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Drugs: Government Consultation Paper

My Lords, I intend to address the evidence base for the strategy on drugs and the changing face of drug use and addictions. They are not synonymous but, of course, associated. I also intend to question how our domestic drugs policy is linked to international policy, because demand and supply are integrally linked. Last week, we debated a major drug: alcohol. Alcohol is a legal drug associated with the problems of other substances that are not legal, but seems to have slipped through this drugs policy net. First, let me congratulate the Government on taking a harm reduction approach, following on from the 1998 strategy. I declare my interest as a member of the UK Drugs Policy Commission and the Advisory Committee on the Misuse of Drugs. Much has been achieved. The national treatment agency seems a good idea. The National Institute for Health and Clinical Excellence guidance is clear and draws on evidence, as far as we have evidence. But that is the problem. The knowledge base to underpin the strategy is woefully underdeveloped through lack of investment in UK research in the field. Changing classifications, legalising or not, is tinkering with the drugs while crime is rife. But why is addiction occurring? We understand neither the problem nor the efficacy of some potential interventions. Why is the young brain physiologically so susceptible to addiction? What are the causal pathways into and out of problematic drug use? Why do UK youths have higher levels of addiction than our European partners? Among school children aged 11 to 15, the use of any drug was 21 per cent in 2003 and fell to 17 per cent in 2006, with a commendable reduction in frequent use among children who have truanted or been excluded. But perhaps we could do better—much better. Interventions such as the drug interventions programme and enforcement activity form the centrepiece of the strategy. Which are the most effective and for which sub-population? We just do not know. Do new substances emerging pose an even greater threat? Or how might some new substance-antagonists that could be produced decrease addiction risk in the long term? Some of those who turn up in accident and emergency with hepatitis C or HIV, or are victims of sexual assault and so on, are sad, pathetic, vulnerable people—victims at the end of a chain of social disaster and exploitation. And then there is another group, if one can generalise, who are locked into crime and criminal activity. Third-party, innocent people in our society are the victims of that. I ask the Minister why Home Office funding to evaluate and monitor our drug strategy is only about 0.5 per cent of this year’s budget for drugs and how that will be rectified. Contrast that with 20 per cent of the US federal drug treatment and prevention budget allocated to research. Will the revised strategy have a dedicated pillar to improve the research and knowledge base, and a programme to deliver this? Without evidence, these policy proposals will be open to unfettered attack from polarised and ill-informed opinion. Since 1998, the number of people in contact with structured drug treatment services has doubled to 195,000 recorded in 2006-07 in England. Harm reduction programmes have expanded, but one in four of those entering treatment dropped out within 12 weeks of triage assessment and only 14 per cent successfully completed treatment. There are about 320,000 problem opiate and crack users in England, with an unknown number of problematic cocaine and cannabis users and unknown numbers of new problem drug users each year. As a member of the Advisory Committee on the Misuse of Drugs, I have read much about cannabis and we will look again and afresh at it. I simply want to point out that since cannabis was reclassified in class C, there is no evidence of increased usage overall. Classification is a guide to the police and to sentencing, but there is no evidence that classification of a particular drug deters use. Meanwhile, its illegal use must not be confused with therapeutic use in multiple sclerosis. Here the problem is that the well-being of some patients is difficult to quantify objectively. I declare my interest as president of MS Cymru. The trends in drug use are changing. Syringe exchange schemes reveal a very high use of anabolic steroids as well as opioids, with over 50 per cent of needle exchanges in some areas being anabolic steroid users, often obtained in body-building gyms. Thus needle exchange schemes have become an important source of information to agencies over what is happening in the illicit drug market world. By contrast, UK Sport is very active and indeed effective in its work to rid competitive sport and all sports of all drugs and it is to be commended for its work. Industrial substances such as benzylpiperazine, gamma-butyrolactone—known as GBL, a precursor of gamma hydroxybutyric acid, or GHB—and also 1, 4-butanediol are being imported through the internet and increasingly abused. Substances such as GBL and 1, 4-butanediol have very wide industrial uses, such as cleaning motorcycle chains, among other things. They are imported by the barrel-load for our industry, so they are particularly difficult to monitor, and as soon as one website is closed down, another pops up, so it is an ever-chasing game. There is recent evidence of contamination of ecstasy tablets. Ecstasy appears to be ubiquitously available in clubs on Saturday nights, and I remind noble Lords that Methaqualone, also known as Mandrax or Mandy, was prevalent in the 1970s and then LSD had its peak, so we have a constantly changing picture. The greatest return on investment in managing drugs is likely to be found by further widening the availability, choice and quality of treatment and self-help programmes. The National Treatment Outcomes Research Study estimates the benefit-to-cost ratio as somewhere between 18:1 and 9.5:1, which suggests that for every £1 spent on treatment for opioid users, almost £10 will be saved, but no programme can be effective without motivation to change behaviour, which is why NICE guidance stresses the importance of short interventions to begin motivational change and why programmes such as Narcotics Anonymous and Cocaine Anonymous are effective. Prison services need improving. I remind noble Lords that deaths from opioids are particularly prevalent in drug addicts who have been away from drugs for some time and have lost tolerance. They go back on the street and have a dose at the same level as previously, but having lost tolerance, they get respiratory depression, often vomit, inhale their own vomit and die. Those particularly at risk are prisoners coming out from prison into the community and those coming from a detox regime who relapse. HM Inspectorate of Prisons recently published The Mental Health of Prisoners: A thematic review of the care and support of prisoners with mental health needs which highlighted the fact that 40 per cent of new arrivals in prisons report drug use. It is sad that that report concludes that there continues to be a lack of co-ordination between substance misuse and mental health services. Lastly, I shall address the contentious area of the international dimension, which has already been referred to by the noble Lord, Lord Mancroft. The Government state in their report that: "““At an international level, effective counter-drugs policies cannot be separated from broader foreign policy””," and that: "““About 90 per cent of the heroin that reaches the UK originates in Afghanistan and passes through Turkey and the Netherlands””." The current policy is failing. The cost of street heroin has fallen to £54 per gram, despite record drug seizures. The consultation document goes on to point out that: "““Afghanistan is a particular priority for the UK””." In a response to Frank Field MP regarding the UK counter-narcotics strategy in Afghanistan, the Prime Minister wrote: "““Eradication is the responsibility of the Afghan Government and is set out in the National Drug Control Strategy. The Strategy takes an integrated approach and focuses on four key priorities - targeting the traffickers; strengthening alternative livelihoods; developing institutions and reducing demand. It is not an eradication-led strategy, but recognises that there is an important role for eradication””." The experiences of Pakistan and Thailand have demonstrated that ridding a country of illegal opium production is a ““long and difficult process””—those words are from the Government’s own report—so why not encourage contracts with farmers who grow poppies? Buy up the raw opium through contracts, rather like a common agricultural policy, and require the production of another crop as well. A breach in the contract by selling to organised crime could have some sanction associated with it, and policing would be the responsibility of the Afghan Government, not ours, which is compatible with their declared policy. If I were a farmer with mouths to feed, I would grow what I know best, and I would hate with every ounce of my body someone who destroyed my livelihood and my ability to feed my family. That is human nature. With a steady contract and a decent price, the farmers might even have a higher standard of living than at present. The noble Lord, Lord Malloch-Brown, informed this House last week that the market for legal poppy for medicinal use is already crowded and there is no additional demand. I do not believe that it is beyond the wit of government to use financial incentives in other parts of the world to encourage diversification. Others growing poppies could easily divert and start producing other substances. I am thankful that the UK does not endorse the US approach of herbicidal spraying, but however a crop is destroyed, there are costs. There are indirect costs to our international security. It must be better to grow poppies than to grow terrorists. Nearly 20 per cent of the world’s top medicines were discovered in Britain. This pharmaceutical expertise is a national strength. With drug development costs around £550 million for each drug, a free government-purchased supply of raw opium would not even dent the costs, but it could make obtaining substrate easier. The raw opium could be supplied for research and drug development, to develop new analgesics with lower addiction potential and fewer side effects and to develop longer-acting antagonists to help addicts stay off drugs. Our pharmaceutical industry should also be urged to manufacture cost-controlled analgesics to supply those countries where millions suffer and die daily without any analgesics because they are too expensive, even if their country allows them to be prescribed. Make no mistake; in some countries you cannot even get analgesics. I urge the Government to think again; it is not too late to rethink the international dimension to the drugs policy.