Select Committee on Home Affairs Memoranda


Submitted by Mike Trace

  My name is Mike Trace. I have worked in the drug field for 16 years, the majority as a practitioner and manager in drug treatment services. In November 1997, I was appointed as Deputy UK Anti-Drug Co-ordinator, a position which I held until June 2001 and in which I was closely involved in the creation of the National Drug Strategy (Tackling Drugs to Build a Better Britain), and its first three years of implementation. My current role is Performance Director of the National Treatment Agency. I am also currently the Chair of the European Monitoring Centre on Drugs and Drug Addiction, and continue to work on the demand reduction aspects of the UNDCP follow up to the international agreement made at UNGASS in 1998. With this background, I feel I have a unique perspective on the progress of the strategy, and of related public policy issues.

  My concern at much of the domestic and international discourse on drug policy is that it concentrates on single policy decisions (cannabis policing, heroin prescribing or abstinence based treatment) without setting them in the context of the overarching objectives of policy, and the evidence of what best achieves them. This is what we tried to achieve in the UK drug strategy we launched in April 1998—we asked what are the problems we want to solve, what are the objectives (and targets) that would show that we have made progress, what actions can be pursued to achieve these objectives, and what evidence exists to show that these actions are effective? I still believe that this is the right approach to such a complex area of social and health policy where, too often, rhetoric rather than reason has guided policy. The structure and approach of the UK strategy has been seen as a model by the international community which has been emulated since by many countries (eg Eire, Portugal, Czech Republic).

  However, there are a number of flaws in the original document, and the evidence base that has developed since it was written is beginning to point to some different conclusions. The main weakness of the original strategy is in its choice of headline objectives. The four chosen—Reduction of Young People's use of heroin and cocaine, Reduction of Drug-Related Crime, Increase in Treatment for Addiction, and Reduction on Availability of Drugs, were broadly appropriate, although a couple have problems with counting mechanisms. Of greater concern is the omission of two areas that I would argue are important objectives of drug policy—Reduction in Harm to Public Health from drug use, and Reduction in Social Exclusion caused by drug use. I am going to structure my evidence according to these objectives that, with hindsight, should have formed the basis of the drug strategy.

  Reduction in young people's use—the strategy objective here is to reduce reported levels of use of cocaine and heroin by Young People (under 25) by 50 per cent by 2008, working from a baseline set in 1999. The thinking is that a lower level of use of these most harmful drugs is in itself a good thing, any reported use being an indicator of addiction or high-risk behaviour. It was suggested in the strategy that a concerted programme of education in schools, backed up by more intensive programmes targeted at socially excluded children and adolescents, would achieve these targets. The evidence base for this hope was thin at the time and looks thinner now. While good drug education in schools, and investments in programmes for marginalised kids may be a good thing in their own right, they are unlikely to have an impact on the overall prevalence of young drug use, and will certainly not get anywhere near the target of a 50 per cent reduction. The reality of the last three years is that more and more young people are using cocaine as part of their social scene which is likely to push the prevalence figures upwards (while not necessarily meaning an increase in addiction or other harms). In my view, the target would only be achieved if a significant shift of youth culture and attitudes towards drugs took place, or enforcement action led to a sustained drought of these substances. Neither scenario looks likely. I will address the availability issues later, but in terms of youth culture and attitudes towards took place, or enforcement action led to a availability issues later, but in terms of youth attitudes, the inexorable move towards greater freedom of choice and purchasing power means that it is inevitable that we will need to become accustomed to high prevalence levels, concentrating instead on minimising the harmful consequences.

  Reduction in drug-related crime—the objective here is to reduce the amount of property crime committed by addicts to fund a drug/crime lifestyle. This analysis holds true—most addicted users of heroin or cocaine raise hundreds of pounds per week through property crime, contributing significantly to the overall level of such offences in the country. Furthermore, programmes designed to identify, assess and refer these addicts through the Criminal Justice System (Arrest Referral Schemes, DTTO's, Prison Programmes) have shown they can be successful in reducing these forms of drug related crime. As the national rollout of these initiatives continues, I am confident that the benefits in terms of reduced property crime committed by addicts will approach the 50 per cent target reduction by 2008. The problem with this objective is that it relates only to property crime, neglecting the crime and disorder associated with drug markets. The fact that a form of drug-related crime that causes significant concern to communities is not reflected in drug strategy objectives or actions is worrying. Violence associated with drug markets, from minor assaults to murders over turf, profits or debts is significant and unrecognised. If we realised its extent, we may have to re-evaluate the levels of harm caused in our society by the widespread existence of illegal drug markets, and find new ways of preventing them.

  Increase in addiction treatment—the objective here is to double the number of addicts treated by 2008, from a baseline established in 1999. The thinking is that the state provided treatment for addiction is humane on a personal level but also, where successful, can deliver on wider social objectives such as crime reduction, increased public health, and reduced social exclusion. This is an area of the strategy where the analysis holds true, and the programme of action is progressing well—treatment activity levels have been increasing nationally at a rate of 16 per cent since 1999, and the much needed improvements in the quality of addiction treatment services are being addressed through the newly established National Treatment Agency.

  Reducing the availability of drugs—the objective here is to reduce the availability of heroin and cocaine on our streets by 50 per cent by 2008. One of the main actions in the strategy was to ask enforcement bodies (Customs, NCIS, NCS and Police Forces) or prioritise their resources on these substances, moving away from the easier target of cannabis. They have been broadly successful in doing this—seizure rates for heroin and cocaine have increased dramatically in the last two years. However, previous trends have been confirmed in that the level of seizures and arrests seem to have had no effect on the price, purity or availability of these substances. The thinking in the strategy was that, if enforcement action passed a certain threshold of success, then heroin and cocaine would be less accessible to young people, and a lower number would be "recruited". The evidence of the last three years seems to support the argument that prevalence is demand led—as long as there is a demand, the market will supply it. Enforcement agencies in the UK should be congratulated for their operational effectiveness in recent years, and the disruption of criminal groups is an important objective in it's own right, but it is not delivering a reduction in availability of drugs.

  Reducing harm to public health—the transmission of HIV and Hepatitis (B and C) through injecting drug use has been a major public health concern since the mid-1980s. In terms of HIV, early responses in the UK (needle exchange, widespread health education, and access to treatment) were effective in keeping HIV levels amongst drug injectors down to one of the lowest rates in the world. The drug strategy did not prioritise action in this area because it was felt that existing actions were sufficient. However, it is becoming clear that this area of activity does need further attention, as new generations of injectors who have not been exposed to previous campaigns emerge. In addition, Hepatitis C rates amongst injectors remain high, with no co-ordinated national approach to prevention or treatment. Similarly, 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.) 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.

  Reducing drug-related social exclusion—the impact of drug use on the process of social exclusion—school failure, unemployment, homelessness—is difficult to define and seemingly impossible to measure. It was for these reasons that a key indicator on this issue was not included in the original strategy. However, the relationship between drug use and these social harms needs to be given more central consideration within the drug strategy. There is no doubt that some patterns of drug use contribute to the process of marginalisation—teenagers preferring a drug using lifestyle to school or the search for a job, addictive patterns of use making the addict unemployable or unable to sustain a home—but it is also true that the effects of our anti-drug policies can also contribute to this process. Hundreds of children are still excluded from school annually for drug possession, thousands receive a criminal record for the same offence. Of even greater concern in my view is the corrosive effect in poor communities of the existence of illicit drug markets. The choice facing hundreds of thousands of adolescents who are at risk of failing at school is whether to commit to the hard work necessary to pass exams and build a career, or take the easy route to money on the fringe of the illicit drug market. The existence of money-making opportunities in the drug markets in every part of the UK is a strong disincentive to large numbers of young people to work in the mainstream economy. Add to this the perceived glamour and wealth associated with "successful" drug dealers in these communities, and I would argue that this presents a significant barrier to the wider government objective of a more inclusive society. This phenomenon has received little policy or research attention so far, but needs to be better understood and quantified.

  In summary:

    —  assessment of the current drug strategy has been focused too heavily on the overall prevalence of drug use in society;

    —  the activities design to bring down prevalence (ie Primary Prevention and Supply Reduction), while of value for other reasons, are unlikely to achieve the key objective;

    —  policy should therefore be based on an acceptance of a continued level of overall prevalence, but concentrate on reducing the consequential harms associated with certain patterns of use;

    —  some programmes within the current strategy are working well in reducing health damage and crime, but further attention is needed to reducing drug-related deaths and social exclusion; and

    —  the way in which we police recreational use (ie cannabis) has very little impact on these harms, so investment in (and inconvenience of) these activities should be minimised.

  Postscript: the current events in Afghanistan raise the prospect that, for the first time since heroin use became widespread in Europe, a significant drought could occur in Western Europe. These unique circumstances present an opportunity to measure the impact on local rates and patterns of use. The impact could, of course, be positive or negative, but if such a reduction of supply can be maintained, it is possible for a supply led approach to deliver on the availability target.

September 2001

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