Drugs Policy

Debate between Mike Weatherley and Caroline Lucas

Thursday 16th December 2010 Westminster Hall

[Caroline Lucas (Brighton, Pavilion) (Green)]

Thank you, Mr Walker. I appreciate that, and I am honoured to follow the hon. Member for Newport West (Paul Flynn) who is such an expert on this issue and speaks such good sense about it.

I congratulate the right hon. Member for Coventry North East (Mr Ainsworth) on securing the debate and on his position, which I believe is the right one and which my party has advocated for many years. My constituency is in a city that has the unenviable reputation of being home to the most drug-related deaths in the UK, so I have a keen interest in what can be done to reduce the harmful effects of drugs both on society as a whole and on individuals.

I shall start by saying a few words about what is wrong with much of the current drug policy, making a few references to the Government’s newly published strategy, and making the case for an approach that focuses on reducing the use of drugs and the harm they cause—treating addiction primarily as a health issue, rather than a criminal justice issue.

The facts about drug use are not new to anyone in the Chamber. In the UK, for example, the social and economic costs of class A drugs are estimated at more than £15.4 billion a year, and more than half of the 35,000 people in prison are thought to have serious drug problems, which put them there. Those facts should be the starting point for any strategy, which should be based on available evidence. Instead, much of our current approach is based on moral judgments against drug use and users. The Home Secretary falls into that trap in the Government’s drug strategy, which they published just last week. For example, she asserts that

“drug use in the UK remains too high”,

while failing properly to recognise that the greatest risk is not drug use per se, but the societal and individual problems caused by a prohibitionist response. Moreover, although there is, understandably and rightly, considerable fear about the impact of drugs, it cannot be allowed to dictate policy. Reducing drug-related harm is a public health concern and should be subject to the same sort of effectiveness and efficiency standards as other areas of public health.

Drug-related harm is caused partly by the nature of the drugs being used—not just their addictiveness—by the way in which they are acquired and used and by how society treats people who use drugs. Unless we develop an approach that seeks to reduce the harm associated with all those aspects of drug use, we risk perpetuating it, and that is what has been occurring since the current prohibition-based policy has been in place.

The matter is not as simple as saying that the war on drugs has failed to reduce drug-related harm; it is actually making it worse. Far from it being a neutral intervention, it often pushes people towards more harmful products and behaviour, and certainly more harmful environments. I am especially mindful that the poorest in society usually suffer most from drug misuse, but it is crucial to differentiate between the suffering caused by drugs and that caused by drugs policy. For example, the vast majority of drug-related offending is a consequence of drugs policy. The burglary, theft and so on to enable drugs to be bought at vastly inflated prices would be significantly reduced under a regulated system.

There is a growing view among the scientific community, as well as among politicians, the police and the legal profession, that we must move away from prohibition, which criminalises people, towards a health-based strategy that seeks to reduce drug use and drug harm through control and regulation. In an intervention, I quoted some of the experts who agree with that position.

All too often, alternatives to the current prohibition-based approach are depicted as a free-for-all, with drugs being readily available with no checks and balances, and with people being encouraged to become users. That is deeply irresponsible, because nothing could be further from the truth. I am certainly not advocating a free market in legalised drugs, and I do not believe that anyone else is. The legalised market exists for tobacco, for example, and it still exists to a great extent in some parts of the global south.

From a public health perspective, the free market approach is even more damaging than the unregulated criminal control of drug markets, with the aggressive promotion of consumption via marketing and advertising, all to the one end of maximising profits for legal commercial actors.

In fact, under the current system there is a free-for-all with no controls on who sells drugs, no controls on who can buy them and no controls on their make-up. Every drug supplier is, by definition, unlicensed, placing them beyond any form of state control or management. If we persist in burying our heads in the sand on this issue, we will miss the opportunity for the state to intervene to regulate and control the drugs market, properly to treat drug users, and to reduce the harm to users and society, all within an overarching framework of seeking to reduce drug misuse.

Poverty, social exclusion and inequality all have an impact on drug use and drug markets, so they must be looked at alongside policies on education, prevention, treatment and recovery. All too often, success in the so-called war on drugs is measured in terms of numbers of arrests or drug seizures, when we should be assessing whether harm experienced by individuals and communities is declining.

As the Home Secretary acknowledges in the foreword to the new drugs strategy:

“Individuals do not take drugs in isolation from what is happening in the rest of their lives”.

I welcome that recognition, and the strategy’s emphasis on the role of tackling disadvantage. In that context, it is important to note the work of the Equality Trust, which shows a clear and demonstrable correlation between drug use and inequality. There is a strong tendency for drug misuse to be more common in more unequal countries such as the UK.

[Mike Weatherley]

Does the hon. Lady agree that there is a small problem with the benefits culture, which often helps to perpetuate drug use?

[Caroline Lucas]

That is an interesting observation. Yes.

If the Government are serious about tackling drug abuse they also need to tackle inequality. Turning people with a medical problem into criminals, and burdening them with a whole new set of obstacles to overcome, seems particularly perverse and counter-productive. As well as tackling some of the social factors that contribute to drug use, we should tightly regulate the production, supply and use of drugs, as that is the most effective way to reduce drug harm.

Legal regulation of potentially risky goods is the bread and butter of Government, so it is logical and consistent to apply the same principles to drugs as those applied to alcohol and cigarettes, for example, or to imported toys and hair dyes. The Government are there to regulate potentially risky goods. Some of the most useful work on this issue that I have come across is from the Transform Drug Policy Foundation, which has published a “Blueprint for Regulation”. It starts by saying that it is helpful to know what regulation would actually look like, so that we can begin to outline different kinds of supply models. For example, it suggests prescription as one particular model, or pharmacies that have restrictions according to buyer age, the quantity of drug being bought, and the case specific concerns relating to potential misuse. One particularly appealing aspect of that approach is the scope to require pharmacists or licensed suppliers to offer advice about harm reduction, safer use and treatment services where appropriate.

I have had the privilege of visiting the RIOTT—randomised injecting opioid treatment trial—programme in my constituency. In case hon. Members have not heard of it, it is one of three trials to examine the effectiveness and cost-effectiveness of treatment with injected opioids, such as methadone and heroin, for patients who were dependent on heroin but did not respond to conventional methadone substitution treatment.

Some 150 people receiving oral methadone substitution treatment and injecting illicit heroin on a regular basis were recruited to the trial. Fifty of them were provided with optimised methadone medicine to take orally, and 50 were given supervised injected long-acting methadone treatment. The remaining 50 were given supervised injected heroin, with access to doses of oral methadone. They also received—this is absolutely crucial—one-to-one personal support and had people who worked with them, got to know them and gave them advice and support. All participants were followed-up for six months to enable researchers to compare the effectiveness and cost-effectiveness of the three treatments.

The main measure of the trial’s effectiveness was the proportion of participants who stopped using illicit heroin. In other words, they stopped trying to get dirty heroin from the streets. Laboratory urine tests allowed researchers to check if the heroin used had been prescribed or had come from the streets. Researchers also collected information about other illicit drug use, injecting behaviour, health and social functioning, criminal activity and so on. The results and the strength of the conclusion were amazing. They suggested that pharmaceutical heroin was far more effective in helping to stabilise people’s lives, get them off the illicit heroin and, crucially, to begin to reduce their overall drug use. The treatment was not just about keeping people on a particular dosage for ever, it was about enabling them to withdraw from ongoing drug use. I met participants on the trial who told me that it had saved their lives. It had given them back control of their lives, allowed them to kick crime, find their families again and, over time, reduce their drug use.

Professor Strang from King’s College London, one of the leading academics on the study, described its outcomes as follows:

“The RIOTT study shows that previously unresponsive patients can achieve major reductions in their use of street heroin and, impressively, these outcomes were seen within six weeks. Our work offers Government robust evidence to support the expansion of this treatment, so that more patients can benefit.”

I am pleased that the drugs strategy foresees a role for substitute prescribing. I call on the Home Office and the Home Secretary to ensure that the results of the RIOTT programmes are properly factored into the analysis, and that such programmes are made more available across the country. The trials are an example of the regulated use of a drug that is otherwise prohibited. They provide a useful, albeit limited, example of how regulation can enable users to become prescribed users, rather than street users, thereby illustrating some of the benefits of regularising the supply route and decriminalising drug use.

I would like to address the issue of cost, which has been mentioned several times. Some people argue that programmes such as RIOTT are extremely expensive, but I would like to look at the other side of the equation. Given the cost of following up drug-related crime to the police, or the cost to the NHS, approaches such as that of the RIOTT programmes are far more cost-effective than the continuing prohibition that we see today.