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'Blair declares war'

or
The unhealthy state of British drugs policy

Text of a speech delivered by Professor Gerry Stimson at the Methadone Alliance Conference Methadone and Beyond: expanding and exploring drug treatment options 22nd March 2000, London, UK

Correspondence:
Prof Gerry Stimson
Centre for Research on Drugs and Health Behaviour
Imperial College
Reynolds Building
St Dunstan's Road
London W6 8RP

Telephone + 44 (0) 20 7594 0776
Fax + 44 (0) 20 7594 0852

I have observed the development of British Drugs Policy for the last 30 years.

The last 12 months have been the most dismal that I can recall.

So, this afternoon I want to talk about healthy and unhealthy drug policies, and why the Labour government drug policies are decidedly unhealthy.

First, let's look back to a period of 'healthy' policy. There were many things about our past approaches of which we could be proud. Many people in other countries looked to the UK as a country which had avoided

  • moral panics about drug use
  • demonising the drug user,
  • overly criminalising the drug user
  • adopting the 'war on drugs' rhetoric
  • and had avoided the politicisation of drugs.

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Others saw us as a country which had drug policies characterised by - or at least striving towards -

  • being humane
  • having respect for human rights
  • being pragmatic
  • being tolerant
  • and having a consensus between government and those working in the drugs field.

There were some notable achievements in reducing drug related harms.

  • We were ahead of many countries in the prescribing of substitute opiate drugs to people who are dependent on them - a history which goes back to the 1920s, to a time when the UK and the US started on very different drugs policy paths.
  • HIV prevention has been a remarkable success story in the UK. We were looked to in admiration by many others around the world. It is a success that has the potential to be repeated, with respect to HCV and HBV.
  • We also managed to develop effective harm reduction measures associated with the consumption of other drugs.

Harm reduction developed in a context of a healthy policy framework - we did not have to fight for harm reduction in the UK - it slipped into an amenable existing framework.

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Our tolerant approach was sustained during the Thatcher years. We need to remember that HIV policy was developed and implemented during the Thatcher government - when one might have expected moralisation, stigmatisation and marginalisation to have been promoted.

It was not.The Thatcher government deliberately avoided taking the moral high ground on sex or drugs. It supported a pragmatic public health approach to issues of sexual behaviour and injecting drug use.

In the period 1987-1997 we had a public health approach - the aim was to help problem drug users to lead healthier lives, and to limit the damage they might cause to themselves or others. When we did interfere for the sake of the wider community, it was done in a spirit of facilitation and respect.

We had a healthy drug policy. We don't have one now.

Drugs policy is now about drugs and crime. If we do things to drug users, it is because of the effect they have on others. We are witnessing the introduction of a punitive and coercive ethos.

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There have been two phases in this recent history.

Phase one began with the election of the Labour government in 1997 and the appointment of Keith Hellawell as the drugs tsar (the Anti-Drugs Coordinator) and his deputy Mike Trace. Phase 1 was the reorientation of policy away from health to drugs and crime.

Some quotes from the key national drugs policy documents illustrate this:

  • To "..break once and for all the vicious cycle of drugs and crime which wrecks lives and threatens communities." Tony Blair's introduction to the White Paper Tackling Drugs to Build a Better Britain.
  • "..to rid our society of the cycle of drugs and crime.." Keith Hellawell's forword to the First Annual Report and National Plan.

This policy has three premises

  • there are demonstrable links between drug use and crime
  • treatment works to reduce criminal behaviour
  • drug using criminals can be persuaded to enter treatment

and a conclusion

  • getting serious drug users into treatment will reduce crime.

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I have argued elsewhere that government policy documents have been injudicious in the selection and interpretation of the evidence to support of these statements. I will not pursue that here - but if you are interested you should look at the statements in the government documents and then see how far they are supported by the research which is quoted.

Key features of the first phase include major new resources to link the criminal justice and drug treatment sectors, drug treatment and testing orders, an expansion of arrest referral, a tightening up on prescribing (including supervised consumption and the implicit policy to drive out the prescribing of injectable drugs), and proposals for the licensing of doctors according to type of treatment they are allowed to give.

I said that it was a re-orientation away from health towards drugs and crime. Where is health in the policy?

Regarding public health, there is no clear policy on blood borne infections. The White Paper has only one sentence on this, and the words HIV, hepatitis B and C appear only once. The UK AntiDrugs Coordination Unit Blood has not been interested in born infections - there are no public health performance indicators.

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This omission is a major blunder. A benign interpretation is that UK-ADCU expected the Department of Health to continue the public health approach. But DH didn't. It ignored this, and now bluntly refuses to accept responsibility for a strategy on HCV infection.

You might think that harm reduction will continue despite this. This is unlikely: if it does not figure in the policy, then it will not be a priority for action or funding at the local level.

We could lose our favourable position vis a vis the control of blood borne infections - especially in the context of the harmful health impacts of current policy - which I will pursue in a moment.

Regarding treatment for people with drug problems - treatment is now justified with reference to crime reduction. Does this matter? We could agree that expanding treatment provision is usually a good thing - treatment not only reduces crime, but also leads to better health and psychological wellbeing, and less risky behaviour. If we can expand our services on the back of this drugs/crime/treatment argument, does it really matter how the money is justified?

There's no such thing as a free lunch!

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It matters because:

  • crime reduction remains the prime motive for policy and used to justify tough - and as we shall see - tougher measures - you may start by accepting money for drug treatment and testing orders - and end up accepting money to enforce court ordered abstinence orders - beware the slippery slope.
  • money spent on the criminal justice system, and on linking crime and treatment is money not spent on other things such as public health harm reduction, and
  • the policy distorts treatment provision and relationships between patients and doctors

I will expand on this last point. Let's compare a treatment system oriented primarily to the care of the individual and within a health/public health ethos, and one oriented to crime reduction, and examine how various features of treatment differ between the two models, for example

  • how do we encourage people into treatment - by having accessible and attractive services, or by using compulsion?
  • who are the priority patients - those wanting help (the health needy), or those considered by others to need treatment because they are causing trouble (the criminal needy)?
  • what are the desired treatment outcomes (and associated treatment performance indicators) - the effect of treatment across many personal domains such as health, work, finances, and relationships, or confined to criminal activity?
  • what are the relationships between staff and patients - are they based on cooperation and trust, or conflict and suspicion?
  • what is the treatment ethos - is treatment done with and for patients, something they choose to enable them to lead better lives, or something done to patients - coercing them into changing their behaviour?
  • how do we get compliance with treatment - by persuasion, or penalty?
  • And finally, in whose interest do staff work - as agents of the patient, or agents of government?

Difficult issues for all of you here today, whichever side of the doctor's desk you are sitting.

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Phase two of the drugs and crime policy phase starts sometime during the middle of last year (1999). The crime and drugs policy mark II - is Blair gets tough!

First we were softened up by the anti-Hellawell briefings to the press - which suggested that he was weak and his strategy ineffective.

Then came the proposals for compulsory drug testing. These were trailed by Tony Blair and Jack Straw at the Labour Party Conference in October 1999, when it was suggested that those testing positive for heroin or cocaine would be remanded into custody automatically with the presumption that bail would not be granted.

Then came the news that Prime Minister is highly involved in drugs strategy. The flurry of activity in February and March this year includes Blair's choice of drugs for his first weekly web-site broadcast 1, and returning to this theme for his fourth broadcast 2 ('I make no apologies for returning to the subject of drugs so soon. As I said three weeks ago, the threat drugs pose to our children is something which terrifies all parents.'). He called for an EU wide strategy of minimum sentences for dealers to make European law consistent and tough. He had a private (but well publicised) meeting with the parents of Leah Betts the Essex teenager who died after taking Ecstacy. There are reports that Blair and Straw consider the police in some areas are too soft on cannabis.

Blair invokes the mantra 'drugs threatens families and the communities'. The phrase "..petrified of drugs..' crops up repeatedly, as do phrases like 'tough new powers', 'crack down... on the drugs industry'. He calls for a 'a war on drugs' and 'for drug free societies in an enlarged European Union'. 3

And then, last week, came the announcement of the government proposals for drug testing offenders. I quote from the Home Office press release 4 of 16th March on the Criminal Justice and Court Services Bill 5:

  • 'Drug testing; The Bill will enable drug testing of offenders at every stage of the criminal process - at the police station after charge, after conviction, through a new drug abstinence order, as a condition of other forms of community sentence; and for offenders released from prison on licence.'

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Under the new 'drug abstinence order', the courts will have the power to order a proven drug abuser using heroin, cocaine or other class A substance to stay clean from between six months and three years with regular drug tests on pain of a further penalty.' 6

The government says that testing will act as a deterrent, and help identify offenders who should be getting treatment.

More tough and measures are promised next year. Heralded in a further Drugs Bill to be in the Queens speech for next year7- is the proposal that anyone convicted of a drugs offence will be liable to have their passport withdrawn.8

I said that in the past we had a healthy drug policy, and that we do not have one now.

There are several ways in which a drug policy can be unhealthy

I have mentioned one, and this is the disregard of the health needs of drug users.

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A second way in which a drug policy can be unhealthy is that it has adverse impacts on health. The new government proposals score badly on any health impact assessment:

  • more drug users will be detained: in police cells, on remand in prison, sentenced to imprisonment, and returned to prison. There will be more drug use in prison and more risk of death from overdose around after release.
  • there will be disruption of voluntary treatment in the community by imprisonment and by abstinence orders
  • and there will be detrimental public health impacts: drug injectors for example may be deterred from carrying syringes, and all drug users may be deterred from carrying any material connected with drugs use - including drug educational literature - if carrying these will alert police to drug use with the potential for arrest and confinement through denial of bail.

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A third way a drug policy can be unhealthy is that the helping system gets distorted. As I have indicated, treatment agencies start to operate as agents of the criminal justice system. We will see a restructuring of treatment services to cope with criminal justice referrals. This will lead to the denial of treatment for drug users seeking help who has not been convicted: treatment resources will go to the criminal needy and not to those voluntarily seeking help.

A fourth way in which a drug policy can be unhealthy is through inequities and injustices in its application.

  • alcohol will not be one of the drugs tested.
  • the process can be abused. Arrest, urine testing and denial of bail could become a summary punishment.
  • evidence will be collected by the police which is not necessarily material to the facts of the case; bail may be denied for a condition unrelated to the facts of the case istelf.
  • police will have wide discretionary powers eg they may test if they have reasonable grounds for suspecting that drug misuse contributed to the offence
  • sentences will be different for those considered by the court to be dependent on or to have a propensity to misuse Class A drugs

It is likely to be the most damaged and marginalised drug users who will be caught up in an cycle of testing, abstinence orders, community orders, and imprisonment.

It is important to remind ourselves that hitherto it has not been not illegal to use drugs in the United Kingdom nor illegal to be a drug user.

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A fifth feature of an unhealthy policy is through the climate of opinion that it creates. We are now seeing the moral panic press headlines - 'Blair calls for global war on drug dealers' 9 , 'Blair declares war on drugs with hard-hitting bill'10, 'Blair: my war on drug pushers' 11. Tougher local action will follow as courts and the police seek to show how tough they now are. The tough policy will drive out people who want to work in this field. It creates a climate of fear: I already detect that people whose jobs depend on direct or indirect government funds are reluctant to speak up against the new policy.

An unhealthy policy stigmatises, stereotypes and marginalises. A healthy policy on the other hand - as often reiterated by WHO - seeks to work with people, to enable them to lead healthy lives, has respect for human dignity, and respect for human rights.

So where will it lead?

Until now, we might have kept quiet because the government is increasing the resources being directed to treatment. We might have tolerated the lack of a focus on public health, feeling perhaps that harm reduction services would continue to be provided even if they are not prominent in the policy.

But recent announcements - in detail and in tone - show that Blair has launched a moral crusade against drug use and drug users.

The final unhealthy impact is on our relationship with government. Most of us are funded directly or indirectly by public money. These are serious problems ahead for the future relationship between government on the one hand, and all those working in drug treatment and helping agencies, the researchers who provide evidence, the experts on the advisory councils and expert committees, and those who provide drugs policy and information. We will need to examine carefully what we are prepared to do - and not do.

This is a crucial juncture in British drugs policy.

We have lost consensus. We are now losing a humane vision of how to respond to drug problems, and losing our respect for human rights.

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References

1. www.number-10.gov.uk Transcript of the Prime Minister's broadcast of Friday 18th February
2. www.number-10.gov.uk Transcript of the Prime Minister's broadcast of Friday 10th March
3. The Times, 10 March 2000
4. Home Office news release 058/2000 Protecting the public - crime fighting plans unveiled
5. www.parliament.the-stationery-office.co.uk/pa/cm199900/cmbills/091/2000091.htm
6. Criminal Justice and Court Services Bill clause 40
7. Independent, 11 Mar 2000
8. And the fanciful ideas keep flowing - four days after this talk Keith Hellawell floated the idea that every person flying into Britain faces having their air tickets tested for traces of drugs. Sunday Times 26 March 2000
9. The Times, 10 March 2000
10. The Independent, 11 March 2000
11. The Express on Sunday 12 March 2000

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