BIRMINGHAM HYPODERMIC

The connection between tattoos and hepatitis C virus (HCV) has long been suspected but never completely substantiated. Tattoos and the connection to the disease were clouded by a perceived propensity to other risk factors, such as injection drug use. "Other studies did not exclude patients with other risk factors for hepatitis C," explains principal investigator Dr. Edmund Bini, "which made it difficult to assess the association between HCV and tattoos. The strength of that association surprised us."

Researchers in New York studied 3871 people, approximately half of whom were control subjects. Patients with HCV were more likely to have had one or more tattoos, and this remained so even after adjusting for age, sex and race/ethnicity.

Patients with tattoos but also with traditional risk factors for HCV -- injection drug use and drug transfusion prior to 1992 -- were excluded from the final analysis of the data of the remaining 1887 patients with tattoos and no other risk factors for HCV, patients with HCV were approximately three times more likely to have had tattoos. This connection was significant even after, once again, adjusting for age, sex, and race/ethnicity.

The researchers concluded that all patients with tattoos should be tested for HCV. "It helps to be able to identify patients early who are eligible for treatment," said Dr. Bini. This information will be further refined when they complete analysis of assessing the risk of having multiple tattoos, as well as whether the patient received the tattoo in the US or abroad.

Abstract title:

Strong association between tattoos and hepatitis C virus infection: A multicenter study of 3,871 patients

AASLD is the leading medical organization for advancing the science and practice of hepatology. Founded by physicians in 1950, AASLD's vision is to prevent and cure liver diseases. This year's Liver Meeting, held in Boston, Massachusetts November 2-6, will bring together almost 5,000 researchers from 55 countries.

American Association for the Study of Liver Diseases

Monday, 31 March 2008


Earlier today my attention was brought to an advertising campaign that I can only describe as sickening. Mersey Care NHS Trust have launched this wide campaign with the aim of "Getting more drug users in treatment and/or detox" and described the method used as "An innovative call for action". Sadly, they have only succeeded in further ostracizing an element of our society that already felt excluded and vulnerable.
Well I have news for you, Mr Bob Dale, service manager at Mersey Care NHS Trust addiction services. We are not in the dark ages. Drug users are not dirty, as your campaign portrays us to be. We are human beings, with feeling's and rights, may I add. How can you get it so wrong? How much did this atrocity cost the tax payer? This abomination only goes to highlight the failings of NHS substance misuse services in this Country. We have such a long way to go.
Mr Bob Dale, you do not deserve the position you hold and should do the honourable thing and resign

Britain's first drug 'shooting galleries' hailed a success
By Jeremy Laurance, Health Editor
Published: 20 November 2007

A trial scheme which set up "shooting galleries" in three cities, enabling heroin users to obtain drugs and inject them under supervision, has dramatically cut crime rates and stopped addicts buying their supplies on the streets.

Yesterday's preliminary results from the £2.5m pilot project sent a ripple of excitement through the treatment community, because long-term heroin users are among the hardest addicts to treat. They lead chaotic lives, often robbing and stealing to fund their habits. According to official figures, 10 per cent of drug addicts commit 75 per cent of the acquisitive crimes in the Britain. But the number of offences committed by the heroin addicts taking part in the shooting gallery scheme fell from an average of 40 each per month before they were admitted to "about half a dozen a month" after six months of intensive therapy, according to Professor John Strang, the head of the National Addiction Centre at the Maudsley Hospital, who is leading the study.

Instead of buying street heroin every day, the 150 volunteers are now buying it only four or five times a month on average – while a third of them have completely stopped "scoring" the drug on the streets.

Professor Strang said: "This is genuinely exciting news. These are people with a juggernaut-sized heroin problem and I really didn't know whether we could turn it around. We have succeeded with people who looked as if their problem was unturnable, and we have done it in six months."

The scheme is modelled on one in Switzerland, where the introduction of injecting clinics "medicalised" heroin use and transformed it from an act of rebellion to a treatable illness. Similar clinics operate in France, Germany and Canada.

The first British injecting clinic opened in south London two years ago, funded by the Home Office and the Department of Health. Two more were opened, in Darlington last year and in Brighton two months ago. During the trial, a third of the volunteer addicts take the heroin substitute methadone orally, while a third inject it under supervision. The remaining third, observed by nurses, attend twice a day to inject themselves with diamorphine – or pure heroin – which is imported from Switzerland and provided by the clinic. Professor Strang said: "The rules are incredibly strict. There is no 'take-away' at all [to avoid the users selling their drugs on the streets]. All injections are witnessed at the clinic.

"The approach introduces routine and drudgery by forcing the users to attend for their fix twice a day. The nurses have become quite involved, telling users off about their bad practice or lack of hygiene. I was quite surprised how, after decades of injecting, some users were still so bad at it."

There are an estimated 280,000 users of hard drugs in Britain, most taking heroin and crack cocaine, and about 2,500 deaths a year. The shooting gallery scheme, targeted at long-term heroin users, operates seven days a week, 365 days a year and costs £15,000 per year for each addict – three times the cost of providing oral methadone treatment.

Jamie, 39, heroin addict: 'I have got no warrants hanging over my head'

Since the age of 16, Jamie has been to jail 28 times. She has lost her children, her possessions and very nearly her life when she was hospitalised for six weeks in 2004. All because of heroin.

"It started when I was 14. I kept running away from home and got involved with some older kids who were using 'skag'. I wanted to know what it was like. By 16 I was addicted."

Much of her life since then has been spent on the run from police and in treatment programmes, none of which succeeded in weaning her off the drugs.

In 2005 she was one of the first addicts to be taken on by the injecting clinic in south London. It has transformed her life. "I am no longer out shoplifting. I have got no fines or arrest warrants hanging over my head and I am not in prison. I have a better relationship with my family and I feel great."

Now 39, she injects diamorphine every morning and afternoon and wants to start reducing her dose soon.

Eastside stories

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We all would feel the payoffs of heroin on prescription


Bernard Hare
Wednesday August 22, 2007
The Guardian


When Ken Jones, president of the Association of Chief Police Officers (Acpo), proposed in February that some heroin addicts should have their fix handed out by the NHS, I could have fallen off my chair. I agree with the idea, but I was shocked that a senior policeman was openly suggesting it.
He is a brave man to go against public opinion. At first sight, the notion is preposterous. Free drugs on the NHS? There would be hordes of people banging at the doctor's door every morning. And why should they get their drugs for free? Let them get a job and pay for their drugs like the rest of us.

Then again, at first sight, you wouldn't take Eastsiders Kelly and Rebecca for shoplifters. In their mid-30s, well groomed, wearing expensive clothes with designer sunglasses, you would be forgiven if you took them for ladies that lunch, or two ordinary housewives out for an afternoon's shopping. But you would be wrong.

They are long-term heroin addicts and prolific thieves. Exactly the sort of people Jones had in mind when he made his announcement. "You need to understand that there is a hard core, a minority, who nevertheless commit masses of crime to fund their habit," he said.

Younger addicts are relatively well served by the current testing and treatment regime, where their drug use is challenged by means of various carrots and sticks. Kelly and Rebecca are old hands when it comes to both methods. It will take more than carrots and sticks to move them. The stick holds no fear for them. They have done time in prison on more than one occasion. "Jail doesn't bother me, because I've done it that many times," says Kelly. "It makes you worse, if anything. That's where me and Rebecca met in the first place." As for the carrot: "I hate talking in groups," Rebecca says. "It makes me want to take drugs even more."

Both women have £80-a-day habits - £40 for heroin and the same for crack cocaine. Between them, they hand over £160 a day (that's £58,000 a year) to a local drug dealer. Stolen goods go for a third of the retail price, so the shopfloor value of the goods they steal each day is £480 - around £170,000 a year.

Jones is first and foremost a policeman. He wants to stop crime and has identified that the best way to do it is with people like Kelly and Rebecca in mind. "If I got it prescribed, I wouldn't need to go out grafting," Kelly says. "I might even be able to hold down a job." Kelly has two kids and she would like to do more for them. She would like nothing better than to lead a normal life.

The NHS doles out piles of anti-depressants every year to help people get through the day. It's a shame that Kelly and Rebecca are excluded from this benevolent aid programme because their drug of choice is shunned and feared by society.

A side-effect of adopting the heroin prescription policy would be that thousands of limbs and hundreds of lives would be saved. Kelly sometimes walks with a slight limp. She injected when she was younger and developed deep vein thrombosis. She considers herself lucky. She knows people who have lost legs, and others who have died. NHS-prescribed drugs would be clean and safe, unlike the poison that is bought on the streets. Many of the drug-related deaths each year in the UK might be prevented with a reliable supply of clean drugs and equipment.

A strong argument against prescription is that many addicts would continue to use crack cocaine. "Maybe we would still use now and again," Rebecca admits. "But you don't need the white like you need the brown." But if the policy cleared up only half the problem, it would be worthwhile. It would be a start.

It goes against the grain in England to give treats to the undeserving poor, but the benefits to society are clearly so immediate in this case, that I, for one, would be willing to make an exception.

· Bernard Hare is a writer based in Leeds

WHY IS HEROIN PRESCRIBING A MORE EXSPENSIVE OPTION IN THE UK THAN EUROPE?

IN THE 5 CENTURY BC HIPPOCRATES, ONE OF THE FIRST & MOST INFLUENTIAL PHYSICIANS WROTE ABOUT A BITTER POWDER EXTRACTED FROM WILLOW BARK THAT COULD EASE ACHES & PAINS & REDUCE FEVER. THE ACTIVE INGREDIENT IN THE POWDER IS CALLED SALICIN, WHICH WHEN CONSUMED IS TURNED INTO SALICYLIC ACID.THE POWDER IN ITS RAW UNREFINED STATE REQUIRED LARGE DOSES TO HAVE BENEFICIAL EFFECTS & THESE LARGE DOSES CAUSED STOMACH UPSET & POSSIBLE INTERNAL BLEEDING TO ITS USER’S.
IN THE LATE 19 CENTURY A GERMAN CHEMIST, FELIX HOFFMAN,DISCOVERED THAT SIMPLE CHEMISTRY COULD CONVERT RAW SALICYLIC ACID INTO A FORM THAT GAVE GOOD RELIEF FROM PAIN & FEVER WITHOUT THE NEGATIVE SIDE EFFECTS. THIS NEW FORM WAS CALLED ACETYLSALICYLIC ACID OR ‘ASPIRIN’ TO YOU & ME.
TODAY ASPIRIN IS MADE FROM CRUDE OIL WHICH IS GOOD NEWS FOR WILLOW TREE’S AS 26 TONNES (80 MILLION TABS) ARE CONSUMED EVERY DAY IN AMERICA ALONE REQUIRING THE BARK OF 10,000 TREE’S EVERY DAY.
TODAY ASPIRIN ISN’T COVERED BY PATENTS, AS A RESULT IT’S CHEAP, SUPERMARKET BRAND ASPIRIN COSTS LESS THAN 7p A GRAM.
HUMANS HAVE LONG KNOWN OF ANOTHER PLANT PRODUCING SIMILAR MEDICINAL PROPERTIES; THE POPPY,THE EARLIEST
WRITTEN RECORD OF IT’S USE DATE’S BACK TO THE 8 CENTURY BC. THE MAIN ACTIVE INGREDIENT IS ‘MORPHINE’. FIRST ISOLATED IN 1805 & NAMED AFTER MORPHEUS THE GREEK GOD OF DREAMS. WHEN MORPHINE IS SUBJECTED TO THE SAME CHEMICAL PROCESS AS THAT USED TO MAKE ASPIRIN, THAT IS, THE RIGHT AMOUNT OF ACETIC ANHYDRIDE IS HEATED TO THE RIGHT TEMPRETURE THEN A NEW CHEMICAL IS PRODUCED; DIACETYLMORPHINE KNOWN AS DIAMORPHINE OR MORE COMMONALY HEROIN.
HEROIN WAS THE BRAND NAME THAT BAYER&CO GAVE TO IT’S NEW PRODUCT WHICH THE COMPANY MARKETED AS AGGRESSIVELY AS IT DID ASPIRIN. DESPITE THE REACTION THE GENERAL PUBLIC HAVE TO THIS BRAND NAME, HEROIN IS STILL OUR MOST EFFECTIVE PAINKILLER, & IS USED EVERY DAY IN THE UK TO REDUCE SUFFERING TO THE TERMINALLY ILL, & PROVIDES ACUTE ANALGESIA IN EMERGENCIES.
SADLY, IN CONTRIES LIKE THE USA & AUSTRALIA & MANY OTHERS , PURITAN MORALITY HAS TRIUMPHED OVER RATIONALITY & DIAMORPHINE IS BANNED, EVEN FOR MEDICINAL
PURPOSSES. ASTONISHINGLY SOME MEDICAL TEXT BOOKS CLAIM IT HAS ‘NO MEDICAL USE WHATSOEVER’ DESPITE AMPLE EVIDENCE TO THE CONTARY.
IN CONCLUSION

THE POPPY IS SO EASY TO GROW IT SHOULD BE RECLASSIEFIED AS A WEED, ABLE TO GROW ALMOST ANYWHERE. HEROIN IS MADE FROM THIS NATRAL PRODUCT COSTING NEXT TO NOTHING TO GROW, & IT’S MANUFACTURE IS THE IDENTICAL PROCESS AS THAT USED TO MAKE ONE OF THE CHEAPEST & COMMONALLY USED DRUGS, ASPERIN. GIVEN THESE FACTS HEROIN SHOULD COST NO MORE THAN THE 7p A GRAM PRICE THAT ASPERIN COST’S, & CERTAINLY LESS THAN SYNTHETIC OPIATES & OPIOIDS LIKE METHADONE, EVEN WITHOUT THE SCALE OF COST APPLICABLE TO ASPERIN PRODUCTION.
THIS MEANS THE UK COULD TREAT, STABALISE & DECRIMINALISE EVERY USER IN THE COUNTRY WHO WANTS TO FOR LESS THAN 14p A DAY(FEW USER’S NEED 2 GRAMS A DAY MOST WOULD STABALISE ON A GRAM OR LESS). SO THE TOTAL COST OF SUPPLY FOR A YEAR SHOULD BE AROUND £25-£50 .
THE GOVERNMENT’S FIGURES FOR A YEAR’S DIAMORPHINE SCRIPT PER PERSON ESTIMATED AT £11,000, RESULT ENTIRELY FROM THERE OWN LEGISLATION, RATHER THAN TO THE ACTUAL COST OF MANUFACTURE.OUR GOVERNMENT REQUIRES THAT DIAMORPHINE REQUIRES THAT DIAMORPHINE BE SUPPLIED AS A FREEZE-DRIED SUBSTANCE IN GLASS AMPOULES, WITH COMPETITION ARTIFICILLY RESTRICTED, & REGULATIONS THAT CONSTRAINS THE UK TO ONLY TWO SUPPLIERS! THESE REGULATIONS FORCE OUR NHS TO PAY APPROX £45 PER GRAM AS COMPARED WITH THE £6 PAID BY HOLLAND GERMANY & THE SWISS FOR THERE DIAMORPHINE. A SUPPOSED NATIONAL ‘SHORTAGE’ OF THE DRUG LAST YEAR BEGAN AS SOON AS THE MAJOR UK SUPPLIER (POWDERJECT) WAS SOLD TO AN AMERICAN COMPANY (CHINON). THIS SALE MADE POWDERJECT’S MANAGING DIRECTOR, PAUL DRAYSON,(A FRIEND OF THE PM & LABOUR DONAR) A VERY RICH MAN, SOON AFTER THE SALE HE BECAME LORD DRAYSON, TAKING ON THE ROLE OF DEFENCE PROCURMENT FOR THE UK.

CAN IT REALLY BE COINCEDENCE THAT A COMPANY BASED IN THE USA, A COUNTRY THAT APPLIES INTERNATIONAL PRESSURE TO BAN THE USE OF DIAMORPHINE WORLD-WIDE, SHOULD CAUSE SUCH A SHORTAGE OF SUPPLY IN THE UK?
ASK YOURSELF THIS ARE WE REALLY STILL A SOVERIGN COUNTRY, ABLE TO MAKE OUR OWN DECISSIONS ABOUT SUCH MATTERS, OR ARE POLICIES BASED NOT ON SCIENCE OR RATIONALITY, BUT INSTEAD ON THE RELIGIOUS & MORAL BELIEFS OF A DIFFERENT CULTURE, BEING FORCED ON US VIA THE BACK DOOR? DO WE REALLY FIND IT ACCEPTABLE THAT PEOPLE ARE DRIVEN TO CRMINALISE,PROSTITUTE & RISK THERE
LIVES TO VIRUS’S. DISEASE , ILL-HEALH & GANGTERISM ON THE STREETS IN ORDER TO PAY FOR ILLICIT HEROIN, WHEN CLEAN LEGAL SUPPLIES COULD BE MADE AVAILABLE AT NEGLIGIBLE COST,WHICH USER’S WOULD BE HAPPY TO PAY & IS REAL HARM REDUCTION .

Think-tank says prohibition has failed and wants talks on legalisation as Home Office defends ban

Jamie Doward, home affairs editor
Sunday October 21, 2007
The Observer


The government's consultation on a new 10-year drugs strategy is a 'sham', according to one of Britain's leading think-tanks on narcotics, which warns that the current policy is fuelling a crime epidemic.
The Transform Drug Policy Foundation, the only UK organisation of its kind to advise the United Nations on such issues, will this week publish a new report claiming the current strategy has failed. The report, 'After the War on Drugs: Tools for the Debate', claims there is an urgent need for full consultation on allowing the controlled supply of illegal drugs. 'It is clear our drug policy cannot continue down the same failed path forever,' the report states. 'Prohibition's failure is now widely understood and acknowledged among key stakeholders in the debate... the political benefits of pursuing prohibition are now waning and the political costs of its continuation are becoming unsustainable.'

The report claims that drug prohibition has allowed organised crime to control the market and criminalised millions of users, putting a huge strain on the justice system. The Home Office estimates that half of all property crime is linked to fundraising to buy illegal drugs. The police claim that drug markets are the main driver of the UK's burgeoning gun culture. Official figures released last week showed that drug offences recorded by police had risen 14 per cent in April to June of this year, compared with the same period in 2006.

Politicians claim tough anti-drugs laws send clear signals to society. But Transform points to a Home Office survey, commissioned in 2000, which showed the social and economic costs of heroin and cocaine use were between £10.1 and £17.4 billion - the bulk of which were costs to the victims of drug-related crime.

'Over the course of 10 years, a series of different inquiry reports into UK drugs policy all say the same thing: the policy is malfunctioning,' said Steve Rolles, the report's author. 'They've all been blithely ignored by the government, which insists it is making progess.'

Last week, North Wales Police chief constable Richard Brunstrom said he would 'campaign hard' for drugs such as heroin to be legalised. Previously he has said that drugs laws are out of date and that the Misuse of Drugs Act 1971 should be replaced by a new 'Substance Misuse Act'.

Transform claims the consultation process, which finished on Friday, was designed to stifle debate on drugs policy. 'The consultation process has been a sham,' Rolles said. 'It hasn't highlighted any policies to consult on. It's becoming very clear the next 10-year strategy is going to be identical to the last one. The whole idea that there is going to be a radical change is just not the case.'

The think-tank has taken the unusual step of writing to the Better Regulation Executive, set up to ensure government runs smoothly, to complain that the Prime Minister, Gordon Brown, is already making policy before the consultation process had finished.

The Prime Minister signalled earlier this year that the government would reclassify cannabis. He also recently insisted the government would never decriminalise drugs, something Transform argues makes a mockery of the consultation process.

A spokeswoman for the Home Office said: 'We have undertaken an open consultation and we welcome constructive ideas and views on how we can continue to reduce drug harm. However, the government is emphatically opposed to the legalisation of drugs which would increase drug-related harm and break both international and domestic law.'

Media/News > Press Releases > 22.10.07

Drugs prohibition is a “policy of mass destruction” and the consultation document is a “dodgy dossier”
News release
No Embargo
Date: Monday 22 October 2007

The Government's consultation on the last ten years of its drug strategy and its future, finished last week (Friday 19 October). As part of its submission Transform uses correspondence from officials, previously not in the public domain, to illustrate the Government's knowledge that its support for drugs prohibition creates significant harms. The report can be seen at:

http://www.tdpf.org.uk/TDPF%20Drugs%20strategy%20consultation%20submission.pdf

The submission demonstrates how the Government:

manipulated the entire consultation to close down genuine debate on drug policy
set the framework in such a way as to have determined the outcome before the consultation had even finished
ignored ten years of constant criticism of its drug policy
hid internal reports critical of prohibition
treats criticism of drug policy with disdain and contempt
refuses to evaluate prohibition
is a hostage to US inspired geopolitical forces
uses drug policy for electioneering
This is despite the fact that the Government admits that prohibition itself is a significant cause of harm. In a letter to Transform's Director Danny Kushlick in Oct 2005, Foreign Office Minister of State the Rt Dr Hon Kim Howells MP wrote:

“Prohibition of course gives rise to illicit trafficking and use and a range of problems associated with those.”

And in a letter to Dr John Marks from the Home Office Direct Communications Unit in September 2007, they admitted that:

“…it is likely that there would be a reduction in acquisitive crime, if drugs were legalised…”

The implication of which is that the Government admits that prohibition creates acquisitive crime. Home Office estimates suggest that crime costs associated with prohibited drugs are about £15 billion a year.

The letter to Dr Marks goes on to say:

“The Government is aware of the arguments for legalising controlled drugs in a regulated way and has concluded that the disadvantages would outweigh the benefits.”

These deliberations on cost benefit analysis have never been made public and, suggest that “arguments” have taken precedence over evidence.

Transform's submission concludes that political parties will not engage in genuine debate and that it is up to individuals from every walk of life to challenge drug policy spin and debate the issue in their workplaces, professional bodies and social circles to avoid another ten years of self inflicted disaster.

Danny Kushlick, Transform Director, said:

“The consultation should have been a thoroughgoing review of the policy making process and the impact that policy has in the everyday world. In the event, it turned out to be a sham. The consultation document is another dodgy dossier. It contained no proposals, breaking one of the fundamental rules for consultations. The document was the most blatant propaganda we have yet seen to support ten more years of prohibition. During the process Gordon Brown announced that cannabis law would be changed and that drugs will never be decriminalised. Lastly, the Government targets were announced, predetermining that the entire framework for future policy development would be unchanged.

“We have an enormous amount of evidence now to show that the Government is in full possession of the facts that the policy of prohibition of currently illegal drugs is the significant driver for harms associated with their production, supply and use. Prohibition is a policy of mass destruction, from Afghanistan and Colombia to London and Liverpool. Transform's submission contains extracts from previously unreleased correspondence from the Foreign Office and the Home Office demonstrating that both departments admit that prohibition causes great harms but that neither are willing to contemplate change. This intransigence is despicable, given the level of chaos and misery associated with the illegal drug market. The correspondence quoted above demonstrates that Government drug policy is explicitly based upon claims to have won an “argument”, rather than evidence. Whilst Government uses primary school debating society rhetoric to decide its drug policy, huge swathes of the global population die or live in misery and degradation as a result.

“In the absence of political parties' willingness to enter into genuine debate, it falls to institutions and individuals outside of government to throw down the gauntlet. Significantly the press has played an enormously valuable role in raising a debate where Westminster has obstinately refused. We believe that this will remain the case for the foreseeable future, until the counterproductive forces of prohibition bring the criminal justice system to its knees and the general public is in possession of the facts and analysis to see through the propaganda that the Government uses to support the status quo.”

Comment

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The true face of drug crime


When a user's quickest route to treatment is to get arrested, the need for new thinking is clear

Matthew Taylor
Wednesday October 17, 2007
The Guardian


The call by the chief constable of north Wales for all drugs to be legalised highlights a pressing issue for Gordon Brown: Britain's failing drugs policy. The 10-year strategy for illegal drugs laid out by Tony Blair in 1998 expires next April, and the Home Office has sent out a consultation paper to "communities, families, experts and current and ex drug users" - an opportunity to press for a more rational approach.
Illegal drugs are notoriously troublesome for policy makers, hedged about with contested statistics. One fact, though, has always seemed solid: drugs cause crime. According to the Home Office document Drug Strategy: Key Facts, drug-related crime accounted for 90% of the economic and social costs of class A drug use in 2003-04, costing the country £13.2bn.

Or did it? Recent research from Alex Stevens, of the University of Kent, suggests that a cornerstone of government thinking, the causal link between drug abuse and criminality, does not stand up - he says that Home Office calculations overestimate the importance of drug-related crime because they ignore the fact that a disproportionate number of drug users get arrested.

Stevens finds a worrying tendency in Home Office material to assume that drug use causes crime. When a user commits an offence, it is assumed that their drug habit is the reason: the popular image is of the crazed junkie scrabbling around in a jewellery box. Stevens shows that some drugs are associated with particular types of crime: heroin addicts are more likely to be caught shoplifting, for example. But he challenges the idea of an overall causal link.

Larger trends bear this out. In the past 10 years property crime has fallen by almost 50%, with particularly steep falls in domestic burglary. The government assumes that this can be explained by reductions in drug use. Yet use of heroin, cocaine and crack, the drugs supposed to be linked to property crime, is at historically high levels. In truth, the declining street value of goods such as TVs and DVD players provides a more powerful explanation.

The link between drugs and crime is more complex than policy accounts for. The desire to make money out of selling mobile phones or iPods does not rely on offenders being addicts.

Stevens feels that drug policy needs a true revolution: a return to the start. At one time the medical profession took the lead in developing and administering drugs policy in the UK. Since 1998, however, the lead role has been played by the Home Office and police. This skews the treatment system, bending it away from those who need its help.

At present, drug users who have committed a crime are required to receive treatment within five days; for non-offending drug users, the suggested maximum wait is three weeks. Perversely, the best route to quick treatment is to get caught shoplifting.

Gordon Brown has been talking tough on decriminalisation and reclassification. This may well be sound politics, but it obscures the problems faced by current strategy. The real issue is not how we treat drugs; it is how we treat users. Not recreational users, mostly enjoying themselves, but problematic users, their lives ruined by addiction. There are nearly half a million problematic users in Britain, many of them seriously underserved by their government.

The key recommendation of the RSA's drugs commission was to treat drugs not as a crime problem, but as a health one. This would not only mean that drugs policy focuses more heavily on clinical treatment. It would mean that the "wraparound" services - housing, education, employment, childcare, family support - would be made more readily available to drug users. There would be more emphasis on the welfare of individuals experiencing problems with drugs, and on the public health benefits of tackling drug-related problems such as HIV and Hepatitis C.

There does seem a willingness in government to look seriously at this alternative. The difficulty, as always, is how to communicate it to voters. Too often we assume tabloid-headline speak to voice public attitudes. In-depth studies show, however, that people understand the problems of a purely coercive approach. This is hardly surprising: many young adults have experienced recreational drug use, and new grandparents are children of the 60s. Labour ministers are working on the right lines. Now they must make the case with the British people for a more enlightened approach.

· Matthew Taylor is chief executive of the RSA and former chief adviser on political strategy to Tony Blair
webmaster@rsa.org.uk

Sunday Times November 26, 2006

The really tough way to control drugs is to license them
Simon Jenkins
A young American friend last week visited Camden Lock, north London, and returned amazed. In a hundred yards he was offered brazenly in the street just about every drug he could imagine. It was easier to buy cannabis or cocaine than a cigarette or a can of beer. The experience could have been repeated in any city centre in Britain. The drug market is totally unregulated and as a result totally dangerous. Welcome to 10 years of Tony Blair’s “war on drugs”.
This war makes the war on terror look like a pushover. The latest figures from the European drug monitoring agency indicate that Britain leads the continent in cocaine and heroin use and is equalled only by Denmark for cannabis. Given how often prohibitionists abuse Holland’s proactive drugs policy, it is worth noting that twice as many Britons as Dutch use cocaine and a third more use cannabis. With 327,000 so-called “problem users” (up a quarter on the last estimate), Britain is far worse than France, Germany and Italy.

Meanwhile, despite billions being spent on policing, trade in these substances is booming and price plummeting. Adjusted for inflation, the prices of ecstasy and heroin are both down by a half in five years. Cocaine is down by 22% and cannabis down by 19%. In Britain a gram of cocaine cost £65 in 2000 and £51 today. An astonishing 10% of 15 to 34-year-olds admit to using cocaine in the past year, topped only by 30% who admit to using cannabis. This renders any statistics of “the incidence of crime in Britain” meaningless. A third of the population are guilty. Last year alone 14 new psychoactive drugs were detected by the police, led by the powerful “crystal meth”.

Carel Edwards, the European Union’s drug enforcer, reflected last week that “after 50 years of a moral international crusade to reduce the drugs problem, the results are not exactly brilliant”. To add to his woes, Europe is about to be hit by a record Afghan opium harvest, supplying 90% of its consumption. After the 2001 invasion, suppressing Afghanistan’s poppy crop was hilariously assigned to the British government. It was like the United Nations assigning Libya and Zimbabwe to its human rights committee. Why should Britain control supply abroad when it refused to control demand at home?

British drugs policy is a disaster. Parliament’s refusal for more than a third of a century even to amend the prohibitionist 1971 Misuse of Drugs Act is the most damning comment on the state of politics today, in thrall to the tabloid mob. The 1971 act must be the only criminal justice statute not to have been rewritten a dozen times by Tory and Labour governments. Charles Clarke and John Reid pass four terrorism acts a year, yet not one to tackle the drug market. The act contributes to the deaths of hundreds of young people each year. It stokes violent crime and impoverishes families and communities, while giving Britain the biggest prison population in Europe. Yet nobody in politics has the guts to touch it.

The police are clearly fed up: 60% of all recorded crime is estimated to be drug related. Last Wednesday Howard Roberts, chief constable of Nottinghamshire, pleaded for the umpteenth time for reform. To a policeman it is crazy for the Home Office to ignore a legal prohibition that contributes to 432 offences at a cost of £45,000 a year per addict, including stabbings and murders. The total price of hard drug prohibition is put by the Home Office itself at a staggering £ 15 billion a year.

Roberts pointed out that the much vaunted treatment by methadone substitution has not worked, with a cure rate of barely 3%. Since local authorities must pay for treatment from their discretionary budgets, they are going for the cheaper methadone substitution option, as result of which more costly residential places in heroin treatment centres lie empty. Yet to the nation the latter programme, costing £12,000 a place but with a success rate of more than a third, is far better value for money. The Dutch and Swiss have achieved significant reductions in heroin addiction by treatment through controlled prescription. They have also achieved a marked fall in crime by addicts. Yet Downing Street seems unable to “join up” its drugs policy as can other countries.

Not just policemen but judges, prison reformers and charities such as DrugScope, Drugsline, Addaction, Adapt, and Action on Addiction cry continually for a review of policy. There have been enough independent reviews to fill a library. I served on one myself, the Police Foundation inquiry into the 1971 act in 2000. Professor David Nutt of the government Advisory Council on the Misuse of Drugs told MPs last Wednesday about the absurdity of ecstasy, used by 500,000 young people each week, being graded alongside heroin. Yet all Vernon Coaker, the hapless drugs minister, could reply was that drugs policy was “a matter of political judgment”. In other words, he had delegated it to the staff of The Sun.

This week an international group of present and former police chiefs called Law Enforcement Against Prohibition is in Britain to lobby for reform. Jack Cole, its American spokesman, points out that when alcohol prohibition was ended in 1933 “we put Al Capone out of business overnight — and we can do the same to the drug lords and terrorists who make over $500 billion a year selling illegal drugs round the world”.

Prohibitionists respond that “if only” these policemen enforced the law and threw all drug users in jail there would be no market for the dealers and no need for addicts to commit crime. Thus a Yorkshire magistrate last week complained about a 15-year-old accused of murdering his brother after seven cans of lager and “several” joints. He blamed government leniency towards cannabis — rather than the magistracy’s notorious leniency towards drunkenness.

The prohibition lobby has held the floor for more than 30 years and has run out of both arguments and time. The home secretary could hire gangs of vigilantes to roam every community and shoot drug users on sight. This might increase street prices, stem consumption for a year or two and deter some middle-class offspring. But this is not serious debate. Southeast Asia has capital punishment for drug use and yet drug use is rife.

I have studied the impact of drugs and regard them as varying from the mildly harmful to the utterly lethal. I would recommend nobody to use them other than medicinally, like amphetamines. But to call for the ruthless enforcement of a law that has patently lost consent (even among opinion pollsters) is not “tough on drugs”, merely a cop-out.

There must be more drug enforcement bureaucrats in Whitehall and police headquarters across the country, achieving nothing, than there are workers combating addiction in the field.

The prohibitionists think that by passing laws they are curing a problem. In reality universal drug availability ensures just two things. An industry catering to almost a third of Britons (reputedly with a turnover similar to that of the petrol or drinks industries) prospers uncontrolled and untaxed. At the same time the quality of its product is unregulated and therefore at risk of adulteration. The dilution of cocaine has recently been shown to be highly carcinogenic. Crooks are making millions out of killing people.

Most drug users can handle the harm it undoubtedly does them personally. To this extent there is no justification for the state interfering in a private activity. As with the control of alcohol, the regulation of outlets should be required only to protect minors, prevent adulteration and collect taxes. Other European countries are moving in this direction, at least with ecstasy, cannabis and heroin.

Britain must find a way of legalising supplies. Only then can smuggling and racketeering be suppressed. How this is achieved is a subsidiary matter and a good subject for a committee. But the prohibitionist softies must first be outgunned. They are the true enemies of drug control. This market will never go away. The only tough policy is to regulate it.

More people die each year from adulterated drugs than from terrorism. The cost of prohibition both to the state and to the community is colossal. The illicit market in drugs undermines Britain’s communities and subverts British values far more than any Muslim cleric or rucksack bomber.

It will never be confronted until the counterproductive prohibitionist 1971 act is repealed.

The Future of the Drugs Field

Reversing Out of the Cul-de-Sac: Thinking about the Next Five Years

What comes first? What is the most important question? In an era of short termism, in an economy devoted to the short term, how can longer term goals be pursued? How can we even begin to think about longer term goals?

I would like to be able to ask where we in the drug treatment industry and the related policy and research fields want to be in five years. However, before one begins to talk about what kind of industry one would like to see in five years, there is a need to be reassured that we can remove the major obstacles that prevent us from thinking about the future and also from developing a longer term analysis.

So this is not intended to be an exercise in 'blue sky thinking'; I don’t much like 'blue sky thinking'.

Settling Accounts with our Opportunism

My belief is that what comes first, what will facilitate the necessary unblocking in our thinking is a settling of accounts, as an industry, with our opportunism.

We need, as an industry, to understand our opportunism, to celebrate our opportunism (it has, after all, led to some dramatic successes) and, ultimately, to move beyond it. That's what comes first.

What comes first is getting much better at putting Crime and Fear in context.

The Punitive Archipeligo and the Care/Control Continuum
We, in our industry, have been a major part of the expansion of what John Muncie calls the Punitive Archipeligo. It helps here to see 'health interventions' not as opposed to 'criminal justice interventions', but to see them both as part of a single 'care/control continuum'. On such a view, it is possible to identify key parts of our industry moving steadily away from the care end towards the control end, especially over the past five years.

A Clear Link between Drugs and Crime

In the early to mid nineties many of the drug field's key academic advisers were arguing for a very clear link between drugs and crime. There were those who, at the time, counselled caution about making such strong claims, these people were, however, in a clear minority: Ruth Runciman was one.

Now, more than a decade later, very different arguments are emerging.
Now, there are a growing number of researchers who are not just asking questions about the drugs crime link, they are reaching conclusions.

Moronically Simplistic

We are now at a stage, based very much on the evidence rather than any supposition, where the 'clear link' as identified over a decade ago is being described on one view as 'moronically simplistic'.

That's not how we saw it back then. Although our sociology may have been flawed, we weren't knowingly dealing in falsehoods. The measure of our opportunism wasn't that we were prepared to tell lies.

No: our opportunism went much deeper.

We were interested in helping our political masters, at that time Labour in opposition, to find policies that would win consent.

Policies That Win Consent

As Norman Fairclough says, 'There is no clear dividing line between finding policies that work and finding policies that win consent'.

Many years ago, I remember buying a Time Magazine Special Edition on the Theory of Relativity. On the front cover was a soft focus picture of Albert Einstein: he had a shock of grey hair and a twinkle in his eye. Next to the picture it said, "He sought to recast the classic concepts of the universe in two simple equations". And that's just what we did.

The Classic Concepts of the Universe

Like Albert Einstein we sought to recast the classic concepts of the universe in two easy equations. They were as follows:

1. Drugs = Crime

2. Drugs Treatment = Crime Reduction + Safer Communities

These two equations went on to command massive political consent. In fact now, apparently, there is very little else needed to fill out our explanatory and descriptive paradigms. We have recast the classic concepts and we have won consent for our 'analysis'.

The Public Gets What the Public Wants

The public may be largely ignorant of the wider achievements of the UK drug strategy; they may know little, or indeed have little interest in our various successes and failures. They may not know:

That we have halved methadone deaths over the past ten years despite doubling the numbers to whom we prescribe;

That we have treated more people, held more people in treatment and all but got rid of waiting times;

That our form of treatment, in very many cases, seems not to affect the quantities of illegal drugs that people take;

The public may not know how ineffective our coercive policies are in retaining primary offenders.

They may not know how many, or rather how few, of our clients receive effective psycho-social interventions designed to address their drug use.

For that matter they may not know what a 'psycho-social' intervention is. Some of us have only just learned!

Nevertheless they do consent to ‘the Proposition’:

Drug Treatment = Crime Reduction + Safer Communities

This is a powerful and reassuring equation for our electorate for whom crime and the fear of crime are issues of very major concern. So how best can the issues of crime and the fear of crime be put into context? Put another way, how can we reverse out of this historical and political cul-de-sac.

Reversing Out of the Historical and Political Cul-de-Sac

How can we move away from the current narrow focus that makes us think about drug use and drug users in a certain kind of way? I suggest that there are two separate bits of thinking that we need to do in order to reverse out of the cul-de-sac.




The First Bit of Thinking

This bit of thinking we really should have done years ago. It involves being clearer about the main different ways of talking about social exclusion.

The Three Discourses of Social Exclusion: RED, SID and MUD
According to Ruth Levitas, there are three discourses of Social Exclusion. One of them owes much to traditional social democratic thinking and is described as the Redistributionist Egalitarian Discourse, RED for short. The second one is described as the Social Integrationist Discourse and emphasises the importance of paid employment as a key to tacking exclusion, SID for short. The third approach is called the Moral Underclass Discourse and emphasises the moral and cultural shortcomings of the excluded, MUD for short. So we have RED, SID and MUD. For supporters of RED, the key problem for the excluded is that they have no money, for supporters of SID, that they have no job and for supporters of MUD, that the excluded have no morals. If you use the RED discourse, the lead indicator is poverty. If you use the SID discourse, the lead indicator is labour force participation rates and if you use the MUD discourse, the lead indicator is the number of workless households in the working age population.

SID and its followers
New Labour's approach to Social Exclusion has been to mix elements of SID with quite a lot of MUD. One influential SID thinker is Geoff Mulgan -- he was one of the founders of the DEMOS think tank. He also advised Tony Blair during his first administration. He thinks that work is the prime source of status: "The worst thing that can happen is to fall out of work, and lose your employability, your skills, your personal qualities, as well as friends and contacts."

There are a number of challenges to this view and these need at the very least an examination in our industry. Paid work is clearly something most of us prize for reasons too obvious to name. Nevertheless low paid, low skilled work of a casual and deregulated kind does not necessarily raise a person's status, or lift them out of poverty, or tackle the marginal nature of their existence. In addition paid employment is not the only kind of work that has meaning and constructive value for individuals and for society. For the drug policy and treatment industry to celebrate paid employment as a total solution for marginal populations, including drug users, is not the kind of opportunism from which many of our clients would necessarily gain much benefit.

In any event, our field really should look in a more dispassionate and thorough way at changing patterns of work and what they mean for all of those who need our services.



MUD and its followers
Many people in our field have swallowed this analysis hook, line and sinker. For them, a key thinker is Theodore Dalrymple. His 'Life at the bottom-The world view that makes the underclass' is required reading for those who have come to the conclusion that many of our service users are inferior human beings. Dalrymple writes: "…there is now a much enlarged constituency for liberal views: the legions of helpers and carers, social workers and therapists, whose incomes and careers depend crucially on the supposed incapacity of large numbers of people to fend for themselves or behave reasonably."

Whatever position one takes, and it is interesting to note how many harm reductionists seem to have bought the world according to Dalrymple, I think it is very important to understand a bit more about key terms like Social Exclusion and the way it's component discourses are shaped and mixed in the pursuit of political policies that have the clearest and most direct impact on poor people with drug problems.

Having done this first bit of thinking we need now to move on to the second bit.

The Second Bit of Thinking

As part our attempt to put our industries subordination to Crime and Fear in context and in order to clear the way to thinking about changes over the next five years, we need to find a way of thinking in a broader and more up-to-date context about three things:

1. Problem Drug Users:

What we have become accustomed to calling Problem Drug Using Populations

2. Our Workforce -- US:

We may have a major job of work to do upon ourselves

3. The Wider Population


Stop This Puerile Marketing Language
It is with the broad mass of the population that we need to begin this second bit of thinking. And in doing this, moreover, we need to stop using the much overworked, marketing language that has become second nature to our industry. We need to stop 'Targeting', stop 'Segmenting' and above all, we need to stop 'Niching'. It's ill-advised, we often don't really know what we're talking about and most importantly it stops us from focusing on the needs of individuals. In addition, it also stops us identifying and describing more fundamental social trends. We end up just fixating on our own bad sociology.

In the drug treatment and policy industry we need to be much better at looking at what Ian Taylor called The Definitive, Contemporary, Social Transitions' taking place in the modern world.

The Definitive, Contemporary, Social Transitions Taking Place in the Modern World

As Taylor points out very clearly, the key social fact of our times is the move away from the Welfare State to a fully- fledged market society. This latter is often referred to as a Post-Industrial Society. It is a common place that societies like the United States and the United Kingdom no longer make any claim to be inclusive societies. They are in terms of their key economic processes 'excluding'.

In this context, income trends are particularly revealing. Figures published in the New York Times in February 2006 show that over the last 30 years in the United States the key trend has been a redistribution of income from the bottom 99% of the income earning population to the top 1%.

Over this period:
Income at the 99th percentile rose by 87%
Income at the 99.9th percentile rose by 181% and
Income at the 99.99th percentile rose 497%.

This process of income redistribution forms part of what some commentators have described as the Brazilianization of Advanced Capitalism. In societies where these trends are becoming evident, and the UK is most certainly one of these, you have a population made up of an excluded many, an at-risk most and excluding few.

Our Contemporary Social Structure:
A Super-Exploitative Rich,
A Squeezed Middle and
A Large Emmiserated Poor

From this 'Brazilianization'1 one can see one of the clearest consequences for the United Kingdom has been the creation of a particularly insecure and unequal labour market.

In these conditions of insecurity and inequality Crime and its attendant Fears have become one of the major dislocating factors across what we now call Civil Society.

Our Workforce -- US!

Our workforce is particularly interesting in this context. Our workforce is very vulnerable in this shifting, changing, insecure, unequal market place devoted towards short-term, year-on-year political goals. For instance, what if it became apparent that our Coercive Policies weren't having the required crime reduction impact with those categories of offender that were meant to be their key target and objective. We may find that our disproportionate focus, our opportunistic focus upon the growth of a crime- reduction based industry has led us up a cul-de-sac from which there is no easy return.

In this climate, we don't just need to equip our workforce with an NVQ level 3, we need to train them in a range of ways to respond to broader emergent trends that already have been identified by researchers like Howard Parker. Once again, our strategic thinking about working with broader populations than those who are targeted currently and our strategic thinking about how we should prepare our workforce for such changes has fallen well behind what our practitioners are experiencing and learning about every day.

Reversing out of our historical and political cul-de-sac isn't about going back; there is no going back. It is about looking more closely at drug trends across the whole population. It is about dispensing with the morally denigrating labels that have become attached to a large section of our client group. In this context it is worth reminding ourselves what from our very own experience as professionals we know only too well, and that is that there is an increasingly large economically at-risk middle class in this country.

This very large group is prone to the same kinds of pressures and stresses that all economically and socially 'squeezed' populations feel. Binge drinking, problematic recreational drug use, multi-drug use, all of these affect much
broader sections of the population than those who are at the most economically deprived margins.

Woe betide our industry if one of our cardinal errors is seen to be one of asking too little of ourselves. If our opportunism has led us to believe that a narrow focus on a government-defined group of target drug users is sufficient to guarantee our futures. Do we really believe this? Is this really the best our industry leaders can come up with?

Will Hutton has written extensively about workforce issues, particularly in respect of what he describes as the 'knowledge economy'. He says that 41% of the UK Labour Force is now employed in Knowledge-Based occupations. In defining the knowledge economy, Hutton states that "While some definitions focus narrowly on technology and science, my own extends the conception from high-tech manufacturing to creative industries like advertising and web design, from investment banking to the world of psychoanalysis, and also included education and health care.

Looking at contemporary Britain, Hutton argues that we remain "in a halfway house between a fully fledged knowledge economy and a low-skill, low value-added, low-innovation economy." Are we part of Hutton's knowledge economy?

In order that we think more constructively about the next five years of our industry we must become clearer about the plainly political uses to which our industry has been put; uses with which we have actively collaborated--we must, in short, acknowledge our opportunism. This involves acknowledging that the link between drugs and crime isn't what we thought it was or what we claimed. That there is a link is indisputable, but the link needs now to be more soberly examined. Our industry needs to move on.

One of the key benefits of the industrial age was mass employment. In the post industrial era we can no longer take quality mass employment for granted. Part of becoming clearer about our future involves recognising that the labour market in our society is very insecure and very unequal. Those in the middle are both 'squeezed' and at risk -- of unemployment, of loss of status, of debt and of disillusion. Far more of us are at risk of substance abuse problems in this modern risk society than our industry currently wishes to acknowledge.

How short-sighted to imagine that the only major areas of problem drug use are those that can linked to certain kinds of property crime. Soon the public may require clearer evidence of the drugs = crime equation. Evidence, for instance, that is as soundly based and as extensive as the links between violent crime and alcohol: 65% of murders, 75% of stabbings, 25% of drownings, 40% of deaths in fire. Now there's a drug for you!

In five years time we will, as an industry, be much clearer about which side of Hutton's divide we fall. Will we part of the knowledge economy, or will we be "low skill, low value-added, and low on innovation.” The answers to those questions are already pressing. As we discuss and debate what should be in the new drug strategy, we need to spend time looking beyond April 2008. Our futures and the welfare of many of future service users may depend on the kind of debates we initiate now, and the kind of decisions we take tomorrow.


Ian Wardle