women and drug agencies.

  Among those drug users who did have experience of drug services all of them identified a local private clinic where they would be "knocked out" and "heavily sedated so you don't feel anything" as a preferred treatment choice. They expressed strong feelings against the use of and value of methadone prescribing.

  Two within the group had experience of residential rehabilitation and spoke about this in very strong terms ie "pork-infested utensils", "being the only Asian in the white group" and "embarrassing".

  While experience of drug services among respondents was low, where it had occurred this was almost always a negative experience.

    "Then one day we decided after getting into trouble too many times and ending up in prison and causing stress to my folks at home, around 10 of us decided we'd come off it together. We went to one service; they said 'sorry we can't offer you an appointment you need to come back in two weeks'. But we were desperate, we couldn't wait that long, so can you believe it we walked to the next service and then to the next, they all gave the same answer". (Ex-user, Male, Pakistani).

  One group were very critical about the local drugs agency complaining about its location and saying that they felt uncomfortable in the waiting room. The service was viewed as a white service for white clients and the group felt it did not offer choices about treatment or support or that they were "listened to".

  The group identified the need for community services, especially community-based detoxication and they all wanted more help to combat boredom and to find employment.

Service awareness of and responses to drug use within Black and minority ethnic communities

  The majority of drug agency respondents reported the existence of an equal opportunities policy, however a number of issues were identified in relation to the implementation of these policies. Staff did not feel a sense of ownership or involvement in designing and initiating the policy and the policies were not specific to drug service provision or drugs workers. There was a general lack of knowledge of the existing policy, with many of the respondents knowing that a policy existed but having little or no knowledge of its content or how it could help in their work.

  There were no examples of practical implementation of policies, ie there was no formal training on the application of the policy and no reviews. Many of the policies had existed for quite some time and had not been reviewed or amended according to the needs of the workers and service users.

  Commissioning bodies did not require service providers to demonstrate how equal opportunities policies were being implemented into everyday practice and as a result policies were seen as a "paper exercise" rather than a practical tool.

Strategic planning and capacity of commissioners

  In each of the five areas there were no specific strategies for addressing the needs of Black and minority ethnic communities. In each area serious questions were raised by service providers and members of Drug Action Teams as to the capacity of the DAT to address commissioning issues in relation to meeting the needs of Black and minority ethic communities.

  Apart from more general concerns about expertise in commissioning and availability of appropriate needs assessments there were particular concerns about the representation of Black and minority ethnic communities on the DATs and the degree of connection with local Black and minority ethnic communities.

  The history of service commissioning and planning in relation to Black and minority ethnic communities in each of the areas studied is largely ad hoc and marked by short-term initiatives. Where specific pieces of work have been undertaken these are often marginalized or take place outside of the mainstream DAT structures.

  The Ethnicity and Health Unit is in the process of completing a large-scale project of £1.2 million invested by the Department of Health, which has led to 47 community needs assessment projects on drug misuse representing 25 separate ethnic groups. These needs assessments have been completed with guidance and instruction from the Ethnicity and Health Unit incorporating a rapid appraisal model and training in both drug issues and research techniques for more than 350 people.

  The final reports represent a significant body of new knowledge about drug issues within these communities as more than 11,000 contacts have been made in the process of completing the needs assessments. This is significantly higher than the total booster sample for the British Crime Survey (BCS) and while we are only currently analysing the final results from the 47 reports there is clearly a different picture of drug use and concerns about drug use within these communities than is shown in the BCS:

    —  There is a general perception amongst the community groups that drug use within them is increasing across a wide range of substances—cannabis, amphetamine, heroin, crack, LSD, solvents. In some of the research samples 25-50 per cent of respondents admitted to having taken drugs at some time, with up to 10 per cent or more admitting to being regular users.

    —  Communities increasingly recognising that it is a myth that they are not affected by drug use.

    —  For the most part, Black and minority ethnic communities are unable to identify supporting agencies. Even when they can identify an agency, they are unaware of the wide range of services that that agency might offer. Some communities have such little faith in local services that they prefer to use private facilities.

    —  Increasing drug misuse is linked by many of the communities to wider deprivation issues such as unemployment, housing, low educational achievement, etc., and accordingly, the solutions that communities would like to see developed to prevent drugs misuse are wide ranging and holistic (eg recreation facilities, economic regeneration etc.).

    —  Patterns of drug misuse in Black and minority ethnic communities in this country often takes part against a backdrop of cultural and political norms (sometimes "imported" from the "mother" country) that workers here often know little about (eg strong anti-drugs norms; tensions between British and other cultures; war; torture; refugee status, etc.).

    —  The issue of drug problems among asylum seekers and refugees is highly significant. Some people arrive in this country traumatised and with drug problems already. They won't identify themselves as drug users for fear that it will adversely affect their claims for asylum.

    —  Issues such as stigma and shame can prevent families from seeking help, even when they are experiencing very real problems.

    —  Communities are very concerned about crime and community safety. For many communities this is the major issue for them when they talk about drugs—they and the communities in which they live feel unsafe.

    —  A number of communities are concerned about substances which are specific to them (eg Khat, Paan). Concern over Khat use centred mainly around the excessive use of Khat by (mainly, but not exclusively) men, who use more heavily in this country than they would have done in Somalia or the Yemen (eg no work, so more time). This impacts upon families in terms of the money and time spent chewing Khat. No services seem to be able to respond to the needs that families and communities may have in relation to these substances.

    —  A number of communities have specific words for drugs that are not mentioned (or probably even known about) by those who produce drugs information booklets and leaflets.

    —  The issue of language is a complex one (eg 137 languages spoken in Brent alone; issues to do with generation, literacy, and dialect). However, it needs to be addressed—many communities have no access to drugs information because of the language barrier.

    —  Drugs education is seen as very important both by, and for, young people and community elders. If there is one theme that comes out again and again and again, it is about the lack of knowledge and information.

    —  Religion is equally complex—some communities see religion as a protective factor, but some don't. Many communities think that religious bodies can and should be drawn into drugs prevention work (eg have access to people, and centres used for many activities, not just worship). Some children, who are educated in religious schools receive no drugs education at all.

    —  Black and minority ethnic workers are not seen as the answer—but the lack of them in most services is seen as a problem.

    —  Some commissioners and service planners/providers are completely unaware of the make up of the communities on their own doorstep.

    —  Communities see themselves as both able, and willing, to be part of the solution, but most have never been seriously engaged before.

    —  Statistics about many ethnic groups are completely unavailable, either because they are not collected at all, or because they cannot be disaggregated.

  One of the central issues raised by communities is in relation to criminalisation and there is something of a mixed response here in terms of different groups and different substances. For instance, there is evidence that Khat use among certain African communities is problematic and is even described in one area of London as "the new cannabis". Khat is currently legal in this country yet there is a call within some of these communities for it to be made subject to greater controls in order to restrict the number of people that are using Khat problematically. However, this has generated considerable debate as there is evidence that the use of cannabis in other Black African and Black Caribbean communities has resulted in an adverse effect on young people within these communities due to the criminalisation of cannabis and so criminalising Khat could create similar problems.

  The Scoping Study also found evidence that Black Caribbean drug users in particular were adversely treated within the criminal justice system as a result of their dominant patterns of drug use ie stimulants such as crack and cocaine for which there are as yet very few options for treatment. The result of this is that as more Black Caribbeans use these drugs they are faced with less options within new initiatives such as Drug Testing and Treatment Orders (DTTOs) and are therefore more likely to fail or receive a custodial sentence.

  Of course, this does not necessarily point to the need for de-criminalisation but rather the need for an increase in the available treatment for stimulant use. However, in any review of the current legal classifications of drugs the adverse impacts on Black and minority ethnic drug users need to be considered, even more so given the requirements of the RRA Act.

  Furthermore, with regard to this aspect of the review, it is often stated that cannabis acts as a gateway drug and that this is why it needs to be classified as it is. However, many Pakistani and Bangladeshi youths despite the evidence of increasing experimentation with a range of drugs, commence drug use with Heroin, not only bypassing cannabis but alcohol also. It is clearly evident that within these communities cannabis is not acting as a gateway drug.


  The Scoping Study makes particular recommendations regarding national and local strategy development and service planning and delivery. Firstly, the Government need to be co-ordinating and financing the development of a strategic response to the needs of Black and minority ethnic communities in relation to drug treatment and prevention services. An emphasis on ethnic equality should be included throughout all aspects of the national drugs strategy, with specific indicators built in.

  Any funding which is released should focus on initiatives which specifically seek to address issues such as Black and minority ethnic representation, community ownership, capacity building and cultural sensitivity—this could be achieved if the Government invested in a national executive and regional structure which represented the interests of Black and minority ethnic communities, who would also have a key role in monitoring progress in the development of services.

  The study also demonstrated the potential value of improving data collection methods and analysis, which needs to be set up with sufficient monitoring and reviewing methods. This would be achieved through the production of clear guidelines to ensure ethnic monitoring is consistent and co-ordinated, with the training of front line staff who implement ethnic monitoring to increase the capacity of Drugs Action Teams to make use of statistical data and other research in planning and commissioning of services.

  These recommendations begin to indicate the need for far reaching changes within drug treatment and education service provision in order to meet the needs of Black and minority ethnic communities, which have been ignored and sidelined for years. Furthermore, these changes are unlikely to take place or be effective unless they are clearly set within a context of addressing institutional racism and are located within the framework provided by the national drugs strategy.

  The key area in which the national strategy can be said to have failed in relation to Black and minority ethnic communities is in ensuring that adequate needs assessments take place and that the communities are actively involved and engaged in the processes of planning and delivering drug services. The issue of engaging communities and how local area DATs and services can achieve this is one that needs substantial development. The Department of Health funded work in this area provides a crucial starting point for this development but this is in the early stages and will need several months further investment and capacity building before it will be possible to provide a more comprehensive contribution to this review.

  What is clear at this stage is that a model for achieving this has been created and that a significant number of people who have so far been actively involved in the needs assessment work have been brought to a particular level of skill and understanding that will bring additional value to the field once further capacity building takes place.

September 2001

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