Drugs: how much longer can the Government ignore the evidence?
By Calum Douglas
Last year we welcomed the publication of the first report of Dame Carole Black’s independent review of drugs. Part two of the review, looking at prevention, treatment and recovery, was published last week.
It’s the latest of a series of recent reports to make recommendations about how to manage drug misuse, many of which have been ignored or rejected. Unlike other recent reports however, Dame Carole Black’s review was commissioned by the Government. As such, its findings - and the weight they’ll carry - have been highly anticipated.
Dame Black doesn’t pull punches, concluding that the current system and provision of prevention and treatment is not fit for purpose.
We have long pointed to the inadequacy of funding for drug treatment. The report makes a strong case for increased investment, highlighting the cost-savings that would result from reducing crime and improving health and social outcomes. The notion that slashing public health budgets saves money is a fallacy, and it's good to see this so clearly illustrated.
The report calls not only for significant investment but crucially for this funding to be ring-fenced. The current lack of a mandate for local authorities to include drug services within their public health functions has meant they’ve often been the services most savagely cut. The mechanism by which funding could be ring-fenced is not set out, but a Statutory Instrument could be used to outline a minimum package that must be delivered.
Drug use doesn't occur in a vacuum, and the report rightly includes recommendations about employment, housing and mental health support. People who use drugs are identified as often being “excluded from mental health services until they resolve their drug problem and excluded from drug services until their mental health problems have been addressed”. This is something we’ve heard first-hand as part of our own research into the suitability of generic mental health services for people living with HIV. Dame Black calls for the development of an action plan to resolve this problem, a call that we wholeheartedly support.
Greater coordination and accountability are also identified as being needed. At a national level there is no clear ownership or responsibility for drug-related outcomes, and at a local level provision varies significantly. Calls for a new cross-departmental Drugs Unit and the development of national and local Outcome Frameworks are welcome, and the announcement by the government last week regarding the former is encouraging. However, despite the involvement of non-criminal justice departments, the Government still isn’t moving away from viewing drugs through a criminal lens, and it'll be important to see how this unit balances work across different departmental briefs.
The review was limited from the outset by being advised not to consider legislative reform.
As we have written previously, addressing the current crisis in drug-related deaths requires removing barriers to the health and safety of people who inject drugs. This involves a shift to a public health approach to drug use, including the decriminalisation of drug possession. While this was once seen as a radical proposal, in recent years it has been called for by a range of medical and parliamentary bodies, including the Royal College of Physicians and the Scottish Affairs Committee.
The review’s focus on treatment and recovery means that harm reduction – an approach to drug use that prioritises the mitigation of harm above ending drug use altogether – was effectively sidelined. That said, the report still calls for “increased overdose prevention, harm reduction and syringe exchange programmes,” and for local authorities to commission a “full range of evidence-based harm reduction and treatment services”. This is essential to reduce drug-related deaths and other associated harms including the transmission of HIV and other blood-borne viruses.
The report doesn't go so far as to call for the Government to enable the opening of drug consumption rooms (spaces where drugs can be self-administered safely and under supervision) but this is not surprising considering its remit. Political pressure must continue to be placed on the Government to reconsider its opposition to such services.
In conclusion, Dame Black’s review is a welcome one. The proof of course will be in the pudding, and there is no guarantee that the Spending Review will deliver the investment required. But the report does set out a raft of recommendations with the potential to dramatically improve our nation’s response to drugs. As drug-related deaths continue to soar and services are cut back, it's imperative that the Government seizes the opportunity to turn things around.
Calum Douglas is Policy and Campaigns Officer at National AIDS Trust