Drugs Policy

Tom Brake Excerpts

Thursday 16th December 2010 Westminster Hall

[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.

[Tom Brake (Carshalton and Wallington) (LD)]

I apologise for not being in the Chamber at the beginning of this important debate and I welcome the opportunity to discuss this issue today. The hon. Lady sets out an alternative approach to tackling the drugs problem. Does she agree that, whatever policies are advocated, it is essential that they are properly assessed for their effectiveness in reducing crime and improving health, and that they should be based on sound science and regularly reviewed after implementation to check whether they continue to be effective?

[Caroline Lucas]

I agree with the hon. Gentleman that our position needs to be based on science and evidence, and regularly reviewed. It is precisely that kind of approach that characterises the RIOTT programmes that I mentioned. I have seen the results in my own constituency and I passionately hope that such programmes will be made more available across the country.

In conclusion, hon. Members will appreciate that to consider the legal regulation of drugs represents a huge shift in thinking. As such, any regulation should be brought in slowly and carefully, step by step, with each phase properly assessed before moving on to the next one. I mentioned earlier that, sadly, any debate on drug strategy is all too often derailed by knee-jerk reaction and an assertion that attempting to question the existing prohibition-based approach is tantamount to dishing pills out like candy to school children.

I hope that hon. Members will not take that kind of simplistic approach today. I am sure that they will not as the nature of the debate has been very constructive. I hope that we can build a cross-party approach to drug regulation that will be open to learning from the example of countries such as Portugal, which primarily treats drugs policy as a health concern. I would certainly advocate an entirely joined-up approach to drug abuse under the auspices of a single unit in the Department of Health, rather than, as at the moment, the Home Office. I hope it is clear that being in favour of drug controls is entirely consistent with the objective of reducing drug-related harm, and that continuing to support prohibition actively works in the other direction.

--- Later in debate ---

[Andrew Griffiths]

It is true that the right hon. Gentleman was drugs Minister for a number of years, and I understand that the drug problem increased in every one of them.

[Tom Brake]

Earlier, the hon. Gentleman said that all the Transform organisation did was research. Does he feel that there is already sufficient evidence on the effectiveness of abstinence programmes versus substitution programmes, or prohibition versus the licensing scheme that the right hon. Gentleman proposed?

[Andrew Griffiths]

The hon. Gentleman raises an important point. It is true that we do not yet have enough evidence on the success of abstinence-based programmes, which is why I am encouraged that the Minister is going for a pilot project in the drugs strategy. I am evangelical on the benefits that proper rehab in an abstinence-based programme can have, but we need to be able to prove that it works. I accept that. Not only am I confident, but the providers and the clients who have been through these programmes are confident that this is a radical change to the drugs strategy and the way we treat drugs. The simple fact is that I agree with the right hon. Gentleman that we cannot continue along the path on which the Labour Government set us.

Last year we spent £235 million on methadone—that is just on the drug, not the prescription or related services—to treat 154,000 methadone users. That £235 million is the equivalent of spending £500 a minute on methadone. It would pay for 11,000 NHS nurses. That puts into perspective not only the costs to society in crime and anti-social behaviour, but the costs in numbers of a purely maintenance-based programme that is simply failing. I say that it is failing because 95,000 of those 154,000 people who received a methadone script last year were still on the script a year later, and more than 25% of them would have been on methadone for four years. The idea that a maintenance programme is a short-term thing that gets people drug free is not correct. It is clearly not working, which is why we need this fundamental shift in our approach to drugs.

I agree that we have lost the war on drugs to date, but I do not think it is inevitable that we have to raise the white flag and accept that heroin and cocaine will be prescribed or sold in our communities. I say that because those dealing with these things on the ground have warmly welcomed the different approach laid out by the Minister. As I said in my all-party group, a number of very cynical and concerned charities, voluntary groups and organisations involved at the sharp end of dealing with addiction have warmly welcomed the change in approach. They recognise that we cannot continue with the current failed policy.

We win the war on drugs by improving rehab, giving people a recovery-based programme and being optimistic and bold about what we can help them deliver. It is about much more than rehab. It is about helping people deal with the chaotic lives they lead as drug users. It is about ensuring that people have the support of their family, and that their family recognise and understand the process, and that they have access to good health care, a safe home and opportunities. We must ensure that we do not simply expect people to go into the same community, where they had been shooting up for the previous 10 years, after a four-week detox programme, and think that they have their lives back together. It is about ensuing that we give them an opportunity to get back into work, have work experience or work in the community. All those things are very important.

I will draw my contribution to a close, but I wish to say that I do not believe for one moment that the solution to our drug problem is the one advocated by the right hon. Gentleman. I do not want to see prescriptions for heroin or cocaine issued in my constituency, and I know that many hon. Members feel exactly the same. We have a blueprint in the Government’s drugs strategy for fixing the mistakes made by previous Administrations, and many of us are completely behind what the Minister is trying to do.