The Cocaine Trade - Home Affairs Committee Contents


7  TACKLING DEMAND

Public information campaigns

163. Surveys have shown that the most credible messages are those given by users' peers. Matthew Atha of the Independent Drug Monitoring Unit told us:

    When we looked at the attitudes of drug users to sources of information, the politicians came out pretty much bottom of the list in terms of credibility of sources, way below doctors, teachers and of course people's peers. In terms of deterring drug use generally the answer is to make it uncool, not to make it dangerous because the more dangerous it is the more risky it is and young people like their risks.[205]

164. Harry Shapiro of DrugScope agreed that the most powerful messages were those about the immediate impact on users' health or physical appearance, rather than long-term consequences, saying that "where people can perceive an immediate risk there is a better chance of changing behaviour".[206] He made a comparison "with some of the health messages around anabolic steroids. Blokes can develop breasts, they can shrink the testicles, that is the sort of thing that young people relate to rather than those health risks which might impact in 10, 20, 30 years' time".[207]

165. The UK Drug Policy Commission told us:

    The scant evidence available suggests that campaigns can be more effective if they seek to reinforce or direct an existing preference (e.g. 'safer clubbing' messages highlighting dangers of dehydration and polydrug use), or reassure non-users that most people do not take drugs. Campaigns can also increase knowledge, reposition associations with drugs (e.g. cocaine is 'glamorous') and encourage take-up of services.[208]

FRANK CAMPAIGN

166. In January 2009 the Government launched a multi-media campaign against cocaine, based around an animated dog called Pablo the drug mule, voiced by comedian David Mitchell. The campaign was developed and re-run in autumn 2009, and in January 2010. Sarah Graham considered the Pablo the dog campaign to be effective:

    It has been very effective in terms of young people being able to tell you some of the health messages that were enclosed in that campaign around the impact on the heart, the impact on the nose, mental health, the fact that it is a dangerous drug. A lot of young people had no idea that cocaine was a dangerous drug, but that work on its own needs to be supported within our schools, within the curriculum.[209]

167. The Home Office carried out an evaluation, surveying 300 young people before and after the campaign. Some 67% of those surveyed agreed that the advertisements had made them realise cocaine was more risky than they thought; 63% said the campaign made them less likely to take cocaine in the future.[210] The Minister also told us that, in 2008/09, 24% of calls to the FRANK helpline related to cocaine.[211]

168. The MixMag survey asked respondents who they would seek help from if they thought they had a drug problem. The most common answer was a friend, at 60.1%, followed by a GP at 37.5%, and then by Talk to Frank, at 31.7%.[212]

SHARED RESPONSIBILITY CAMPAIGN

169. In 2006 the Colombian government launched an on-going communications campaign, Shared Responsibility, to raise awareness in 'consumer' countries in Europe of the impact cocaine use has in Colombia. The effects include deforestation, the use of illegal landmines, armed violence, kidnapping, terrorism, exploitation and water contamination. HE Mr Mauricio Rodriguez Munera, Colombian Ambassador to the UK, told us that "for each gram of cocaine consumed, 4 square metres of tropical forest are destroyed".[213] The Colombian Government describes its aims as follows:

    If cocaine consumers were made aware of the atrocious ways in which their drug money is put to use in Colombia, they would not only rethink their cocaine habit but actively support the eradication of coca crops from Colombia.[214]

170. A number of UK agencies including the police have, and continue to, work with the Colombian Government to promote the campaign's messages about the destructive impact of the cocaine trade on South America. We asked police witnesses if such 'ethical' messages about destruction of the rainforest and fuelling instability and exploitation in Colombia would be effective in deterring cocaine use, especially amongst the professional classes who may be concerned about 'green' issues. Mr Pearson of the Metropolitan Police considered that "the police would certainly support such a campaign, and perhaps get other agencies involved, such as Greenpeace".[215]

171. In 2007 the Head of the UN Office for Drugs and Crime, Antonio Maria Costa, argued that the message about damage to source and transit countries from the cocaine trade had not been properly driven home when compared to messages about other trades:

    Europeans now understand that they should not buy blood diamonds, or clothes made by slaves working in sweatshops. Major initiatives are in place to curb illicit trade in ivory, endangered species, even precious wood from illegal logging. And yet with cocaine the opposite occurs. Nobody makes movies about blood cocaine. Worse than that: models and socialites who wouldn't dare to wear a tiger fur coat, show no qualms about flaunting their cocaine use in public.[216]

172. Public information campaigns have an important role to play in challenging cocaine use. The Frank campaign on the effects of cocaine use has been successful in generating greater public awareness of the dangers of cocaine, with 63% of young people surveyed saying that the campaign made them less likely to take cocaine in the future.

173. In keeping with some of the more hard-hitting Frank campaign messages—such as those around bleeding and loss of cartilage in the nose, or sudden heart attacks—and similar graphic images used in anti-smoking campaigns, the most powerful public information messages seem to be around the immediate physical impacts of a drug, rather than long-term health damage. The effects of cocaine on executive brain function could be better exploited, especially as cocaine use is more common amongst the professional classes. More could be made also of the immediate risks—from even single use—of heart attack and sudden death, especially when cocaine is combined with alcohol. Similarly the message that up to 95% of what is sold as cocaine actually comprises harmful adulterants may well influence behaviour.

174. The Colombian Government's Shared Responsibility campaign on the environmental costs of the cocaine trade also packs a powerful punch, particularly since it feeds into an increasing public concern about environmental damage. More however could be made of the human effect—for instance child soldiers in Colombia, or the many drug mules locked into a vicious circle of exploitation. More graphic use should also be made of the number and size of internal concealments carried by drug mules who are often exploited, such as the up to 20 pellets swallowed by a single individual, or pellets the size of a pint glass inserted into a body cavity. We found the message that, for every gram of cocaine consumed in the West, 4 square metres of tropical rainforest are destroyed, especially striking.

Treatment

175. As set out in paragraphs 64 to 66, the number of people entering treatment for cocaine powder addiction rose from 10,770 in 2006/07, to 12,592 in 2008/09, and the number of 19-24 year olds almost doubled between 2005/06 and 2007/08. In 2007/08 cocaine powder also overtook crack cocaine as the primary addiction of those accessing treatment for cocaine that year, although the total number of crack cocaine users still outnumbered cocaine powder users in the treatment system by five to one.[217]

176. In 2001 the Government set up the National Treatment Agency, a special health authority within the NHS, to improve the availability and effectiveness of treatment for drug misuse in England. A pooled budget was also introduced for drug treatment. The NTA gave the figures for drug treatment funding between 2001 and 2009 as follows:


Figure 7: Drug treatment funding, 2000/01 to 2009/10[218]

The Government told us that it had committed "an additional £11.8 million of investment in 2009/10, around a quarter of which will be earmarked specifically for expanding the residential treatment sector".[219]

177. Paul Hayes told us that it costs, on average, between £1,500 and £3,000 to treat one individual with cocaine addiction, although if residential rehabilitation were required as part of the treatment it would be "much more expensive".[220] Dr Brener explained that the average cost of a 28 day residential rehabilitation at The Priory cost around £15-17,000.[221]

EFFECTIVE TREATMENT

178. There is currently no maintenance-based medical treatment for cocaine as there is with heroin, so abstinence-based psychosocial interventions, typically delivered in the community are the main treatments of cocaine, as for other stimulants. These include motivation, using incentives, mutual support (such as Cocaine Anonymous), and behavioural therapy.

179. State-funded treatment tends to consist of community-based non-residential programmes, with a lesser number of residential rehabilitation programmes available. Private treatment is more often residential. The most common route into treatment is self-referral. In 2008/09 some 40% of all drug users starting treatment funded by the National Treatment Agency referred themselves. In the same period 27% of referrals came through the criminal justice system, and other referrals were through other health and social care organisations such as GPs, social services and other drug treatment services.[222] For private residential treatment, referrals tended to be made either through a General Practitioner or by self-referral.[223]

180. Interestingly, there was some evidence that coercing or semi-coercing users into treatment had similar outcomes to those who self-referred to treatment. John Jolly told us

    There have been a number of studies focused on coming out with the answer that it is dreadful forcing people into treatments, and have been surprised by the research which tells them that there is really no difference between the two groups.[224]

181. Dr Brener of the Priory described the advantages of residential treatment :

    All patients when they come to treatment are quite chaotic, their lives are falling apart in many cases, they need some structure in their lives…Separating them from their environment for a period of time can be quite useful.[225]

However, John Jolly of Blenheim Community Drug Programme noted that "the difficulty with moving people out of their environment and treating them in isolation is that you have to put them back in the world".

182. But there were also difficulties with treating people in their environment, through community-based programmes. John Jolly told us that:

    People are often living a hand to mouth existence, often in houses with multiple occupancy with many other people around them who are also misusing drugs…you have to address those issues as well as dealing with addiction, so it can be helpful to move people out of that environment into residential accommodation.[226]

183. The National Treatment Agency suggested that "most drug users—even those who need intensive treatment—can recover whilst in the community and do not need to go into residential services", but that "for the small minority with more severe problems who cannot make sufficient behavioural change in the community, residential rehabilitation may be required".[227] John Mann MP agreed, writing that "whilst residential stays have a health benefit, their ongoing effectiveness in dealing with substance abuse is highly questionable. Medical opinion in most countries puts the success rates of rehabilitation in eliminating substance abuse as low as 2% of clients".[228]

184. However, Sarah Graham, an ex-cocaine addict, argued that residential rehabilitation was vital:

    My whole life was surrounded by drinking and drugging. I knew I needed to leave and the treatment on offer to me was a day programme in the local community and that was not going to work for me. I was fortunate; I could pay The Priory to take me, and I was in there for eight months…Addicts want to go to rehab because they know that is where they are going to get well, but rehabs are being shut down and we have had this move towards day programmes.[229]

185. The National Treatment Agency told us that in 2008/09, 63% of the 8,479 who left community-based treatment that year for cocaine dependency, did so after having overcome their addiction.[230] In the same year a small number of people were treated in residential services for cocaine misuse—they had similar outcomes to those in community treatment: 62% left residential rehab free from dependence on cocaine.[231] By comparison, Dr Brener told us that after one year 25% of The Priory clients had not used drugs, another 50% had relapsed and then gone clean, and 25% relapsed and continued to use. Around 3 -5% of that latter group died.[232]

SHORTAGE OF TREATMENT PLACES?

186. Mitch Winehouse, who was then making a documentary about drug dependency and treatment, told us that users he had interviewed had claimed that drug treatment in the UK was hard to access and long waits were common.[233] The National Treatment Agency strongly refuted this. Paul Hayes, the Chief Executive, told us that "in 2002 the Audit Commission reported average waiting times of up to three months; this has now been reduced to less than a week",[234] adding:

    It takes a long time for the popular consciousness to catch up with what is happening on the ground. For a very long time it was very difficult to access treatment in this country so it has become engrained in people's consciousness that there are lengthy waiting times.[235]

187. The picture was now, he said, quite different. The average waiting time to get into community treatment for cocaine powder was 6 days in 2008/09, and the average waiting time for residential rehabilitation for cocaine powder was 12 days in 2008/09—both within the NTA target of three weeks. As a provider of community programmes John Jolly agreed that places were readily available: "we have been able to expand our level of provision to meet a lot of supply needs…people can access our services as and when they need to without waiting lists".[236] The average waiting time for his programme was between two and a half and five days.[237]

188. However, there seemed to be a distinction between treatment in the community, to which there is quick access, and the availability of residential rehabilitation. Although the NTA told us that there was "no evidence of unmet clinically appropriate demand for rehab", John Jolly warned that "access to residential treatment provision has actually been getting more and more difficult, certainly over the last four or five years…we find it difficult to access residential treatment within what we would define as the relevant time window".[238] Paul Hayes agreed that "waits for rehab can be longer" but added that they could be "misunderstood by the individual".[239] He later clarified what this meant:

    For the minority of clients who need rehab, they will probably consider their wait to have begun when they first considered rehab as an option, and not when it was agreed with their clinician or keyworker that this was the best type of treatment for them, and began the process of applying for a rehabilitation place [which is the point from which the NTA would measure the waiting time].[240]

DEFINITION OF PROBLEM DRUG USERS

189. The Addiction Recovery Foundation was critical of the Government's narrow definition of Problem Drug Users (PDUs) as "those who use opiates (heroin, morphine or codeine) and/or crack cocaine", arguing that:

    Discrimination results from the Home Office definition of "problem drug users" solely as heroin and crack cocaine users; so only the latter can be used for targets, statistics and funding.[241]

190. The National Treatment Agency's performance is assessed by the Government's Public Service Agreement (PSA) 25, Indicator 1. PSA 25 is to "reduce the harm caused by alcohol and drugs" and Indicator 1 is "the number of drug users recorded as being in effective treatment". A HM Treasury document explains that the indicator is to:

    Improve on the 2007/09 baseline the number of drug users recorded as being in effective treatment. It measures the per cent change in the number of drug users using crack and/or opiates in treatment in a financial year.[242]

191. This means that the Government's target for the NTA for getting drug users into treatment only measures those using opiates and/or crack cocaine, thereby excluding cocaine powder users. Some treatment service providers surveyed by the Addiction Recovery Foundation considered that this definition meant that services were unable to obtain funding to treat cocaine powder users. For instance, Action on Addiction wrote:

    It is our experience that the commissioning system seems to prioritise crack and opiate users over cocaine users.[243]

Treatment provider The Providence Projects agreed:

    Our experience in line with the NTA definition is that one needs to be heroin/crack dependent to have any chance of getting treatment, although it seems as though this group are also being denied residential treatment.[244]

192. We did not find any substance to the allegation that there are long overall waiting lists to access treatment for cocaine misuse, nor that those in the criminal justice system receive preferential access. It is clear that provision of community-based treatment has vastly improved from a very poor situation in 2002, with waiting times having reduced from three months then to six days in 2008/09. It is perhaps understandable that public perception has not yet caught up with this shift.

193. However, we were perturbed by reports that access to residential rehabilitation was not as readily available as to community programmes. Despite the insistence of the National Treatment Agency that community programmes offer appropriate treatment for the majority of cocaine users, doctors, treatment providers and ex-users expressed the view that addicts in a chaotic environment could benefit from periods of stable, residential treatment. The Government has invested an additional £11.8 million investment in treatment in 2009/10, a quarter of which is earmarked for residential treatment. We recommend that the proportion dedicated to residential treatment be increased.

194. Whilst it was clear from the figures provided by the National Treatment Agency that powder cocaine users were accessing treatment, we were unhappy to learn that the Government's target for getting drug users into treatment only counted opiate and/or crack users, according to its narrow definition of problem drug users. We are worried that this will adversely affect the funding, commissioning and availability of good treatment services for powder cocaine users, which are vital given the increase in users. We therefore recommend that the Government revise the basis on which PSA 25, Indicator 1 is measured, to include powder cocaine users.

Policing and penalties

POSSESSION AND DEALING

195. The Ministry of Justice gave us a breakdown of penalties handed down for supply and possession (excluding import) of cocaine powder for 2006, 2007 and provisional data for 2008 (see table 6). The data showed:

  • A significant majority of those sentenced for supply or offer to supply[245] cocaine powder in each of the last three years were given an immediate custodial sentence (71% in 2006, 67% in 2007 and 73% in 2008); the average custodial sentence length in 2008 was 47 months.
  • The most common penalty given to those sentenced for possession[246] of cocaine was a fine (52% in 2006, 47% in 2007 and 49% in 2008); the next most common was a community sentence, followed by conditional discharge. For the 4% who were given an immediate custodial sentence in 2008 the average custodial sentence length was 5.5 months.
  • The vast majority of those sentenced for possession with intent to supply[247] were given an immediate custodial sentence (78% in 2006, 72% in 2007 and 75% in 2008); the average custodial sentence length in 2008 was 38 months.

 
2006
2007
2008(1)
Supply or offer to supply (cocaine)
  
  
  
Absolute discharge
0
0
0
Conditional discharge
9
4
5
Fine
12
6
9
Community sentence
69
70
70
Suspended sentence
47
89
99
Immediate custody
358
353
505
Otherwise dealt with
7
4
13
Total sentenced
502
526
701
ACSL(2)
38.7
35.6
46.5
Possession (cocaine)
 
 
 
Absolute discharge
4
9
13
Conditional discharge
574
776
815
Fine
2,055
2307
2817
Community sentence
984
1350
1512
Suspended sentence
93
140
130
Immediate custody
187
213
251
Otherwise dealt with
84
87
241
Total sentenced
3,981
4,882
5,779
ACSL(2)
9.7
6.0
5.5
Possession with intent to supply (cocaine)
 
 
 
Absolute discharge
1
4
1
Conditional discharge
6
5
8
Fine
9
19
13
Community sentence
94
119
125
Suspended sentence
94
171
194
Immediate custody
774
837
1137
Otherwise dealt with
8
10
42
Total sentenced
986
1,165
1,520
ACSL(2)
38.2
40.8
38.3

Table 6: Sentencing for offences relating to cocaine, 2006-2008[248]

With regard to possession, ACPO told us that "it is rare for individuals to be cautioned [for cocaine possession]; where the evidence allows, most will be charged with the relevant drug offence".[249]

196. The Ministry of Justice expressed some frustration that the length of short custodial sentences were preventing offenders from completing drug rehabilitation programmes whilst in prison. The Minister, Maria Eagle MP, told us that:

    If we only have people on remand for a very short sentence that severely limits what kind of intervention we can offer. If we have somebody sent to prison for a long sentence that gives us more possibilities.[250]

197. We note the concern expressed by the Ministry of Justice that custodial sentences are often too short to allow a drug user to complete a treatment programme in prison. We strongly believe that, if custodial sentences are handed down to cocaine users, they should be sufficiently long to ensure that the user can complete a treatment programme in prison.

198. Drug dealers prey on the weaknesses of others. Given that the maximum penalty for cocaine dealing is life imprisonment and an unlimited fine, and yet the average custodial sentence for supply or intent to supply in 2008 was only 47 months, it seems that sentences for dealing may be tending to leniency.

HIGH-VISIBILITY OPERATIONS

199. The Home Office told us that its approach to cocaine involved the establishment of "offender management schemes aimed at supporting drug users to enter treatment and reduce their offending behaviour and, if this is not successful, to proactively target them for arrest".[251] We saw this approach in operation when we visited Kent police in Maidstone to observe an anti-cocaine policing operation on a Friday night.

200. Kent was recommended to us by the Association of Chief Police Officers as an example of a force with an innovative approach to tackling cocaine use. The aim of its high-profile operations is to detect those using and dealing cocaine in pubs and clubs; and deter cocaine use by visible use of hand-held scanners in the entrance queues for clubs and pubs, passive drugs dogs, and working with licensees to refuse entry to anyone who declines to be drug tested, or who is found with cocaine traces on their hands. Alongside a very visible and ubiquitous police presence in the town centre, operations involve local drug outreach counsellors, who accompany the police during the evening, and the use of an 'SOS' bus, which is parked in the town centre offering medical, outreach and information services provided onboard by representatives of different agencies.

201. Kent police use hand-held "Ion Track Itemiser 3" electronic drug trace machines to swab the hands of people entering clubs and pubs. Agreeing to a hand swab is a condition of entry to the venue, and the machine processes the swab within a few seconds to identify any drugs present. If an individual tests positive for cocaine traces they are searched and, if cocaine is found, arrested; if not, they are referred to the drugs outreach worker on patrol with police. During the one operation we attended, 294 swabs were taken and processed in the Ion Track machine: of those, ten tested positive—8 for cocaine and 2 for ketamine. In addition, 20 stop and searches were carried out for drugs, 5 arrests were made for class A possession (4 cocaine and 1 ecstasy), and 5 referrals were made to drugs outreach workers.

202. The Ion Track machine can be programmed to detect different drugs and comes in two versions: a desktop machine costs around £25,00-£30,000[252] and a mobile one £18,000. The machines have multiple applications, including the testing of banknotes, at crime scenes, in custody suites and in prisons, making them cost-effective in terms of the amount of time they are in use. The machines are effective deterrents. ACC Matthews of ACPO told us that:

    A recent survey by Kent police showed that over 70% of people who were going to nightclubs would be deterred from trying to carry a drug into the nightclub if they saw the police deploying that sort of equipment. Equally, over 60% felt that it would be safer to go into that nightclub.[253]

203. Kent police has 10 machines in total, 4 of which are mobile.[254] ACC Matthews told us that 26 out of 43 forces had the capability to deploy an Ion Track, or equivalent trace machine.[255] He told us that ACPO took the position that all forces should deploy this or similar technology, although there would be "a capital cost involved and investment to be made by forces".[256] The National Policing Improvement Agency already supports the roll-out to all police forces of Evidential Drug Identification Testing (EDIT), which uses special equipment to test substances found on arrestees. The NPIA describes the benefits of the EDIT programme as "reduced forensic analysis costs, savings in police officer and custody staff time".[257]

204. We were very impressed with the high-visibility anti-cocaine police operation which we observed in Kent. This kind of proactive approach combines visible, zero-tolerance enforcement in the town centre with treatment through the drugs outreach workers, and medical agencies in the 'SOS' bus. It is an excellent example of how law enforcement and other agencies can work together to tackle supply and demand concurrently, and we urge Chief Constables to consider running more high-visibility operations on the basis of the Kent model.

205. The handheld Ion Track machines are a particularly effective weapon in both deterring and detecting cocaine use in the night-time economy. The capital costs involved are amply recouped by the multiple ways in which one machine can be employed. We urge all Chief Constables to ensure that their forces have one or more hand-held drug trace machines, and recommend that the National Policing Improvement Agency promotes the roll-out of these machines to all forces, as part of its Evidential Drug Identification Testing programme.



205   Q 117 Back

206   Q 55 Back

207   Q 57 Back

208   Ev 154, citing Let's Get Real: Communicating with the Public about Drugs. Drugs Prevention Advisory Service 2001: http://drugs.homeoffice.gov.uk/publication-search/communications-campaigns/lets-get-real.pdf?view=Binary  Back

209   Q 195 Back

210   Ev 190 Back

211   Ev 190 Back

212   MixMag magazine, 10 February 2010, p.49 Back

213   Ev 176 Back

214   Colombian Government's Shared Responsibility campaign website: www.sharedresponsibility.gov.co  Back

215   Q 387 Back

216   Antonio Maria Costa, Europe's cocaine problem is a curse…and not only for Europe, Speech to the Conference on Cocaine, Madrid, 15 November 2007: http://www.unodc.org/unodc/en/about-unodc/speeches/2007-11-15.html  Back

217   Q 241 [Paul Hayes]  Back

218   Figures provided by the National Treatment Agency, Ev 198 Back

219   Ev 96 Back

220   Q 239 Back

221   Q 243 Back

222   Ev 197 [National Treatment Agency]  Back

223   Q 251 Back

224   Q 260 Back

225   Q 257 Back

226   Q 258 Back

227   Ev 197  Back

228   Ev 202 Back

229   Q 188 Back

230   Ev 197 Back

231   Ev 197 Back

232   Q 274 Back

233   Q 186 Back

234   Ev 198 Back

235   Q 262 Back

236   Q 250 Back

237   Q 265 Back

238   Qq 253 & 266  Back

239   Q 264 Back

240   Ev 198 Back

241   Ev 186 Back

242   HM Treasury, PSA Delivery Agreement 25: Reduce the harm caused by alcohol and drugs, (Revised June 2009) , Measurement Annex, pp.19-20: http://www.hm-treasury.gov.uk/d/pbr_csr07_psa25.pdf  Back

243   Ev 189  Back

244   Ev 189  Back

245   'Offer to supply' is when an individual offers to supply a controlled drug but in fact supplies a substance that isnot controlled.  Back

246   'Possession' iswhen an individual has a controlled drug on their person. Back

247   'Possession with intent to supply' is when there is circumstantial evidence to believe that an individual intends to supply the drugs found in their possession to another individual (for instance, the presence of very large amounts of the drug, or drug-related paraphernalia such as scales). Back

248   Ev 200-201 Back

249   Ev 95 Back

250   Q 467  Back

251   Ev 95 Back

252   Q 389 [ACC Matthews]  Back

253   Q 383 Back

254   Constable Adrian Parsons, Oral evidence to the HASC, 15 December 2009, Q 92 Back

255   Q 388 Back

256   Q 389 Back

257   National Policing Improvement Agency website: http://www.npia.police.uk/en/14139.htm. Accessed 28 January 2010. Back


 
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