Today was the Drug and Alcohol Today conference held at the Amex Community Stadium in Brighton. This is what I said during the plenary on the theme ’5 Year Forecast: What Lies Ahead’. “There will be a fundamental shift away from methadone and other substitute drugs. Anything short of promoting and achieving, sustaining abstinence for the overwhelming majority of our clients 50, 60, 70%, will not be acceptable, politically, financially or ethically. Current changes to welfare, and the employment agenda, will be just the start of changes, and we must ensure we do everything to best prepare our clients to meet thesechallenges. Anything less will be negligent. “In my early career, in the 1980’s, I came across the case of a woman who had been in a long stay psychiatric hospital for just over 30 years. Her admission papers gave the diagnosis on admission as “promiscuous”. Today we look back at the incarceration of people like her as monstrous. “Recently, with Health Minister, Dan Poulter, we heard from a woman who, until she achieved abstinence in BHT’s Addiction Services, had been on methadone for 17 years. Our successors, in years to come, will regard parking someone on substitute prescribing for 17 years as equally monstrous.” (Short and sweet, just 53 seconds long. My shortest speech ever!)
During September two of our local Members of Parliament, Caroline Lucas (Brighton Pavilion) and Mike Weatherley (Hove), had the courage to organise debates on a major issue facing Brighton and Hove: drugs. I say courage since drugs is an issue that many politicians will shy away from.
The two events were quite different, one behind closed doors with senior officers from statutory and third sector agencies, the other in public. I am grateful to both Caroline and Mike for the invitations to speak at both events.
The topics under discussion ranged from health and social care to decriminalisation and legalisation. If I may offer one criticism of both events, the subjects under discussion were too wide-ranging. To do justice to each topic, they should have been considered at different meetings, health and social care at one, decriminalisation and legalisation at another, rather than all issues being discussed at both meetings.
While Caroline and Mike are not often found lining up together, they are both to be applauded for their separate initiatives in addressing the reasons for Brighton and Hove’s high rate of drug-related deaths. They work together through the All Party Group on Drug Reform.
I remain firmly of the view that there needs to be a move away from a medical approach (as opposed to a health and social care approach) when dealing with drug addiction.
A medical intervention is important in stabilising individuals and then detoxing them quickly and with as little discomfort as possible. After that there is little need for any medical involvement (unless there is a co-existing yet separate medical condition). After that social care, housing and self-help interventions should take over aimed at helping clients to become independent and to sustain a drug-free lifestyle.
I am not a supporter of decriminalisation, and a strong opponent of legalisation. I have always felt that helping addicts achieve and maintain abstinence is the best form of harm minimisation and removes the need for criminal activity.
What the impact will be of the events organised by Caroline Lucas and Mike Weatherley is unknown. I know what I want to see: all local agencies, and all their staff, championing abstinence, and I hope to hear fewer people writing off the potential of all addicts with comments such as “abstinence is not for everyone”. My advice to them is it’s not your place to say that.
This is the text of an article I wrote that first appeared in the Brighton Argus on 21st June 2011 and in Drink and Drug News in July 2011:
In the last week I bumped into two former clients of Brighton Housing Trust’s Recovery Project. The project offers an abstinence based programme which provides a route to life without use of illegal drugs or prescribed substitutes.
Rob (not his real name) is just finishing his final exams at Sussex University. He looked well although stressed and tired due to lack of sleep. The next day I saw Rachel (again not her real name) who spoke about how much she was loving her new job – she had recently been promoted to become a manager within her organisation. I remember her 15 years ago when many would have written her off as another “hopeless junkie”.
One had left the Project four years ago, the other more than a decade ago. They have remained abstinent and have turned their aspirations into reality. Both are happy. Both are an inspiration to me and others, showing that recovery from addiction is possible.
In the same week I read the comments of two leaders in the City with whom I often agree, Caroline Lucas MP, and the head of Brighton police, Chief Superintendent Graham Bartlett, who have called for the decriminalisation of drugs and a harm-minimisation, health-based response. They said that “the war on drugs” has failed, that a new approach is needed that looks at the problem from a health perspective, with more prescribing to reduce crime and social dysfunction.
Like them I am deeply concerned about the high death rate of addicts in Brighton and Hove. However, I was frankly depressed by their proposals since (apart from the call for formal decriminalisation of private use) they are simply advocating a view which has dominated government policy since at least 1997. It is a policy that has failed. This policy has seen ever-increasing numbers maintained in drug use, with spiralling costs to addicted individuals and the wider community that cannot be sustained in ethical or economic terms.
The coalition government has signalled a fundamental change in approach, although this has yet to be translated on the ground. It says it wants to change the way drug addiction is tackled, with more people with problems diverted away from prison and into treatment as part of what it calls a “rehabilitation revolution”. Its strategy involves “championing abstinence” and the Department of Health said its aim is to get users “off drugs for good”. I support all of this.
The Department says the current annual cost of maintaining treatment for 320,000 problem drug users is made up of £1.7bn in benefits, £1.2bn for looking after their children and £730m for prescribing the heroin substitute methadone.
A key issue is one of ambition or rather what can now be seen, in hindsight, as a poverty of ambition. Do we think that it is acceptable to tolerate the £3.6bn now spent on treating users with drug substitutes like methadone and keeping them on benefits each year, not to mention the wasted potential of 320,000 (a conservative estimate) addicts who are maintained in their drug use. Is it acceptable that addicts who wish to be abstinent have for many years now been all too often either denied the detoxification facilities they need or have been actively encouraged to use heroin substitutes?
It is a simple matter of logic that things cannot improve if much of what we do is to maintain people in their addiction. Clients in the Recovery Project testify that, before entering our abstinence programme and when on maintenance scripts, they ‘topped up’ with street drugs. There is also an active market in prescribed drugs which are sold on by addicts supposedly ‘in recovery’. Those addicted in this way may not use or commit crime at the same rate, but they are certainly still stuck in the drug using culture and often acting illegally and destructively.
It is surely ethical that addicted people should be helped to achieve genuine abstinence since it is only when abstinence is achieved that healthy relationships, safe parenting, genuinely secure housing, education, training and employment become viable options.
I fully support the call made by the think tank, the Centre for Policy Studies (CPS), for “a real transfer of power from large distant organisations to small innovative providers” for
rehabilitation. I agree that small units such as the Recovery Project have a better chance of getting addicts off drugs completely, not least because they tend to involve abstinent users in the planning and delivery of services.
Kathy Gyngell, from the CPS, said prescribing methadone to addicts delays their recovery. “The state is subsidising people to be any number of years on methadone, which has turned out not to be a cheap option and will only subsidise the tiniest proportion – 2% – to go into a rehabilitation unit that would actually free them from dependency and allow them to live their life.”
The CPS states “There is one simple measure of success: that of six months abstinence from drugs.” As the CEO of an organisation which offers both harm minimisation services and genuinely abstinence-based treatment, I am ambitious on behalf of our clients. I maintain that 6 months abstinence is readily achievable and would go a step further. Treatment providers should be judged on whether the client is genuinely abstinent – from all mood-altering drugs – six months after finishing treatment.
Recovery from addiction is possible. Those of us involved in policy making, commissioning services and delivering treatment for addicts have an ethical duty to offer safe care to using addicts, but to ensure that treatment leads, in each and every case, to abstinence. Too many lives depend on it.
The outgoing president of the Royal College of Physicians, Sir Ian Gilmore, has said the laws on misuse of drugs should be reviewed and that their supply should be regulated.
While there are many superficial benefits, I have never supported decriminalisation because there are a number of basic questions that have not been properly thought through.
For example, from what age do you decriminalise drugs? Should it be 18, as with alcohol? Then what about the 14, 15, 16 year olds in our towns and cities who are using? Do you leave under 18s in the hands of “violent gangsters”? Or do we say there is no minimum age? There can be nobody in their right mind who would advocate drug use amongst children.
Would we place restrictions on users? For example, would we require users to forfeit their driving licences since some drugs stay in the system for 4 weeks and influence reaction time and other performance?
Would we say that users should be allowed to have custody and responsibility for children? We know that incidents of domestic violence and child abuse increase due to alcohol use. Are we certain that by giving respectability to drug use that there will not be similar increases in neglect?
Do we really want to write off hundreds of thousands to a life of worklessness and benefit dependency? I wouldn’t employ someone who is drunk at work, nor would I employ someone who is under the influence of drugs. Most employers want clear minded, focused employees.
Alcohol use is closely related to availability. Things have become so much worse since the last government liberalised alcohol availability. It seems shear lunacy to go down the same road with drugs and expect to arrive at a different destination.
Research by Exeter University identified its illegal status as the main reason why the majority of 15 year olds don’t experiment with cannabis
I support the policy changes being introduced by the coalition government to champion abstinence. Policy for the last 25 years has often resulted in addicts being supported to stay on drugs. I welcome the government’s greater ambition to commit itself to helping people to come off, and stay off, drugs.
A spokesperson for the Home Office said: “Drugs such as heroin, cocaine and cannabis are extremely harmful and can cause misery to communities across the country. The government does not believe that decriminalisation is the right approach. Our priorities are clear; we want to reduce drug use, crack down on drug-related crime and disorder and help addicts come off drugs for good.”
I think the government has got it just right.