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Lord Rea: My Lords, does not the noble Baroness agree that a large part of the harm caused to families of drug abusers is not necessarily caused by the drug itself but arises from the lifestyle that drug addicts have to lead in order to finance their habit? That leads to poverty, loss of home and inability to work. They are in a vicious circle. It is not necessarily the substance itself which causes the problems.

I have known a number of people who have been able to carry on a perfectly normal family life and hold a responsible job provided their drug has been prescribed, as my noble friend Lady Mallalieu said, in a clean way at an adequate dose.

Baroness Blatch: My Lords, there is so much practical evidence that somebody under the influence of drugs does not behave normally. That abnormal behaviour is seriously distressing, both mentally and physically, to families, relatives and people around addicts. The point was made in passing of the difficulty which doctors face when they take drug addicts onto their books. One of the problems is the behaviour of drug addicts in surgery waiting rooms. The behaviour of drug addicts has a serious impact on the people around them.

The noble Baroness, Lady Jay, referred to the role of the voluntary sector. I should like to think that the role of the voluntary sector is implicit in much of what is contained in the Green Paper. The voluntary sector plays a vital role in prevention and education as well as in treatment and rehabilitation. My noble friend Lady Cumberlege has already mentioned some examples. There are so many others, but there is not time to enumerate them. I do not underestimate the role of the voluntary sector. We value it greatly. I am chairman of the Ministerial Group on the Voluntary Sector. I know that there is much that can be contributed by the community in that way.

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The noble Baroness also raised the fact that the voluntary sector was not included in the Green Paper consultative committee. We are open to suggestions for altering the proposed membership of the drug action teams. The key principle to bear in mind is that the teams must be small, manageable in size, and members must be serious players who can influence the relevant policy and resource decisions of their respective organisations.

The noble Baroness went on to talk about resources in relation to the Green Paper. Over £500 million was spent in the United Kingdom and internationally last year in tackling drug misuse. The strategy focuses those resources clearly on explicit aims, objectives and priorities which all departments have agreed. It is a matter of making the most effective use of existing resources and realigning priorities in line with the aims of the strategy. We are confident that we are making available the necessary resources to do what we propose in the Green Paper.

Drug education in schools was also mentioned. Drug education in schools is covered in science lessons as part of the national curriculum. It may also form part of personal, social and health education. It is important that it is placed within the context of developing healthy lifestyles and of other substance misuse. The Department for Education has recently issued guidance for teachers for consultation. It includes advice on principles and practices to be adopted, the use of outside speakers, parental involvement and materials to be used. It reaffirms the importance of involving school governors in developing drug education policies as well as recognising how sensitive the issue is.

The Department for Education also intends to support up to 10 substantial innovative projects in drug education which will help to inform good practice in this area. I cannot remember which noble Lord referred disparagingly to the 10 innovative projects, but a number of noble Lords said, as did the noble Baroness, Lady Mallalieu, in the most recent speech, that there will not be one answer to the problem. I believe that we should try a range of interesting ideas and leave no stone unturned in looking for solutions in this respect.

A number of noble Lords referred to the concept of harm minimisation, to use the jargon. The aim of services for drug misusers should be to help people to stop taking drugs. For some misusers, however, abstinence must be a long-term goal with intermediate stages. The Green Paper does not rely on the terms "harm reduction" or "harm minimisation" because in England those terms have become loaded with confusion and dogmatic debate. What is needed is less extremist argument and more information on what works. That is why the Department of Health is commissioning pilot studies for structured methadone maintenance programmes which will offer a clear route to abstinence for those who are ready to take it. In preventive work with young people our clear objective is to discourage them from taking drugs. But the Government also attach importance to the availability of early intervention services for those who choose to take risks and need help with the consequences.

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The noble Lord, Lord Addington, was concerned about young people rebelling against messages. I do not underestimate the harmful effects of smoking and the misuse of alcohol. The Government are concerned to make young people aware of the harmful effects of smoking and to discourage the habit. We are also concerned to encourage sensible drinking--and I have to say to the noble Viscount, Lord Falkland, that I believe that there is such a thing as sensible drinking; I indulge in it occasionally--and to reduce alcohol misuse.

The draft circular on drug prevention in schools issued for consultation by the Department for Education, covers tobacco, alcohol and volatile substance misuse as well as illegal drug misuse wherever they raise common issues for schools. I fully accept that in putting messages across to young people we must take account of how they view the problem. We must recognise that many do not see drug misuse as a problem at all. We have to acknowledge that for some young people drug taking may appear exciting. For others it is the thing to do because others are taking drugs. Our message is: know the facts about drugs, be wise to the real dangers and risks, and make the smart decision not to take drugs.

We need to help young people develop the skills to resist peer pressure to take drugs, in the context of developing healthy lifestyles. It is also important to communicate to young people that there are places to go for advice and help, and in confidence.

My noble friend Lord Mancroft referred to the Home Office drugs prevention initiative. He referred to what he regards as the ineffectiveness of the Home Office drug prevention initiative in view of the fact that drug misuse has increased in the four years since the initiative was introduced. Prevention initiatives, especially educational programmes, are long-term investments. The point was well made by the noble Lord, Lord Russell of Liverpool. All the work supported by the initiative's local teams is monitored and evaluated. The drugs prevention initiative is pulling together the lessons learned to produce good practice guidance for use all over the country. The first route to that programme should be evaluated and circulated next year.

On the subject of legalisation, my noble friend has made his views known on a number of occasions. To destroy the black market in the way he suggests would be to make available all the drugs currently misused--not only cannabis, amphetamines and ecstasy, but heroin, cocaine and crack--on demand, at a price lower than the traffickers' who would assuredly fill the gaps. I cannot agree that that is the right way forward. Think of the health problems that we would have to face, my Lords.

My noble friend also made reference to drug education in schools, much of which I have touched on. However, I welcome the interesting points made by my noble friend Lord Mancroft on how to persuade young people not to misuse drugs. I do not share his pessimism on the prospect of success, but I welcome his confirmation that we should try to change young people's attitudes. We recognise that young people often know more about drugs than their parents or teachers. Simply telling them that they are wrong to take drugs

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will not work. It is not enough. We have to recognise that young people are knowledgeable and that they like to rebel. Messages in schools and in the wider community must be directed at undermining young people's views that drug misuse is acceptable and not harmful. The fact that drug misuse is harmful and can destroy their health and their prospects is an important message.

My noble friend also referred to the Government taking account of results of an examination of what works in the methadone treatment. As part of the effectiveness review, there will be a major research study looking at the effectiveness of treatment for up to 1,000 clients receiving treatment, including people receiving methadone. The results will be considered by the Department of Health. One of the tasks identified for the Department of Health in year two of the strategy is to ensure that cost-effective and appropriate services are available to drug misusers.

The noble Baroness, Lady Masham, was concerned about crack. She asked what the Government will do about crack. The Department of Health's task force will be commissioning a study to look specifically at what treatment is available for people who use crack cocaine, and what works. Its recommendations on how such services should be provided in future will form part of its report to Ministers.

Much was made of the review of the Customs officers. A number of figures have been bandied around in the course of the debate. Let me assure your Lordships that the outcome of the fundamental expenditure review will not detract from the effectiveness of the Customs' response to drug smuggling. The proposals are designed to enhance and develop existing strategies to provide greater flexibility and better targeting for Customs operations against drug smuggling. The review builds upon successful enforcement techniques established over recent years, notably since the abolition of internal borders with the completion of the single market in 1993. The review recommends enhanced targeting and matching resources to areas of highest risk to maximise the incidence of drug seizures. There will be a continuous Customs presence at locations where the highest risks exist, coupled with the flexible use of mobile anti-smuggling teams. That will provide a swift response across the UK to identify threats as well as providing a highly visible and unpredictable deterrent.

It has been found that Customs objectives could be achieved through a net reduction of 242--the figure is not 800--anti-smuggling posts, out of more than 4,000. However, intelligence activity will be enhanced by the creation of 50 new posts in investigation or intelligence work using posts redeployed from other locations. There will be no Customs-free airports or ports in the UK. There is no evidence to suggest that that flexible, selective and targeted approach has adversely affected the effectiveness of enforcement activity. Indeed, Customs' results prove otherwise. Seizure values increased from £244 million in 1990 to over £500 million in both 1992 and 1993. In 1992, 47 major drug

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smuggling organisations were dismantled, and 69 in 1993, a rise of 28 per cent. In the current year the figures are looking even better.

There is no question of Customs being left with insufficient anti-smuggling resources to combat illegal importation of drugs, firearms or any other dangerous item or product. There appears to be success in using intelligence rather than relying on ad hoc random inspection of goods on entry into the United Kingdom.

My noble friend Lady Gardner of Parkes was concerned about the insurance industry. The Government understand that all members of the Association of British Insurers have accepted the change in policy, and that the vast majority will introduce the changes to the questionnaire by the end of this year. We very much welcome that. I have no doubt that my noble friend will be vigilant in ensuring that that happens.

With regard to Scottish Provident, we have not seen the wording of each society's form. I am happy to write to my noble friend about the specific case to which she referred.

The noble Lord, Lord McNair, referred to the Narconon programme. The purchase of services for the treatment of drugs misusers is for local and health authorities to decide for themselves based on the assessment of the needs of an individual. Therefore if those authorities can be persuaded that it is effective treatment, it must be a matter for them to consider purchasing into it.

The future of the central drugs co-ordination unit was referred to by the noble Lord, Lord Russell of Liverpool. During the next few months Ministers will be considering proposals for monitoring implementation of the strategy and as regards how a national co-ordination can be ensured. That will include consideration of a continuing role for the central drugs co-ordination unit. The noble Lord made some interesting and constructive suggestions in relation to education programmes. In particular he commented about the importance of training and the training of trainers. I am sure that my right honourable friend the Secretary of State for Education, who indeed is aware of the debate, will note and take account of the references that he made to Ofsted.

The noble Baroness, Lady Mallalieu, made reference to GPs. Many doctors choose to prescribe for their addict patients, often in a shared care arrangement with a specialist agency. That is, frankly, the preferred model of care set out in the clinical guidelines to which the noble Baroness referred. Guidelines give advice to doctors on how to establish appropriate prescribing levels from gradual withdrawal programmes to the longer-term maintenance programmes. The Green Paper recognises that general practitioners have the same responsibility to provide general medical care to drug misusers as to any other patients. The Department of Health will review the arrangements for shared care of drug misusers. It will also consider ways to ensure that an adequate number of general practitioners in each health authority treat drug misusers, and that appropriate

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training and support is available for those who need it. It is our view that doctors prefer guidance rather than governments interfering in clinical decisions.

Reference was made to the heavy hand of the Home Office drugs inspectorate. It is not a gestapo. Its role is to monitor the prescribing of controlled drugs in order to prevent diversion to the illicit market. It does so in close co-operation with the medical profession. It is not unknown for a doctor to enter into the illicit market. It is also not unknown for a doctor to become embroiled in becoming a misuser or abuser of drugs. It is precisely because of the international research evidence which indicates that there are considerable benefits in providing methadone--I refer again to the methadone point--in structured programmes that the Department of Health is funding up to seven structured methadone maintenance programmes. There will be full evaluation. I believe that that was the final point made by the noble Baroness.

I am grateful to all noble Lords who have contributed to this wide-ranging, interesting and, as I said earlier, sensitive debate. The theme of the debate, which I believe has received unanimous support throughout, is that tackling this vexed issue is most effectively done by tackling it together. I thank the noble Baroness, Lady Masham, because I believe that she was the force behind the proposition for today's debate.

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