It’s hard for an old ‘leftie’ to acknowledge it, but Margaret Thatcher created a more effective drug policy environment than her New Labour successor, Tony Blair.
Specialists in the field, even those who opposed Margaret Thatcher’s political views in most other matters, recognise that the heyday of evidence-based British drug services was during her time as Prime Minister. Even today, advocates of radical drug policy reform tend to acknowledge that the UK’s high international standing in the drug reform debate dates back to the Thatcher era. During that period, the Advisory Council on the Misuse of Drugs was permitted to shape and direct day-to-day policy and practice. This, combined with smart policy-linked funding schemes, light enabling management, and outcome-orientated monitoring and evaluation, led to a revolution in drug services and the impact they had on the lives of people who use drugs and the communities they live in.
That approach remains the model that the UK’s Department for International Development continues to follow internationally and champion within the United Nations. It determines DfID’s international strategy on drugs, HIV and global health and is why the UK enjoys high standing within the European Union and the UN and has become an area of close collaboration with the United States under the current administration.
Yet, while DfID is commended for its promotion of harm reduction and progressive, humane and pragmatic drug treatment models, the Coalition’s ‘recovery-oriented’ domestic strategy falls back into an ideologically laden approach. Breaking the Cycle of Dependence - launched in December 2010 - is so evangelical that it gives little attention to ‘the inconvenient science’ or to listening to those who use drugs. It promotes a simplistic, one-size-fits-all solution, ignoring the evidence base, the guidance of the World Health Organisation and other professional advice.
New Labour’s failure
The drug policy that New Labour adopted when it came to power in 1997 was fundamentally flawed in two ways. It was both moralistic and bureaucratic. Tony Blair’s view was distorted by his moralising start point. As Prime Minister, he first promoted the US model of that time and established a ‘Drug Tsar’. Many in the US now acknowledge that that was bad policy; even at the time, professionals advised Blair that the strategy was flawed. When it failed to deliver the results he had hoped for, the PM blamed and ousted the Drug Tsar and established the National Treatment Agency (NTA). In seeking to demonstrate that he could be tough, he scapegoated drug users, and inhibited a rational cross-party discussion on drugs policy.
The NTA has been a failure. It has overwhelmed the drugs field with bureaucracy, crushed innovation, wasted money, and taken control of day-to-day drugs policies away from the experts. Because the Agency sees the world through a criminal justice lens and those who use drugs either as victims in recovery or victimisers in need of punishment, it has failed to understand new trends in the underground drug scene, for example new drug trends around ketamine and ‘legal highs’.
New Labour offered advocates of evidence-based drug policy, drug user networks and professionals in the field a hard choice. They either gave full support to these drugs policy initiatives or risked being excluded from policy-making and practical support. Yet, drug-user groups, in particular, are a key source of intelligence on illicit drug scenes and a possible point of influence on them.
The UK has historically had a high level of drug use. This is linked to a strong youth culture, comparative affluence, continuing patterns of poverty, a history of immigration, and a general disposition as a nation to enjoy a party. As a result, pursuing the wrong drug policy in the UK has a significant impact on the whole country, compounding poverty and undermining social regeneration.
It is now widely acknowledged that enforcement-based strategies have been counter-productive and have helped bring otherwise law-abiding citizens into conflict with the law. Incarceration doesn’t help those having problems with drugs; nor does it address the underlying reasons for drug-related offending. Drug use is prominent among those who repeatedly commit acquisitive crimes with the result that our prisons are clogged up with short-term offenders.
Half of all offenders whose crimes are drug-related were criminals before they first took drugs. They become involved in drug use in their daily work, as do doctors, pharmacists and veterinary surgeons. A burglar, sitting at home bored during the day, may turn to taking the heroin and crack cocaine that is sold in his or her criminal circle. Once they become dependent on drugs, the intensity of their offending increases rapidly. Notably this group may only reduce the intensity of offending when offered drug treatment.
However, the other half of drug-related offenders become involved in crime only to fund drug dependency. If this group were offered drug treatment services in a non-judgmental, empowering manner, we would be giving them a reason not to turn to crime.
Such a strategy, one that addressed the unnecessary link between acquisitive crime and drug use, would result in significant cost savings for government, both from a decrease in the prison population and from a reduced workload and more targeted role for the police. For that reason alone, it should commend itself to all parties in a time of attempts to cut public spending.
The approach would also reinforce the UK’s role as a global leader in evidence-based drugs policy and would avert the worst unintended consequences of current drug policies. For example, social regeneration and anti-poverty measures would not have to deal with the negative impact of gang culture associated with drug dealing in the poorest communities. This, too, would result in savings in policing and welfare budgets.
There would be further benefits in terms of social cohesion, management of the increasingly troublesome night-time economy. A more effective drug treatment system would also result in great healthcare savings, for example, the high costs of treating hepatitis C.
Seven Pillars of Drug Wisdom
In 1999 I ‘came out’ professionally and publicly as a drug user. I had previously been a health service drug service manager and I remain a professional drug specialist. My experiences in acting as a bridge between the drug-using community and the professionals have led me to identify seven simple but bold policy interventions that could have tremendous impact. Each of these individual elements have already been tried and tested within the existing UN drug control conventions.
1. Remove drugs policy from the rough and tumble of party politics
The Government should set targets but otherwise devolve day-to-day management of drug policy to the Advisory Committee on Misuse of Drugs. This specialist advisory body would be accountable to parliamentary committees, as is the case with the Bank of England. Membership of ACMD should include those directly affected by drug policy and practice, including representatives of the active drug using community.
2. Decriminalise drug possession
The police service has successfully transformed its approach to engaging with drug users. Taking the individual person who uses drugs out of the criminal justice system, as has been successfully practised in Portugal, would save police and court time and increase treatment uptake more effectively than coercive strategies.
3. Target only suppliers who cause a public nuisance
Policing priorities should be changed to target only suppliers who cause a public nuisance, for example supplying in areas close to schools or other sensitive public spaces. Such a strategy, combined with customer preference for safe, good quality service, would drive gangster dealers out of the market and take income and influence away from street gangs. Police and court resources would be freed up. This strategy has been successful in the Netherlands.
4. Improve and normalise treatment
Drug services spend too much time policing and treating people seeking support around their drug use. Providing advice, guidance, and psycho-social support allows people to get back on their feet but too often treatment focuses on abstinence, ignoring the individual and social benefits of running a comprehensive drug treatment system. Improving services is often hindered by the ideology of those offering the programmes. Drug treatment settings should foster self-reliance and honest dialogue between people who use drugs and healthcare workers.
5. Extend harm-reduction services
Thanks to good social enterprises, private concerns and innovative peer-based responses, the UK has some of the best harm-reductions services in the world. Extending their range and reach could offer early warnings of those who can no longer afford to fund their drug use by legal means.
6. Tackle short-term drug-related offending
Currently, demand for drug treatment services outstrips supply and offenders are given priority. Multi-agency responses, involving police, probation and court system, should target prolific offenders but cessation of offending rather than drug abstinence should be the priority of this multi-agency response. A responsive and accessible drug treatment system should address the reasons drug-related prisoners re-offend when they leave prison.
7. Foster healthier user communities
Drug-user organisations have been shown to be of great value as bridges with drug services, supporting service access and retention, acting as advocates when problems occur, and supporting the planning and review of services. The ethos of the National Treatment Agency has had a suffocating effect on some of these community networks, which now need renewed fostering and support.
Bad policies lead to bad outcomes
Travelling around the world as a drug-user activist and drugs specialist, I have seen some of the best and worst of current drug policy and practice. Most importantly I have learnt from my fellow users of drugs what it is like to live in these different systems. It has made me acutely aware of the need for bold thinking.
Bad drugs policy and practice compound other social problems such as crime, poverty, unemployment, urban decline, mental illness and gang culture. However, the majority of those who use drugs have a self-regulated relationship with them. Many ‘age out’ of use as they get jobs or start families (or even become politicians). Most resolve problems without professional help. Reducing the moralising around drug services would be one way to make these services accessible and effective for those who would most benefit.
Such a pragmatic and humane approach would have the support of the majority of policy experts, academics, senior law enforcement officers, and the relevant royal colleges.
Current policy does not work, as Government analyses show; the public needs to be engaged in a new rational discussion on drugs. The ‘seven pillars’ outlined here represent a middle road between calling for legalisation and models that have clearly failed.
I am not sure Margaret Thatcher would actually approve but fresh thinking on drug policy in the UK is long overdue.
To read more articles in the Centrestage - voices for change debate, click here