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.
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".
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".
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.
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.
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.
The Minister also told us that, in 2008/09, 24% of calls to the
FRANK helpline related to cocaine.
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%.
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
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.
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".
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
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.
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 messagessuch as those around bleeding and
loss of cartilage in the nose, or sudden heart attacksand
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
risksfrom even single useof 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 effectfor 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.
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.
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
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".
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
Dr Brener explained that the average cost of a 28 day residential
rehabilitation at The Priory cost around £15-17,000.
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
private residential treatment, referrals tended to be made either
through a General Practitioner or by self-referral.
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
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.
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.
183. The National Treatment Agency suggested that
"most drug userseven those who need intensive treatmentcan
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".
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".
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
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.
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
the same year a small number of people were treated in residential
services for cocaine misusethey had similar outcomes to
those in community treatment: 62% left residential rehab free
from dependence on cocaine.
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.
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.
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",
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.
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 2008/09both
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".
The average waiting time for his programme was between two and
a half and five days.
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
find it difficult to access residential treatment within what
we would define as the relevant time window".
Paul Hayes agreed that "waits for rehab can be longer"
but added that they could be "misunderstood by the individual".
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
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
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.
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.
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.
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
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
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
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
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.
|Supply or offer to supply (cocaine)
|Otherwise dealt with
|Otherwise dealt with
|Possession with intent to supply (cocaine)
|Otherwise dealt with
Table 6: Sentencing for offences relating to cocaine, 2006-2008
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
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.
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.
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".
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 positive8 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
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.
203. Kent police has 10 machines in total, 4 of which
are mobile. ACC
Matthews told us that 26 out of 43 forces had the capability to
deploy an Ion Track, or equivalent trace machine.
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".
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".
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
205 Q 117 Back
Q 55 Back
Q 57 Back
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
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Ev 190 Back
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Ev 176 Back
Colombian Government's Shared Responsibility campaign website:
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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
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Figures provided by the National Treatment Agency, Ev 198 Back
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Q 243 Back
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Ev 202 Back
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Q 265 Back
Qq 253 & 266 Back
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Ev 198 Back
Ev 186 Back
HM Treasury, PSA Delivery Agreement 25: Reduce the harm caused
by alcohol and drugs, (Revised June 2009) , Measurement Annex,
Ev 189 Back
Ev 189 Back
'Offer to supply' is when an individual offers to supply a controlled
drug but in fact supplies a substance that isnot controlled. Back
'Possession' iswhen an individual has a controlled drug on their
'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
Ev 200-201 Back
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2009, Q 92 Back
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National Policing Improvement Agency website: http://www.npia.police.uk/en/14139.htm.
Accessed 28 January 2010. Back