to The Home Affairs Select Committee
The Home Affairs Select Committee
on the Government's drug policy
The United Kingdom Harm Reduction Alliance
wish to address two issues raised by the Select Committee:
existing drugs policy work?
- The effectiveness
of the ten year National Strategy on Drug Misuse.
UKHRA is a campaigning coalition of health and social care workers,
drug users, criminal justice workers and educationalists,i,
established in March 2001 as a direct response to inadequacies of
the UK national drug strategies.ii
and build upon the developments of harm reduction in the UK;
UK governments to maintain and strengthen harm reduction and public
health initiatives and to include these in national drug policies;
- Provide support
and direction to harm reduction thinking and initiatives in the
- Build a working
alliance between drug users, health workers, criminal justice
workers, educationalists and others committed to harm reduction
across Northern Ireland, Wales, Scotland and England; and
- Work with
international and organisations in other countries to promote
We believe that that a drugs strategy should be based on the principle
of reducing drug related harm (often known as 'harm reduction')
and that policy and legislation should be judged by the contribution
they make to reducing harms to individuals and communities.
Limitations of the National Drug strategies in the UK
UK national drug strategies are structured around four similar key
aims, focused on young people, communities, treatment and availability.
Although to some extent the prevention of individual and public harm
to health is present in the national strategies (more so in Wales
and Scotland than in England), there is no key aim which brings
together public health issues and harm reduction. This is a major
1987 and 1997 Britain led the world in developing a harm reduction
approach to drug use. The clearest achievement was in the prevention
of HIV infection among people who inject drugs (by heeding advice
outlined in the 1988 report of Advisory Council on the Misuse of Drugs)iv.
The UK has thus far averted an epidemic of HIV infection associated
with drug injectingv
and there is evidence that harm reduction has resulted in lower rates
of hepatitis C virus (HCV) infection than found in comparable countries.vi
reduction is appropriate for reducing potential problems with the
use of all drugs (such as heroin, cocaine and crack-cocaine, ecstasy
and amphetamine type stimulants, LSD, and cannabis) and by all routes
of administration (injecting, smoking, inhaling, or swallowing).vii
is a pragmatic approach that:
- Accepts (while
not necessarily condoning) drug use;
the poor results of drug supply and demand reduction policies
(desirable as these may be); and
- Targets achievable
changes in the way drugs are used.
It is similar
in principle to public health and social policy attempts to limit
the potential damage from a wide range of behaviours (such as motor
vehicle driving, sport and sex).
and the National Strategy
emphasis of the current drug strategy on drugs and crime has meant
that harm reduction has slipped down the agenda. The strategy
belittles the importance of the health of individual drug users: the
UK Anti-Drugs Coordinator's Annual Report 1999/2000 and the Second
National Plan do not mention HIV and HCVviii.
There has been a minimal investment in new harm reduction initiatives:
£0.25m for the 'Making Harm Reduction Work' programme of seminars
and materials on HBV immunisation, preventing injecting and overdose,
compared with spending on new crime reduction initiatives such as
£220 million for Crime and Disorder Partnerships and the £45
million anticipated cost of urine testing under the Criminal Justice
and Court Services Act. This lack of a central lead encourages
local authorities to give essential harm reduction services such as
needle exchange a low priority.
no other sector of health and social care does service provision prioritise
the needs of other members of society above the health and welfare
needs of its clients (as the focus on crime prevention does with
drugs). This violates the principle of providing services in ways
that prioritise the needs of the patient or client and undermines
the relationship between services and their clients.
potentially dangerous situation is now present where HIV transmission
through injecting drug use could rapidly escalate, as has occurred
in some other countriesix.
There are indications of an increase in risk behaviours among injectors.x
Hepatitis B remains endemic among injectors, despite the availability
of an effective vaccine. There is a major epidemic of HCV infection
in the UK. Estimates suggest that 400,000 of the population of the
UK have been infected with HCV, 80% of whom are believed to have obtained
this infection through injecting drug use. The ACMD 2000 report, Reducing
Drug Related Deaths, recognises that overdose, often involving
the use of opiates in combination with alcohol and other drugs, is
a major cause of premature death among drug users.
of current legislation and policy can maximise rather than minimise
harm. Examples include, the laws on drug paraphernalia, the provision
in the Criminal Justice and Court Services Act to sentence people
to be abstinent from drugs, the revised section 8 of the Misuse of
Drugs Act in which drug paraphernalia may be used as evidence of drug
use on premises, and the failure to implement methadone maintenance
in prison. The climate of current policy with 'war on drugs' rhetoric
central in 2000 to the speeches of the Prime Minister and the previous
Home Secretary, is one that marginalises, excludes and scapegoats
drug users. This particularly affects problem drug users who are already
disadvantaged and creates a situation in which it is harder to contact
and work with people to promote health. A 'war on drugs', is a war
on drug users - and that is a war on a majority of the young
In the light
of these circumstances we believe that:
- the underlying
basis for all policy and legislation must be its contribution
to reducing drug related harm;
to reduce the social, psychological, and medical harms from drug
use should be an integral part of all treatment and care;
- all drug
users must have access to advice on how to reduce their risks
of potential harms from drug use; and
- all new
drugs legislation and policy must be evaluated against its positive
or negative impact on the health of drug users.
and public health should be the underpinning principle of our national
drug strategy. We urge that as a minimum measure a 'fifth' aim
should be added to national drug strategies:
and Public Health - To minimise harm to the health of individuals
and communities arising from drug use.
We have set
out a number of detailed suggestions for immediate policy change
in the accompanying document 'Harm reduction and the national
drug strategies of the United Kingdom'.
Submitted on behalf
of UKHRA by:
Prof Gerry Stimson
Department of Social Science and Medicine
Imperial College of Science, Technology and Medicine
St Dunstan's Road
London W6 8RP
Telephone: +44 (0)
20 7594 0776
FAX: +44 (0) 20 7594 0852
current steering committee is:
Centre for Research on Drugs and Health Behaviour, Imperial College,
(RGN), Director of Services, Powys Drug and Alcohol Centres, Wales.
Harm Reduction Writer and Trainer, Liverpool. (Vice Chair and Media)
General Practitioner, Lonsdale Medical Centre, London.
Stockwell Project, London.
Lecturer, Kent Institute of Medicine and Health Sciences, University
of Kent at Canterbury
Researcher and Activist, Liverpool. (Webmaster).
Harm Reduction Writer and Trainer, Dorset. (Treasurer).
Area Pharmacy Specialist-Drug Misuse , Greater Glasgow Primary Care
The Harm Reduction Team, Lanarkshire Primary Care Trust
Lecturer in Pharmacy Practice, University of Bath. (Secretary).
Drug Users Development Agency, London.
Chair, Action on Hepatitis C, Specialist in Substance Misuse in Ipswich,
G.V. (2000) Blair Declares War: the unhealthy state of British drug policy.
International Journal on Drug Policy 11, 4, 259-264.
information will be found at http://www.ukhra.org
Council on the Misuse of Drugs (1988) Report. AIDS and Drug Misuse
Part 1. HMSO.
G V. (1995) AIDS and injecting drug use in the United Kingdom, 1988-1993:
the policy response and the prevention of the epidemic. Social Science
and Medicine, 41,5,699-716
V.D., Judd, A., Hickman, M., Lamagni, T., Hunter, G., Stimson, G.V. et
al. Prevalence of hepatitis C virus in current injecting drug users in
England and Wales: is harm reduction working? American Journal of Public
Health 91, 38-42
the Good Practice Guide on the Implementation of the Public Entertainments
Licenses (Drug Misuse) Act 1997 - produced by Association of Chief Police
Officers (ACPO); the extensive range of harm reduction materials for all
the commonly used drugs produced by organisations such as Lifeline, HIT
and Exchange Publications.
Office, Tackling Drugs to Build a Better Britain, Second National Plan
2000/2001; 1999/2000 Annual Report
SA, Patrick DM, Currie SL, et al. Needle exchange is not enough:
lessons from the Vancouver injecting drug use study. AIDS 1997,11:F59-65.
from the Unlinked Anonymous Prevalence Monitoring Programme (2000) Prevalence
of HIV and hepatitis infections in the United Kingdom, 1999, Department